Patient
AUTO-BREAST-001 · Algorithm: ALGO-BREAST-1L
Clinical significance of mutations (ESCAT / OncoKB)
Tumor-board context — the engine does not use these tiers to rank tracks
| Biomarker | Variant | ESCAT | OncoKB | Clinical significance | Drugs | Sources |
|---|
| No clinically actionable variants matched in this profile. |
Treatment options (6 tracks)
- Indication
- IND-BREAST-HR-POS-MET-1L-CDKI
- Regimen
- AI + ribociclib (HR+/HER2- metastatic 1L; OS-validated)
- Drugs + NSZU
- Letrozole (DRUG-LETROZOLE) 2.5 mg PO daily · Continuous · PO ✓ NSZU covered
- Ribociclib (DRUG-RIBOCICLIB) 600 mg PO daily, days 1-21 of 28-day cycle · 21 days on, 7 days off · PO ⚠ NSZU — not for this indication
- Supportive care
- SUP-BONE-HEALTH-PROSTATE
- Reason
- Engine default per algorithm ALGO-BREAST-1L: {'step': 5, 'outcome': False, 'branch': {'result': 'IND-BREAST-HR-POS-MET-1L-CDKI'}, 'fired_red_flags': [], 'winner_red_flag': None}
- Indication
- IND-BREAST-HER2-POS-EARLY-NEOADJUVANT
- Regimen
- TCHP — docetaxel + carboplatin + trastuzumab + pertuzumab (HER2+ neoadjuvant)
- Drugs + NSZU
- Docetaxel (DRUG-DOCETAXEL) 75 mg/m² IV · Day 1 of 21-day cycle x 6 cycles · IV ✓ NSZU covered
- Carboplatin (DRUG-CARBOPLATIN) AUC 6 IV · Day 1 of 21-day cycle x 6 cycles · IV ⚠ NSZU — not for this indication
- Trastuzumab (DRUG-TRASTUZUMAB) 8 mg/kg IV loading, 6 mg/kg IV maintenance · Day 1 of 21-day cycle · IV ✓ NSZU covered
- Pertuzumab (DRUG-PERTUZUMAB) 840 mg IV loading, 420 mg IV maintenance · Day 1 of 21-day cycle · IV ✓ NSZU covered
- Supportive care
- SUP-BONE-HEALTH-PROSTATE, SUP-G-CSF-PRIMARY-PROPHYLAXIS-PROSTATE
- Reason
- Alternative track presented for HCP consideration
- Indication
- IND-BREAST-HER2-POS-MET-1L-THP
- Regimen
- THP — docetaxel + trastuzumab + pertuzumab (HER2+ metastatic 1L)
- Drugs + NSZU
- Docetaxel (DRUG-DOCETAXEL) 75-100 mg/m² IV · Day 1 of 21-day cycle x 6-8 cycles, then HP maintenance · IV ✓ NSZU covered
- Trastuzumab (DRUG-TRASTUZUMAB) 8 mg/kg loading, 6 mg/kg maintenance IV · Day 1 of 21-day cycle, continuous until progression · IV ✓ NSZU covered
- Pertuzumab (DRUG-PERTUZUMAB) 840 mg loading, 420 mg maintenance IV · Day 1 of 21-day cycle, continuous until progression · IV ✓ NSZU covered
- Supportive care
- SUP-BONE-HEALTH-PROSTATE
- Reason
- Alternative track presented for HCP consideration
- Indication
- IND-BREAST-HER2-POS-MET-2L-TDXD
- Regimen
- T-DXd monotherapy (HER2+ metastatic 2L+, also HER2-low metastatic)
- Drugs + NSZU
- Trastuzumab deruxtecan (T-DXd) (DRUG-TRASTUZUMAB-DERUXTECAN) 5.4 mg/kg IV · Day 1 of 21-day cycle, continuous until progression · IV ✓ NSZU covered
- Supportive care
- SUP-BONE-HEALTH-PROSTATE
- Reason
- Alternative track presented for HCP consideration
- Indication
- IND-BREAST-TNBC-EARLY-NEOADJUVANT
- Regimen
- Pembrolizumab + chemo (TNBC neoadjuvant)
- Drugs + NSZU
- Pembrolizumab (DRUG-PEMBROLIZUMAB) 200 mg IV q3 weeks · Days 1 of cycles 1-8 (4 cycles each phase) · IV ⚠ NSZU — not for this indication
- Paclitaxel (DRUG-PACLITAXEL) 80 mg/m² IV weekly · Cycles 1-4 (12 weekly doses) · IV ✓ NSZU covered
- Carboplatin (DRUG-CARBOPLATIN) AUC 5 IV · Cycles 1-4 q3 weeks (or weekly AUC 1.5) · IV ⚠ NSZU — not for this indication
- Doxorubicin (DRUG-DOXORUBICIN) 60 mg/m² IV · Cycles 5-8 q3 weeks · IV ✓ NSZU covered
- Cyclophosphamide (DRUG-CYCLOPHOSPHAMIDE) 600 mg/m² IV · Cycles 5-8 q3 weeks · IV ✓ NSZU covered
- Supportive care
- SUP-G-CSF-PRIMARY-PROPHYLAXIS-PROSTATE, SUP-BONE-HEALTH-PROSTATE
- Reason
- Alternative track presented for HCP consideration
- Indication
- IND-BREAST-BRCA-POS-MET-PARPI
- Regimen
- Olaparib monotherapy (BRCA-mutant HER2- breast: metastatic OR adjuvant high-risk early)
