OpenOnco · Treatment Plan

Treatment plan — Pituitary adenoma

PLAN-VERIFIED-PITUITARY-ADENOMA-L1-PITUITARY_ADENOMA_1L_CUSHING_S-V1 · v1 · 2026-07-15

Patient

VERIFIED-PITUITARY-ADENOMA-L1-PITUITARY_ADENOMA_1L_CUSHING_S · Algorithm: ALGO-PITUITARY-ADENOMA-1L

DiagnosisPituitary adenoma

MOH / ICD-10D35.2

ICD-O-38272/0; C75.1

Clinical significance of mutations (ESCAT)

Tumor-board context — the engine does not use these tiers to rank tracks

✅ Covered biomarkers (matched in KB)

Biomarker	Variant	ESCAT	Evidence	Clinical significance	Drugs	Sources
No clinically actionable variants matched in this profile.

⚠️ Not included in plan

Biomarker	Status
adenoma_hormone_type	Not in KB — ask clinician to verify

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-PITUITARY-ADENOMA-1L-CUSHING-SURGERY-MEDICAL

Regimen

Pasireotide for Cushing disease (pituitary-directed medical therapy)

Drugs + NSZU

Pasireotide (DRUG-PASIREOTIDE) 0.6 mg SC starting dose · Twice daily subcutaneous injection, titrated per 24-hour urinary free cortisol / late-night salivary cortisol response and tolerability (product-label range approximately 0.3-0.9 mg SC BID); pasireotide LAR 10 mg IM q4w is an alternative long-acting formulation for surgery-ineligible disease · SC ✗ Not registered in UA

Reason

Primary current-line option selected by ALGO-PITUITARY-ADENOMA-1L at step 3.

Other current-line alternatives (3 tracks)

Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.

Standard plan

Indication

IND-PITUITARY-ADENOMA-1L-PROLACTINOMA-CABERGOLINE

Regimen

Cabergoline for prolactinoma (dopamine agonist, first-line)

Drugs + NSZU

Cabergoline (DRUG-CABERGOLINE) 0.25 mg PO twice weekly starting dose (or 0.5 mg PO once weekly) · Twice weekly; titrate by 0.25-0.5 mg/week increments no more often than every 4 weeks per serum prolactin, to a typical maintenance dose of 0.5-2 mg/week (occasionally higher for resistant macroprolactinoma) · PO ⚠ Out-of-pocket

Reason

Current-line alternative presented for HCP consideration

Standard plan

Indication

IND-PITUITARY-ADENOMA-1L-ACROMEGALY-SURGERY-SSA

Regimen

Somatostatin analogue for acromegaly (lanreotide first-generation SSA; pasireotide for SSA-refractory disease)

Drugs + NSZU

Lanreotide (DRUG-LANREOTIDE) 120 mg SC deep subcutaneous injection · Every 4 weeks (q4w), titrated per IGF-1 response; may extend interval to q6-8w if IGF-1 stably normalized on long-term therapy · SC ⚠ Out-of-pocket

Reason

Current-line alternative presented for HCP consideration

Local therapy plan

Indication: IND-PITUITARY-ADENOMA-1L-NFPA-SURGERY-MASS-EFFECT
Regimen: —
Reason: Current-line alternative presented for HCP consideration

Pre-treatment investigations

Investigations before treatment start · critical / standard / desired · merged across tracks

ID	Name	Priority	Category	Where to order	Needed for
TEST-CBC	Complete Blood Count with Differential	Critical	lab	—	all tracks
TEST-CMP	Comprehensive Metabolic Panel	Critical	lab	—	all tracks
TEST-LFT	Liver Function Tests (ALT, AST, bilirubin, ALP, GGT, albumin)	Critical	lab	—	standard
TEST-BRAIN-MRI-CONTRAST	Brain MRI with contrast	Standard	—	—	all tracks
TEST-CORTISOL-MORNING	Morning cortisol	Standard	lab	—	standard
TEST-OPHTHALMOLOGIC-EXAM	Ophthalmologic examination	Standard	clinical_assessment	—	local_therapy

What NOT to do

Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity

Standard plan (IND-PITUITARY-ADENOMA-1L-CUSHING-SURGERY-MEDICAL)

Do not initiate pasireotide without baseline and ongoing glucose monitoring — hyperglycemia is an expected class effect.
Do not diagnose Cushing disease without confirming ACTH-dependence and a pituitary (not ectopic or adrenal) source of hypercortisolism.

