Treatment plan — DIS-HCC

OpenOnco · Treatment Plan

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

Patient

AUTO-HCC-001 · Algorithm: ALGO-HCC-SYSTEMIC-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 (3 tracks)

Standard plan

★ DEFAULT

Indication

IND-HCC-SYSTEMIC-1L-ATEZO-BEV

Regimen

Atezolizumab + Bevacizumab

Drugs + NSZU

Atezolizumab (DRUG-ATEZOLIZUMAB) 1200 mg · IV q3w · IV ⚠ NSZU — not for this indication
Bevacizumab (DRUG-BEVACIZUMAB) 15 mg/kg · IV q3w (concurrent) · IV ⚠ NSZU — not for this indication

Hard contraindications

CI-PEMBROLIZUMAB-AUTOIMMUNE

Reason

Engine default per algorithm ALGO-HCC-SYSTEMIC-1L: {'step': 3, 'outcome': True, 'branch': {'result': 'IND-HCC-SYSTEMIC-1L-ATEZO-BEV'}, 'fired_red_flags': ['RF-FITNESS-ECOG-FIT'], 'winner_red_flag': 'RF-FITNESS-ECOG-FIT'}

Aggressive plan

Indication

IND-HCC-SYSTEMIC-1L-DURVA-TREME

Regimen

Durvalumab + Tremelimumab (STRIDE)

Drugs + NSZU

Tremelimumab (DRUG-TREMELIMUMAB) 300 mg · IV — single priming dose only (cycle 1 day 1) · IV ✗ Not registered in UA
Durvalumab (DRUG-DURVALUMAB) 1500 mg · IV q4w (cycle 1 with tremelimumab; subsequent cycles mono) · IV ⚠ NSZU — not for this indication

Hard contraindications

CI-PEMBROLIZUMAB-AUTOIMMUNE

Reason

Alternative track presented for HCP consideration

Standard plan

Indication

IND-HCC-SYSTEMIC-1L-SORAFENIB

Regimen

Sorafenib monotherapy

Drugs + NSZU

Sorafenib (DRUG-SORAFENIB) 400 mg PO BID (start 200 mg BID; escalate to 400 mg if tolerated) · Continuous · PO ⚠ NSZU — not for this indication

Reason

Alternative track presented for HCP consideration

Why this branch was chosen

Triggers from the patient profile that fired and drove the chosen branch.

Step 3 → branch IND-HCC-SYSTEMIC-1L-ATEZO-BEV

RF-FITNESS-ECOG-FIT ★ winner: Fit performance status (ECOG 0-1): patient is fully active or restricted in physically strenuous activity but ambulatory and able to carry out light work. Eligible for full-dose chemotherapy and intensive regimens (CHOEP, BEACOPP-escalated, HD-MTX, ASCT consolidation, CAR-T). SRC-NCCN-BCELL-2025SRC-ESMO-DLBCL-2024

Pre-treatment investigations

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

ID	Name	Priority	Category	Needed for
TEST-AFP	АФП (сироватка)	Critical	lab	all tracks
TEST-CHILD-PUGH-CALCULATION	Calculation Child-Pugh	Critical	clinical_assessment	all tracks
TEST-CT-CHEST-ABDOMEN-PELVIS	КТ грудна клітка + черевна порожнина + малий таз з контрастом	Critical	imaging	all tracks
TEST-EGD-VARICES-SCREENING	ФГДС з оцінкою варикозу стравоходу	Critical	imaging	standard
TEST-HBV-SEROLOGY	Серологія HBV: HBsAg, anti-HBc, anti-HBs	Critical	lab	standard
TEST-HCV-ANTIBODY	Антитіла до HCV	Critical	lab	standard
TEST-LFT	Печінкові проби (АЛТ, АСТ, білірубін, ЛФ, ГГТП, альбумін)	Critical	lab	standard

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Child-Pugh B or C cirrhosis in HCC patient. CP-A is the only fully- studied class for ICI combinations (atezo+bev, durva+treme); CP-B has partial sorafenib/lenvatinib data but worse safety; CP-C generally precludes systemic therapy (focus on supportive care + transplant evaluation if liver-limited disease). RF-HCC-CHILD-PUGH-B-C
Active or recent (≤6 months) variceal hemorrhage in HCC patient with cirrhosis. Mandates EGD assessment + variceal band ligation BEFORE any bevacizumab-containing regimen (atezo+bev, IMbrave150 prerequisite). Active bleeding is an absolute hold on systemic therapy until controlled. RF-HCC-VARICEAL-BLEED

