Treatment plan — DIS-GBM

OpenOnco · Treatment Plan

PLAN-AUTO-GBM-001-V1 · v1 · 2026-04-27

Patient

AUTO-GBM-001 · Algorithm: ALGO-GBM-NEWLY-DIAGNOSED-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 (1 tracks)

Standard plan

★ DEFAULT

Indication

IND-GBM-NEWLY-DIAGNOSED-STUPP

Regimen

Stupp protocol — Temozolomide concurrent + adjuvant

Drugs + NSZU

Temozolomide (DRUG-TEMOZOLOMIDE) Concurrent: 75 mg/m² PO daily during RT 6 weeks; Adjuvant: 150 mg/m² PO days 1-5 cycle 1 (escalate to 200 if tolerated) every 28 days × 6 cycles · Concurrent daily × 42 days then 4-week break then adjuvant cycles 1-6 · PO ✓ NSZU covered

Reason

Engine default per algorithm ALGO-GBM-NEWLY-DIAGNOSED-1L: {'step': 1, 'outcome': False, 'branch': {'result': 'IND-GBM-NEWLY-DIAGNOSED-STUPP'}, 'fired_red_flags': [], 'winner_red_flag': None}

Pre-treatment investigations

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

ID	Name	Priority	Category	Needed for
TEST-IDH-MUTATION	Мутація IDH1/2 (ІГХ R132H + рефлекс NGS)	Critical	histology	all tracks
TEST-MGMT-METHYLATION	Метилювання промотора MGMT (MSP / піросеквенування)	Critical	histology	all tracks
TEST-MRI-BRAIN-CONTRAST	МРТ головного мозку з гадолінієвим контрастом	Standard	imaging	all tracks
TEST-NGS-COMPREHENSIVE	Комплексна NGS-панель пухлини	Desired	histology	desired (standard)

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Symptomatic raised intracranial pressure / mass effect in glioblastoma: declining GCS, new focal deficit, papilledema, midline shift on imaging, or seizure cluster. Mandates immediate neurosurgical / corticosteroid intervention BEFORE oncologic systemic therapy. RF-GBM-INTRACRANIAL-PRESSURE-EMERGENCY

CONTRA-AGGRESSIVE

Hard contraindications to escalation

What NOT to do

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

Standard plan (IND-GBM-NEWLY-DIAGNOSED-STUPP)

Do NOT delay starting RT beyond 6 weeks post-resection
Do NOT skip MGMT testing — defines elderly (≥70) regimen choice
Do NOT skip PJP prophylaxis (universal lymphopenia → opportunistic infection)
Do NOT use enzyme-inducing AEDs (phenytoin, carbamazepine) — accelerate TMZ clearance; use levetiracetam

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Stupp protocol — Temozolomide

28-day cycles × Concurrent phase 6 weeks + adjuvant 6 cycles (~7 months total)

MDT brief

Skills (recommended) — for consideration (1)

Молекулярний генетик / молекулярний онколог recommended
Indication посилається на actionable геномний біомаркер — потрібна інтерпретація мутації / target / actionability.
skill: molecular_geneticistv0.1.0reviewed 2026-04-25STUBsign-offs: 0lead: TBD

Data quality

Unevaluated RedFlags: RF-GBM-FRAILTY-AGE, RF-GBM-HIGH-RISK-BIOLOGY, RF-GBM-INFECTION-SCREENING, RF-GBM-INTRACRANIAL-PRESSURE-EMERGENCY, RF-GBM-TRANSFORMATION-PROGRESSION

Skill catalog (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
Specialist з клітинної терапії (CAR-T)	`cellular_therapy_specialist`	v0.1.0	2026-04-25	cellular_therapy
Клінічний фармацевт	`clinical_pharmacist`	v0.1.0	2026-04-25	clinical_pharmacy
Гематолог / онкогематолог	`hematologist`	v0.1.0	2026-04-25	hematology_oncology
Гематопатолог (специфічно для лімфом / лейкозів / мієломи)	`hematopathologist`	v0.1.0	2026-04-25	hematopathology
Інфекціоніст / гепатолог	`infectious_disease_hepatology`	v0.1.0	2026-04-25	infectious_diseases
Медичний онколог (хіміотерапевт солідних пухлин)	`medical_oncologist`	v0.1.0	2026-04-25	solid_oncology
Молекулярний генетик / молекулярний онколог	`molecular_geneticist`	v0.1.0	2026-04-25	molecular_oncology
Паліативна допомога	`palliative_care`	v0.1.0	2026-04-25	palliative_care
Патолог (загальний)	`pathologist`	v0.1.0	2026-04-25	pathology
Сімейний лікар / терапевт	`primary_care`	v0.1.0	2026-04-25	primary_care
Психолог / онкопсихолог	`psychologist`	v0.1.0	2026-04-25	psychosocial
Радіотерапевт (променева терапія)	`radiation_oncologist`	v0.1.0	2026-04-25	radiation_oncology
Лікар-радіолог	`radiologist`	v0.1.0	2026-04-25	diagnostic_imaging
Соціальний працівник / кейс-менеджер	`social_worker_case_manager`	v0.1.0	2026-04-25	psychosocial
Хірург-онколог	`surgical_oncologist`	v0.1.0	2026-04-25	surgical_oncology
Specialist з трансплантації (BMT)	`transplant_specialist`	v0.1.0	2026-04-25	cellular_therapy

