Treatment plan — DIS-OVARIAN

OpenOnco · Treatment Plan

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

Patient

AUTO-OVARIAN-001 · Algorithm: ALGO-OVARIAN-ADVANCED-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-OVARIAN-ADVANCED-1L-CARBO-PACLI-HRD-NEG

Regimen

Carboplatin + Paclitaxel (ovarian 3-weekly)

Drugs + NSZU

Carboplatin (DRUG-CARBOPLATIN) AUC 5-6 · IV day 1 every 21d · IV ✓ NSZU covered
Paclitaxel (DRUG-PACLITAXEL) 175 mg/m² · IV day 1 every 21d · IV ✓ NSZU covered

Reason

Engine default per algorithm ALGO-OVARIAN-ADVANCED-1L: {'step': 6, 'outcome': False, 'branch': {'result': 'IND-OVARIAN-ADVANCED-1L-CARBO-PACLI-HRD-NEG'}, 'fired_red_flags': [], 'winner_red_flag': None}

Aggressive plan

Indication

IND-OVARIAN-ADVANCED-1L-CARBO-PACLI-HRD-OLAP

Regimen

Carboplatin + Paclitaxel (ovarian 3-weekly)

Drugs + NSZU

Carboplatin (DRUG-CARBOPLATIN) AUC 5-6 · IV day 1 every 21d · IV ✓ NSZU covered
Paclitaxel (DRUG-PACLITAXEL) 175 mg/m² · IV day 1 every 21d · IV ✓ NSZU covered

Reason

Alternative track presented for HCP consideration

Aggressive plan

Indication

IND-OVARIAN-MAINTENANCE-OLAPARIB

Regimen

Olaparib maintenance (HRD+ ovarian post-platinum response)

Drugs + NSZU

Olaparib (DRUG-OLAPARIB) 300 mg PO BID continuous · Continuous · PO ✓ NSZU covered

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-CBC	Загальний аналіз крові з лейкоцитарною формулою	Critical	lab	aggressive

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

BRCA1 or BRCA2 pathogenic variant (germline OR somatic) in high-grade serous ovarian carcinoma — ~20-25% prevalence (15% germline + ~7% somatic). Olaparib maintenance after platinum-based 1L (SOLO-1 — mPFS 56.0 vs 13.8 mo BRCA-mut) is treatment-defining; rucaparib + niraparib alternatives. SOLO-2 — 2L+ relapse maintenance. RF-OVARIAN-BRCA-MUT-ACTIONABLE
Frailty profile precluding standard carbo+pacli + bev intensified induction in ovarian: ECOG ≥3, OR (age ≥75 + Charlson ≥3), OR composite (age ≥70 + ascites large-volume + albumin <3.0). Triggers carbo-mono OR weekly-dose-dense-pacli (less neuropathy / bone marrow). RF-OVARIAN-FRAILTY-AGE
HRD-positive (BRCA1/2 mutation OR Genomic Instability Score ≥42) high-grade serous ovarian carcinoma. Treatment-defining for PARPi maintenance after platinum-based induction. Olaparib (SOLO-1 BRCA-only, PAOLA-1 with bev) + niraparib (PRIMA all-comer) substantially improve PFS in HRD-positive subset. RF-OVARIAN-HRD-ACTIONABILITY
Homologous Recombination Deficiency (HRD)-positive high-grade serous ovarian carcinoma (BRCA1/2 mutation OR Genomic Instability Score ≥42). PARPi maintenance after platinum-based induction is treatment-defining: niraparib (PRIMA — mPFS 21.9 vs 10.4 mo HRD-pos), olaparib + bevacizumab (PAOLA-1 — mPFS 37.2 vs 17.7 mo HRD-pos). RF-OVARIAN-HRD-POSITIVE-ACTIONABLE
Suboptimal primary cytoreductive surgery (residual disease ≥1 cm) or unresectable at presentation in advanced (FIGO III-IV) ovarian carcinoma. MDT-trigger for neoadjuvant chemo (NACT) → interval debulking surgery (IDS) pathway per CHORUS / EORTC55971 trials, rather than primary debulking. RF-OVARIAN-SUBOPTIMAL-DEBULKING

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-OVARIAN-ADVANCED-1L-CARBO-PACLI-HRD-NEG)

Do NOT use olaparib maintenance in HRD-negative — minimal benefit, MDS/AML risk
Do NOT initiate bev maintenance within 28 days of major surgery

Aggressive plan (IND-OVARIAN-ADVANCED-1L-CARBO-PACLI-HRD-OLAP)

Do NOT skip HRD testing — defines maintenance choice (PARPi-only HRD+; niraparib-all-comer if HRD-negative weak benefit)
Do NOT start olaparib without confirmed CR/PR to platinum induction
Do NOT continue olaparib through Grade 3 anemia without dose reduction

Aggressive plan (IND-OVARIAN-MAINTENANCE-OLAPARIB)

Do NOT start without confirmed CR/PR to platinum
Do NOT continue past 2 years for non-BRCA HRD+ unless still benefiting (label allows ≤24 mo)
Do NOT skip pre-treatment counseling on long-term MDS/AML risk

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Carboplatin + Paclitaxel (ovar

21-day cycles × 6 cycles (per GOG-218 / ICON-7 induction); subsequent maintenance per HRD/biomarker stratification