- Drugs + NSZU
- Olaparib (DRUG-OLAPARIB) 300 mg PO BID continuous · Until progression (metastatic) or 1 year (OlympiA adjuvant) · PO ⚠ NSZU — not for this indication
- Supportive care
- SUP-BONE-HEALTH-PROSTATE
- Reason
- Alternative track presented for HCP consideration
Pre-treatment investigations
Investigations before treatment start · critical / standard / desired · merged across tracks
| ID | Name | Priority | Category | Needed for |
|---|
| TEST-CECT-CAP | КТ органів грудної клітки/черевної порожнини/таза з внутрішньовенним контрастуванням | Critical | imaging | all tracks |
| TEST-ER-PR-IHC | ІГХ ЕР + ПР на пухлині | Critical | — | all tracks |
| TEST-HER2-IHC-FISH | HER2 ІГХ + рефлексна FISH на пухлині | Critical | — | all tracks |
| TEST-GERMLINE-BRCA-PANEL | Гермінальне секвенування BRCA1/2 + HRR панель | Standard | — | all tracks |
| TEST-PIK3CA-NGS | Тестування мутації PIK3CA (тканина або ctDNA) | Standard | — | desired (standard) |
Red flags — PRO / CONTRA aggressive
PRO-AGGRESSIVE
Triggers that push toward the aggressive track
- Age ≥75 + ECOG ≥2 + significant comorbidity — anthracycline + dose-dense regimens poorly tolerated; consider TC, weekly paclitaxel, single-agent endocrine, or trastuzumab + chemo of reduced intensity.RF-BREAST-FRAILTY-AGE
- Cardiac dysfunction (LVEF <50%) — anthracycline + trastuzumab/pertuzumab + T-DM1/T-DXd all carry cardiotoxicity risk; baseline echo + serial monitoring required.RF-BREAST-ORGAN-DYSFUNCTION
CONTRA-AGGRESSIVE
Hard contraindications to escalation
Timeline
Treatment timeline — derived from regimen + monitoring schedule
Standard plan
Induction · AI + ribociclib (HR+/HER2- met
28-day cycles × Continuous until progression
Standard plan
Induction · TCHP — docetaxel + carboplatin
21-day cycles × 6 (then surgery → adjuvant trastuzumab + pertuzumab to complete 1 year HER2-targeted therapy; T-DM1 if residual disease)
Standard plan
Induction · THP — docetaxel + trastuzumab
21-day cycles × Docetaxel × 6-8; HP continues until progression
Standard plan
Induction · T-DXd monotherapy (HER2+ metas
21-day cycles × Continuous until progression or unacceptable toxicity
Standard plan
Induction · Pembrolizumab + chemo (TNBC ne
21-day cycles × 8 (paclitaxel/carbo+pembro phase 1-4, then AC+pembro phase 5-8)
Standard plan
Induction · Olaparib monotherapy (BRCA-mut
28-day cycles × Adjuvant: 12; Metastatic: continuous until progression
MDT brief
Data quality
- Unevaluated RedFlags: RF-BREAST-AKT1-E17K-ACTIONABLE, RF-BREAST-BRCA-GERMLINE-ACTIONABLE, RF-BREAST-ESR1-MUT-ACTIONABLE, RF-BREAST-FRAILTY-AGE, RF-BREAST-HER2-AMP-ACTIONABLE, RF-BREAST-HER2-LOW-ACTIONABLE, RF-BREAST-HIGH-RISK-BIOLOGY, RF-BREAST-INFECTION-SCREENING, RF-BREAST-ORGAN-DYSFUNCTION, RF-BREAST-PIK3CA-MUT-ACTIONABLE, RF-BREAST-TRANSFORMATION-PROGRESSION
Skill catalog (0/16 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 |
|---|
| Specialist з клітинної терапії (CAR-T) | cellular_therapy_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
| Клінічний фармацевт | clinical_pharmacist | v0.1.0 | 2026-04-25 | 0 | clinical_pharmacy |
| Гематолог / онкогематолог | hematologist | v0.1.0 | 2026-04-25 | 0 | hematology_oncology |
| Гематопатолог (специфічно для лімфом / лейкозів / мієломи) | hematopathologist | v0.1.0 | 2026-04-25 | 0 | hematopathology |
| Інфекціоніст / гепатолог | infectious_disease_hepatology | v0.1.0 | 2026-04-25 | 0 | infectious_diseases |
| Медичний онколог (хіміотерапевт солідних пухлин) | medical_oncologist | v0.1.0 | 2026-04-25 | 0 | solid_oncology |
| Молекулярний генетик / молекулярний онколог | molecular_geneticist | v0.1.0 | 2026-04-25 | 0 | molecular_oncology |