Sources cited

SRC-EANO-GBM-2024: EANO Guidelines on Diagnosis and Treatment of Diffuse Gliomas of Adulthood (2024 update)
SRC-NCCN-CNS-2025: NCCN Central Nervous System Cancers (v.3.2025)

Експериментальні опції (клінічні дослідження)

Третій трек плану — open-enrollment trials з ClinicalTrials.gov. Останнє оновлення: 2026-04-26. Render-time metadata; engine selection не змінюється цим блоком (CHARTER §8.3).

NCT	Name	Phase	Статус	Спонсор	UA
NCT06883747	Clinical Trial of BMS-986504 in Recurrent GBM Patients	EARLY_PHASE1	RECRUITING	Nader Sanai	—
NCT05864976	Neurosurgical Neuronavigation Using Resting State MRI and Machine Learning	N/A	RECRUITING	Washington University School of Medicine	—
NCT06810544	Safety and Tolerability of TNG456 Alone and in Combination With Abemaciclib in Patients With Solid Tumors With MTAP Loss	PHASE1 / PHASE2	RECRUITING	Tango Therapeutics, Inc.	—
NCT05463848	Surgical Pembro +/- Olaparib w TMZ for rGBM	PHASE2	RECRUITING	L. Nicolas Gonzalez Castro, MD, PhD	—
NCT05450744	131I-TLX-101 for Treatment of Newly Diagnosed Glioblastoma (IPAX-2)	PHASE1	RECRUITING	Telix Pharmaceuticals (Innovations) Pty Limited	—
NCT04708171	The PROGRAM-study: Awake Mapping Versus Asleep Mapping Versus No Mapping for Glioblastoma Resections	N/A	RECRUITING	Erasmus Medical Center	—
NCT04765514	Chemoradiotherapy Versus Chemotherapy for Elderly and Frail GBM Patients	PHASE2	RECRUITING	AHS Cancer Control Alberta	—
NCT04780009	Loupe-Based Intraoperative Fluorescence Imaging	N/A	RECRUITING	Guoqiang Yu	—
NCT07193628	B7H3/IL13Ra2 Bispecific Armored Chimeric Antigen Receptor T-Cell Therapy Study for Recurrent/Refractory Glioblastoma	PHASE1	RECRUITING	Second Affiliated Hospital, School of Medicine, Zhejiang University	—
NCT07143812	A Study to Evaluate the Safety of a Stem Cell-Based Gene and Cell Therapy in Patients With Newly Diagnosed Glioblastoma	PHASE1	RECRUITING	CHA University	—

Перевіряти статус набору безпосередньо у дослідницькому центрі. Дані ctgov можуть відставати від поточного статусу UA-сайтів.

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 Stupp protocol — Temozolomide concurrent + adjuvant (REG-STUPP-TMZ)	✓ зареєстровано	✓ покривається	₴-? — verify pathway	НСЗУ formulary
Trial · NCT06883747 Clinical Trial of BMS-986504 in Recurrent GBM Patients No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT05864976 Neurosurgical Neuronavigation Using Resting State MRI and Machine Learning No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT06810544 Safety and Tolerability of TNG456 Alone and in Combination With Abemaciclib in Patients With Solid Tumors With MTAP Loss No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT05463848 Surgical Pembro +/- Olaparib w TMZ for rGBM No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT05450744 131I-TLX-101 for Treatment of Newly Diagnosed Glioblastoma (IPAX-2) No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT04708171 The PROGRAM-study: Awake Mapping Versus Asleep Mapping Versus No Mapping for Glioblastoma Resections No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT04765514 Chemoradiotherapy Versus Chemotherapy for Elderly and Frail GBM Patients No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT04780009 Loupe-Based Intraoperative Fluorescence Imaging No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT07193628 B7H3/IL13Ra2 Bispecific Armored Chimeric Antigen Receptor T-Cell Therapy Study for Recurrent/Refractory Glioblastoma No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT07143812 A Study to Evaluate the Safety of a Stem Cell-Based Gene and Cell Therapy in Patients With Newly Diagnosed Glioblastoma No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor

Інформація про ціни — orientation. Перевіряти у конкретній аптеці / foundation / трайл-сайті. Status updated: 2026-04-27.

plan_id: PLAN-AUTO-GBM-001-V1 | version: 1 | generated: 2026-04-27T10:14:01.608312+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.