MDT brief

Skills (recommended) — for consideration (2)

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

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-OVARIAN-BRCA-MUT-ACTIONABLE, RF-OVARIAN-FRA-HIGH-ACTIONABLE, RF-OVARIAN-FRAILTY-AGE, RF-OVARIAN-HRD-ACTIONABILITY, RF-OVARIAN-HRD-POSITIVE-ACTIONABLE, RF-OVARIAN-INFECTION-SCREENING, RF-OVARIAN-PERIOPERATIVE-VTE, RF-OVARIAN-PLATINUM-RESISTANT, RF-OVARIAN-PLATINUM-SENSITIVE, RF-OVARIAN-SUBOPTIMAL-DEBULKING, RF-OVARIAN-TRANSFORMATION-PROGRESSION

Skill catalog (2/16 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-ESMO-OVARIAN-2024: ESMO Ovarian Cancer Clinical Practice Guideline (2024)
SRC-NCCN-OVARIAN-2025: NCCN Ovarian Cancer (v.2.2025)

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
NCT06778863	A Study of CLSP-1025 in Adult Patients With Solid Tumors That Harbor the p53 R175H Mutation	PHASE1	RECRUITING	Clasp Therapeutics, Inc.	—
NCT06533332	A Phase 1 Trial of ERX-315 in Participants With Advanced Solid Tumors	PHASE1	RECRUITING	EtiraRx Australia Pty Ltd	—
NCT03382158	International PPB/DICER1 Registry	N/A	RECRUITING	Children's Hospitals and Clinics of Minnesota	—
NCT06445621	Early Detection of Relapse in Ovarian Cancer Using Capillary Home-sampling and a Protein Biomarker Test	N/A	RECRUITING	Uppsala University Hospital	—
NCT06572735	Study on the Relative Dose Intensity of PARP Inhibitors in Real-life on a Population of Patients Over 70 Years With Advanced Ovarian Cancer	N/A	RECRUITING	Hospices Civils de Lyon	—
NCT05025878	13C-Glucose Tracing of Tumour and T Cells in the Ascites of Ovarian Cancer Patients.	N/A	RECRUITING	British Columbia Cancer Agency	—
NCT04585750	The Evaluation of PC14586 in Patients With Advanced Solid Tumors Harboring a TP53 Y220C Mutation (PYNNACLE)	PHASE1 / PHASE2	RECRUITING	PMV Pharmaceuticals, Inc	—
NCT06215950	A Clinical Research About CD70-targeted CAR-T in the Treatment of CD70-positive Advanced/Metastatic Gynecologic Cancer	PHASE1	RECRUITING	Chongqing Precision Biotech Co., Ltd	—
NCT06962059	Healthy Volunteers Study	N/A	RECRUITING	Abramson Cancer Center at Penn Medicine	—
NCT06469281	A Study to Learn if 27T51, a Mucin-16 (MUC16) Protein Targeting Immune Cell Therapy, Administered Alone or in Combination is Safe and How Well it Works for Adult Participants With Recurrent or Treatment Resistant Ovarian Cancers	PHASE1	RECRUITING	Regeneron Pharmaceuticals	—

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 Carboplatin + Paclitaxel (ovarian 3-weekly) (REG-CARBO-PACLI-OVARIAN)	✓ зареєстровано	✓ покривається	₴-? — verify pathway	НСЗУ formulary
Aggressive plan Carboplatin + Paclitaxel (ovarian 3-weekly) (REG-CARBO-PACLI-OVARIAN)	✓ зареєстровано	✓ покривається	₴-? — verify pathway	НСЗУ formulary
Aggressive plan Olaparib maintenance (HRD+ ovarian post-platinum response) (REG-OLAPARIB-MAINT-OVARIAN)	✓ зареєстровано	✓ покривається	₴-? — verify pathway	НСЗУ formulary
Trial · NCT06778863 A Study of CLSP-1025 in Adult Patients With Solid Tumors That Harbor the p53 R175H Mutation No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT06533332 A Phase 1 Trial of ERX-315 in Participants With Advanced Solid Tumors No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT03382158 International PPB/DICER1 Registry No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT06445621 Early Detection of Relapse in Ovarian Cancer Using Capillary Home-sampling and a Protein Biomarker Test No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT06572735 Study on the Relative Dose Intensity of PARP Inhibitors in Real-life on a Population of Patients Over 70 Years With Advanced Ovarian Cancer No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT05025878 13C-Glucose Tracing of Tumour and T Cells in the Ascites of Ovarian Cancer Patients. No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT04585750 The Evaluation of PC14586 in Patients With Advanced Solid Tumors Harboring a TP53 Y220C Mutation (PYNNACLE) No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT06215950 A Clinical Research About CD70-targeted CAR-T in the Treatment of CD70-positive Advanced/Metastatic Gynecologic Cancer No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT06962059 Healthy Volunteers Study No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT06469281 A Study to Learn if 27T51, a Mucin-16 (MUC16) Protein Targeting Immune Cell Therapy, Administered Alone or in Combination is Safe and How Well it Works for Adult Participants With Recurrent or Treatment Resistant Ovarian Cancers 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-OVARIAN-001-V1 | version: 1 | generated: 2026-04-27T10:14:01.625922+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.