Synthetic educational example. Do not self-treat: a qualified treating physician must verify the sources, patient data, contraindications, and final plan.
Patient
VERIFIED-PITUITARY-ADENOMA-L1-PITUITARY_ADENOMA_1L_ACROMEGAL · Algorithm: ALGO-PITUITARY-ADENOMA-1L
Clinical significance of mutations (ESCAT)
Tumor-board context — the engine does not use these tiers to rank tracks
| Biomarker | Variant | ESCAT | Evidence | Clinical significance | Drugs | Sources |
|---|
| No clinically actionable variants matched in this profile. |
| Biomarker | Status |
|---|
| adenoma_hormone_type | Not in KB — ask clinician to verify |
Primary current-line option
- 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
- Primary current-line option selected by ALGO-PITUITARY-ADENOMA-1L at step 2.
Other current-line alternatives (3 tracks)
Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.
- 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
- 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
- Current-line alternative presented for HCP consideration
- 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-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.
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-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.
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)
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 | Sign-offs | Domain |
|---|
| Cellular therapy specialist (CAR-T) | cellular_therapy_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
| Clinical pharmacist | clinical_pharmacist | v0.1.0 | 2026-04-25 | 0 | clinical_pharmacy |
| Hematologist / oncohematologist | hematologist | v0.1.0 | 2026-04-25 | 0 | hematology_oncology |
| Hematopathologist (lymphoma / leukemia / myeloma) | hematopathologist | v0.1.0 | 2026-04-25 | 0 | hematopathology |
| Infectious disease / hepatology | infectious_disease_hepatology | v0.1.0 | 2026-04-25 | 0 | infectious_diseases |
| Medical oncologist (solid-tumor chemotherapist) | medical_oncologist | v0.1.0 | 2026-04-25 | 0 | solid_oncology |
| Molecular geneticist / molecular oncologist | molecular_geneticist | v0.1.0 | 2026-04-25 | 0 | molecular_oncology |
| Palliative care | palliative_care | v0.1.0 | 2026-04-25 | 0 | palliative_care |
| Pathologist (general) | pathologist | v0.1.0 | 2026-04-25 | 0 | pathology |
| Primary care / family physician | primary_care | v0.1.0 | 2026-04-25 | 0 | primary_care |
| Psycho-oncologist | psychologist | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Radiation oncologist | radiation_oncologist | v0.1.0 | 2026-04-25 | 0 | radiation_oncology |
| Radiologist | radiologist | v0.1.0 | 2026-04-25 | 0 | diagnostic_imaging |
| Social worker / case manager | social_worker_case_manager | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Surgical oncologist | surgical_oncologist | v0.1.0 | 2026-04-25 | 0 | surgical_oncology |
| Transplant specialist (BMT) | transplant_specialist | v0.1.0 | 2026-04-25 | 0 | 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)
Last synced: 2026-09-09 · ctgov.
No active trials matched this scenario in ctgov.
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 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 |
| 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 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 |
| Local therapy plan — No regimen components on this track — availability unknown | — unknown | — unknown | ₴-? — verify pathway | not recorded |
Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-09-09.