CONTRA-AGGRESSIVE

Hard contraindications to escalation

Pembrolizumab (and other PD-1/PD-L1 inhibitors) augment T-cell responses; in patients with active autoimmunity or post-transplant immunosuppression, this can precipitate severe organ-specific flares (colitis, hepatitis, pneumonitis, transplant rejection) that may be fatal or require transplant loss. CI-PEMBROLIZUMAB-AUTOIMMUNE

What NOT to do

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

Standard plan (IND-HCC-SYSTEMIC-1L-ATEZO-BEV)

Do NOT initiate without EGD within 6 months — high-risk varices must be ligated/banded first (perforation/bleed risk)
Do NOT use in Child-Pugh B/C — atezo+bev not studied; mortality risk
Do NOT skip HBV prophylaxis in HBsAg+ / anti-HBc+ patients (entecavir or TDF) — HBV reactivation reported under anti-VEGF + ICI; continue ≥12 mo post-therapy
Do NOT delay HCV-DAA in HCV-RNA+ patients — initiate sofosbuvir/velpatasvir before or concurrently with atezo+bev; SVR12 reduces decompensation risk and may improve OS in HCC-on-HCV-cirrhosis
Do NOT combine sofosbuvir with amiodarone — severe bradycardia / cardiac arrest
Do NOT continue bevacizumab through Grade 3+ HTN or proteinuria >3.5 g/24h

Aggressive plan (IND-HCC-SYSTEMIC-1L-DURVA-TREME)

Do NOT use in Child-Pugh B/C
Do NOT skip HBV prophylaxis
Do NOT continue through Grade 3+ irAE without permanent discontinuation consideration (CTLA-4 colitis can be fatal)

Standard plan (IND-HCC-SYSTEMIC-1L-SORAFENIB)

Do NOT continue through hepatic decompensation onset
Do NOT delay HFSR prophylaxis (urea cream, emollient, friction avoidance)

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Atezolizumab + Bevacizumab

21-day cycles × Until progression / unacceptable toxicity

Aggressive plan

Induction · Durvalumab + Tremelimumab (STR

28-day cycles × Until progression / unacceptable toxicity

MDT brief

Skills (recommended) — for consideration (1)

Клінічний фармацевт recommended
Хіміоімунотерапевтичний схема — drug-drug interactions, dose adjustments, premedication.
skill: clinical_pharmacistv0.1.0reviewed 2026-04-25STUBsign-offs: 0lead: TBD

Open questions (1, 0 blocking)

OQ-LDH-CURRENT
Який актуальний LDH? Маркер пухлинного навантаження і трансформації.
LDH входить у прогностичні індекси індолентних лімфом.
→ hematologist

Data quality

Unevaluated RedFlags: RF-HCC-AFP-RAPID-RISE, RF-HCC-CHILD-PUGH-B-C, RF-HCC-FRAILTY-AGE, RF-HCC-HBV-REACTIVATION-RISK, RF-HCC-HIGH-RISK-BIOLOGY, RF-HCC-VARICEAL-BLEED

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-AASLD-HCC-2023: AASLD Practice Guidance on HCC (2023)
SRC-NCCN-HCC-2025: NCCN Hepatocellular Carcinoma (v.3.2025)

Експериментальні опції (клінічні дослідження)

Третій трек плану — open-enrollment trials з ClinicalTrials.gov. Останнє оновлення: 2026-04-27. Render-time metadata; engine selection не змінюється цим блоком (CHARTER §8.3).