Standard plan (IND-PITUITARY-ADENOMA-1L-PROLACTINOMA-CABERGOLINE)

Do not offer surgery as first-line therapy for prolactinoma — dopamine agonists (cabergoline) are first-line regardless of adenoma size.
Do not diagnose prolactinoma without excluding secondary causes of hyperprolactinemia (medication effect, hypothyroidism, renal failure, pregnancy).

Standard plan (IND-PITUITARY-ADENOMA-1L-ACROMEGALY-SURGERY-SSA)

Do not rely on GH level alone for diagnosis or monitoring — IGF-1 and OGTT GH-suppression are the primary biochemical criteria.
Do not default to medical therapy ahead of surgical evaluation for a surgically accessible somatotroph adenoma without multidisciplinary discussion.

Local therapy plan (IND-PITUITARY-ADENOMA-1L-NFPA-SURGERY-MASS-EFFECT)

Do not operate on asymptomatic, non-compressive nonfunctioning pituitary adenoma — observation with surveillance MRI is indicated.
Do not skip a complete pituitary hormone biochemical panel before classifying an adenoma as nonfunctioning.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Somatostatin analogue for acromegaly (lanreotide first-generation SSA; pasireotide for SSA-refractory disease)

28-day cycles × Continuous until IGF-1 normalization is achieved and maintained, or until switched to pegvisomant / pasireotide for inadequate response

MDT brief

MDT talk tree (1 steps)

#	Owner	Topic	Action
1	social_worker_case_manager	Specialist review	Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed.

Skills (recommended) — for consideration (1)

Social worker / case manager recommended
Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed.

Data quality

Usable with caveats. No critical default-track gap was found, but the MDT should review the listed caveats before final sign-off.

Biomarker coverage: 1/1 known (100%), 0 missing, 0 default-track gaps
Unevaluated RedFlags: RF-PITUITARY-MASS-EFFECT-VISUAL-COMPROMISE

Technical MDT skill metadata (1/16 activated in this plan)

All registered virtual specialists. ✓ — activated for this case; ○ — not activated (available for other clinical scenarios).

Specialist	skill_id	Version	Last reviewed	Domain
Cellular therapy specialist (CAR-T)	`cellular_therapy_specialist`	v0.1.0	2026-04-25	cellular_therapy
Clinical pharmacist	`clinical_pharmacist`	v0.1.0	2026-04-25	clinical_pharmacy
Hematologist / oncohematologist	`hematologist`	v0.1.0	2026-04-25	hematology_oncology
Hematopathologist (lymphoma / leukemia / myeloma)	`hematopathologist`	v0.1.0	2026-04-25	hematopathology
Infectious disease / hepatology	`infectious_disease_hepatology`	v0.1.0	2026-04-25	infectious_diseases
Medical oncologist (solid-tumor chemotherapist)	`medical_oncologist`	v0.1.0	2026-04-25	solid_oncology
Molecular geneticist / molecular oncologist	`molecular_geneticist`	v0.1.0	2026-04-25	molecular_oncology
Palliative care	`palliative_care`	v0.1.0	2026-04-25	palliative_care
Pathologist (general)	`pathologist`	v0.1.0	2026-04-25	pathology
Primary care / family physician	`primary_care`	v0.1.0	2026-04-25	primary_care
Psycho-oncologist	`psychologist`	v0.1.0	2026-04-25	psychosocial
Radiation oncologist	`radiation_oncologist`	v0.1.0	2026-04-25	radiation_oncology
Radiologist	`radiologist`	v0.1.0	2026-04-25	diagnostic_imaging
Social worker / case manager	`social_worker_case_manager`	v0.1.0	2026-04-25	psychosocial
Surgical oncologist	`surgical_oncologist`	v0.1.0	2026-04-25	surgical_oncology
Transplant specialist (BMT)	`transplant_specialist`	v0.1.0	2026-04-25	cellular_therapy

Sources cited

SRC-NCCN-CNS-2025: NCCN Central Nervous System Cancers (v.3.2025)
SRC-NCCN-NET-2025: NCCN Neuroendocrine and Adrenal Tumors (v.2.2025)

Experimental options (clinical trials)