| Паліативна допомога | palliative_care | v0.1.0 | 2026-04-25 | 0 | palliative_care |
| Патолог (загальний) | pathologist | v0.1.0 | 2026-04-25 | 0 | pathology |
| Сімейний лікар / терапевт | primary_care | v0.1.0 | 2026-04-25 | 0 | primary_care |
| Психолог / онкопсихолог | psychologist | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Радіотерапевт (променева терапія) | radiation_oncologist | v0.1.0 | 2026-04-25 | 0 | radiation_oncology |
| Лікар-радіолог | radiologist | v0.1.0 | 2026-04-25 | 0 | diagnostic_imaging |
| Соціальний працівник / кейс-менеджер | social_worker_case_manager | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Хірург-онколог | surgical_oncologist | v0.1.0 | 2026-04-25 | 0 | surgical_oncology |
| Specialist з трансплантації (BMT) | transplant_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
Sources cited
- SRC-DESTINY-BREAST03-CORTES-2022: Trastuzumab Deruxtecan versus Trastuzumab Emtansine for Breast Cancer (2022)
- SRC-ESMO-BREAST-EARLY-2024: ESMO Clinical Practice Guideline on Early Breast Cancer (2024)
- SRC-ESMO-BREAST-METASTATIC-2024: ESMO Clinical Practice Guideline on Metastatic Breast Cancer (2024)
- SRC-HER2CLIMB-MURTHY-2019: Tucatinib, Trastuzumab, and Capecitabine for HER2-Positive Metastatic Breast Cancer (2019)
- SRC-KEYNOTE-355-CORTES-2020: Pembrolizumab plus chemotherapy versus placebo plus chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer (KEYNOTE-355) (2020)
- SRC-MONALEESA-2-HORTOBAGYI-2016: Ribociclib as First-Line Therapy for HR-Positive, Advanced Breast Cancer (2016)
- SRC-MONALEESA-3-SLAMON-2018: Phase III Randomized Study of Ribociclib and Fulvestrant in Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Advanced Breast Cancer (MONALEESA-3) (2018)
- SRC-MONALEESA-7-TRIPATHY-2018: Ribociclib plus endocrine therapy for premenopausal women with hormone-receptor-positive, advanced breast cancer (MONALEESA-7) (2018)
- SRC-NCCN-BREAST-2025: NCCN Clinical Practice Guidelines — Breast Cancer (2025.v4)
Експериментальні опції (клінічні дослідження)
Останнє оновлення: 2026-04-27 · ctgov.
Жодного активного трайла для цього сценарію в ctgov не знайдено.
Доступність опцій в Україні
Per-track UA registration · НСЗУ · cost · access pathway. Render-time metadata; engine selection не залежить від цих полів (CHARTER §8.3).
| Опція | Реєстрація UA | НСЗУ | Cost orientation | Access pathway |
|---|
| Standard plan AI + ribociclib (HR+/HER2- metastatic 1L; OS-validated) (REG-AI-RIBOCICLIB) | ✓ зареєстровано | ✓ покривається | ₴-? — verify pathway | НСЗУ formulary |
| Standard plan TCHP — docetaxel + carboplatin + trastuzumab + pertuzumab (HER2+ neoadjuvant) (REG-TCHP-NEOADJUVANT) | ✓ зареєстровано | ✓ покривається | ₴-? — verify pathway | НСЗУ formulary |
| Standard plan THP — docetaxel + trastuzumab + pertuzumab (HER2+ metastatic 1L) (REG-THP-METASTATIC) | ✓ зареєстровано | ✓ покривається | ₴-? — verify pathway | НСЗУ formulary |
| Standard plan T-DXd monotherapy (HER2+ metastatic 2L+, also HER2-low metastatic) (REG-TDXD-METASTATIC) | ✓ зареєстровано | ✓ покривається | ₴-? — verify pathway | НСЗУ formulary |
| Standard plan Pembrolizumab + chemo (TNBC neoadjuvant) (REG-PEMBRO-CHEMO-TNBC-NEOADJUVANT) | ✓ зареєстровано | ✓ покривається | ₴-? — verify pathway | НСЗУ formulary |
| Standard plan Olaparib monotherapy (BRCA-mutant HER2- breast: metastatic OR adjuvant high-risk early) (REG-OLAPARIB-BREAST) | ✓ зареєстровано | ✓ покривається | ₴-? — verify pathway | НСЗУ formulary |
Інформація про ціни — orientation. Перевіряти у конкретній аптеці / foundation / трайл-сайті. Status updated: 2026-04-27.