NCT	Name	Phase	Статус	Спонсор	UA
NCT06789198	Peptide Vaccine for Fibrolamellar Hepatocellular Carcinoma Patients and Other Tumor Entities Carrying the Driver Fusion DNAJB1-PRKACA	PHASE1	RECRUITING	University Hospital Tuebingen	—
NCT02838836	Tumor Cell and DNA Detection in the Blood, Urine and Bone Marrow of Patients With Solid Cancers	N/A	RECRUITING	University of Missouri-Columbia	—
NCT07052253	A Phase II Clinical Study of AK104/AK112 in Combination With TT-00420 Tablet for Advanced HCC.	PHASE2	RECRUITING	Akeso	—
NCT05870969	Digitalized Surveillance Management for Liver Cancer Risk Population in Improving Eearly Diagnosis Efficancy in Chinese Population (dSEARCH)	N/A	RECRUITING	Ruijin Hospital	—
NCT07001085	ctDNA Monitoring in Patients With HCC and mCRC	NA	RECRUITING	Medical University of Warsaw	—
NCT05440708	A Study of TTI-101 as Monotherapy and in Combination in Participants With Locally Advanced or Metastatic, and Unresectable Hepatocellular Carcinoma	PHASE1 / PHASE2	RECRUITING	Tvardi Therapeutics, Incorporated	—
NCT06077591	Prospective Clinical Validation of Next Generation Sequencing (NGS) and Patient-Derived Tumor Organoids (PDO) Guided Therapy in Patients With Advanced/ Inoperable Solid Tumors	NA	RECRUITING	Chinese University of Hong Kong	—
NCT05489289	A Phase III Study of AK104 as Adjuvant Therapy in HCC With High Risk of Recurrence After Curative Resection	PHASE3	RECRUITING	Akeso	—
NCT06028724	A Study on the Prevalence of Clinically Useful Mutations in Solid Tumor Characterized by Next Generation Sequencing Methods on Liquid Biopsy Analysis (POPCORN)	N/A	RECRUITING	Centro di Riferimento Oncologico - Aviano	—
NCT06383520	Study on the Clinical Application Value of PET Imaging Targeting GPC3 in Hepatocellular Carcinoma	EARLY_PHASE1	RECRUITING	Union Hospital, Tongji Medical College, Huazhong University of Science and Technology	—

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 Atezolizumab + Bevacizumab (REG-ATEZO-BEV)	✓ зареєстровано	✓ покривається	₴-? — verify pathway	НСЗУ formulary
Aggressive plan Durvalumab + Tremelimumab (STRIDE) (REG-DURVA-TREME-STRIDE) 1/2 component drug(s) not registered in Ukraine +1	✗ не зареєстровано	✗ out-of-pocket	₴-? — verify pathway	not recorded
Standard plan Sorafenib monotherapy (REG-SORAFENIB-MONO)	✓ зареєстровано	✓ покривається	₴-? — verify pathway	НСЗУ formulary
Trial · NCT06789198 Peptide Vaccine for Fibrolamellar Hepatocellular Carcinoma Patients and Other Tumor Entities Carrying the Driver Fusion DNAJB1-PRKACA No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT02838836 Tumor Cell and DNA Detection in the Blood, Urine and Bone Marrow of Patients With Solid Cancers No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT07052253 A Phase II Clinical Study of AK104/AK112 in Combination With TT-00420 Tablet for Advanced HCC. No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT05870969 Digitalized Surveillance Management for Liver Cancer Risk Population in Improving Eearly Diagnosis Efficancy in Chinese Population (dSEARCH) No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT07001085 ctDNA Monitoring in Patients With HCC and mCRC No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT05440708 A Study of TTI-101 as Monotherapy and in Combination in Participants With Locally Advanced or Metastatic, and Unresectable Hepatocellular Carcinoma No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT06077591 Prospective Clinical Validation of Next Generation Sequencing (NGS) and Patient-Derived Tumor Organoids (PDO) Guided Therapy in Patients With Advanced/ Inoperable Solid Tumors No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT05489289 A Phase III Study of AK104 as Adjuvant Therapy in HCC With High Risk of Recurrence After Curative Resection No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT06028724 A Study on the Prevalence of Clinically Useful Mutations in Solid Tumor Characterized by Next Generation Sequencing Methods on Liquid Biopsy Analysis (POPCORN) No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT06383520 Study on the Clinical Application Value of PET Imaging Targeting GPC3 in Hepatocellular Carcinoma 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-HCC-001-V1 | version: 1 | generated: 2026-04-27T10:14:01.593853+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.