Third plan track — open-enrollment trials from ClinicalTrials.gov. Render-time metadata; engine selection is not affected by this block (CHARTER §8.3). Last synced: 2026-07-15.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT06353529	Postop Pain Management in Pituitary Tumour Patients	PHASE4	RECRUITING	Hamilton Health Sciences Corporation	—	Single country
NCT04081701	68-Ga DOTATATE PET/MRI in the Diagnosis and Management of Somatostatin Receptor Positive CNS Tumors.	PHASE4	RECRUITING	Weill Medical College of Cornell University	—	Single country
NCT07456878	Use of [18F] Fluoroethyl-L-tyrosine PET/MRI for Identifying Small Functional Pituitary Adenomas	PHASE1	RECRUITING	Mayo Clinic	—	Phase 1 only Small N (<50) Single country
NCT07179926	Effects of Pasireotide Lar Therapy on Bone Metabolism	N/A	RECRUITING	Fondazione Policlinico Universitario Agostino Gemelli IRCCS	—	Single country
NCT00001595	An Investigation of Pituitary Tumors and Related Hypothalmic Disorders	N/A	RECRUITING	Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)	—	Single country
NCT07268183	How Estrogen Fluctuations Before Diagnosis Affect the Size Prolactin-secreting Tumors	N/A	RECRUITING	Hospices Civils de Lyon	—	Single country
NCT06973824	A Twenty-years' Experience in Pituitary Disease.	N/A	RECRUITING	Fondazione Policlinico Universitario Agostino Gemelli IRCCS	—	Single country
NCT06163261	Individualized Physical Activity or Patients With Non Functioning Pituitary Adenoma	NA	RECRUITING	Vastra Gotaland Region	—	Single country
NCT04278118	Hypofractionated Proton Therapy for Benign Intracranial Brain Tumors, the HiPPI Study	NA	RECRUITING	Emory University	—	Single country
NCT06679816	Hydrocortisone in Hormone Replacement Therapy for Large Pituitary Neuroendocrine Tumors	PHASE4	RECRUITING	Beijing Tiantan Hospital	—	Single country

Verify recruitment status directly with the trial site. ctgov data can lag behind current UA-site status.

Option availability in Ukraine

Per-track UA registration · NSZU · cost · access pathway. Render-time metadata; engine selection does not depend on these fields (CHARTER §8.3).

Option	UA registration	NSZU	Cost orientation	Access pathway
Standard plan Pasireotide for Cushing disease (pituitary-directed medical therapy) (REG-PASIREOTIDE-CUSHING) 1/1 component drug(s) not registered in Ukraine +1	✗ not registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Standard plan Cabergoline for prolactinoma (dopamine agonist, first-line) (REG-CABERGOLINE-PROLACTINOMA) 1/1 component drug(s) not on NSZU formulary	✓ registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Standard plan Somatostatin analogue for acromegaly (lanreotide first-generation SSA; pasireotide for SSA-refractory disease) (REG-SSA-ACROMEGALY) 1/1 component drug(s) not on NSZU formulary	✓ registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Local therapy plan — No regimen components on this track — availability unknown	— unknown	— unknown	₴-? — verify pathway	not recorded
Trial · NCT06353529 Postop Pain Management in Pituitary Tumour Patients No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04081701 68-Ga DOTATATE PET/MRI in the Diagnosis and Management of Somatostatin Receptor Positive CNS Tumors. No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07456878 Use of [18F] Fluoroethyl-L-tyrosine PET/MRI for Identifying Small Functional Pituitary Adenomas No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07179926 Effects of Pasireotide Lar Therapy on Bone Metabolism No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT00001595 An Investigation of Pituitary Tumors and Related Hypothalmic Disorders No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07268183 How Estrogen Fluctuations Before Diagnosis Affect the Size Prolactin-secreting Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06973824 A Twenty-years' Experience in Pituitary Disease. No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06163261 Individualized Physical Activity or Patients With Non Functioning Pituitary Adenoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04278118 Hypofractionated Proton Therapy for Benign Intracranial Brain Tumors, the HiPPI Study No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06679816 Hydrocortisone in Hormone Replacement Therapy for Large Pituitary Neuroendocrine Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor

Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-07-15.

plan_id: PLAN-VERIFIED-PITUITARY-ADENOMA-L1-PITUITARY_ADENOMA_1L_CUSHING_S-V1 | version: 1 | generated: 2026-07-15T13:33:22.976744+00:00

Per FDA non-device CDS positioning (CHARTER §15): Outpatient oncology treatment planning to support tumor-board discussion. Not a medical device; not for autonomous clinical decision-making.

Per FDA non-device CDS positioning (CHARTER §15): Both treatment options below are presented for review. The engine's selection of a 'recommended' default does not constitute a clinical decision. Final treatment selection requires HCP judgment incorporating information not available to the system.

This document is an informational resource supporting tumor-board discussion (per CHARTER §11). It is not a system that makes clinical decisions. Every recommendation must be verified by the treating physician.