Treatment plan — DIS-RCC

OpenOnco · Treatment Plan

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

Patient

AUTO-RCC-001 · Algorithm: ALGO-RCC-METASTATIC-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 (2 tracks)

Standard plan

★ DEFAULT

Indication

IND-RCC-METASTATIC-1L-PEMBRO-AXI

Regimen

Pembrolizumab + axitinib (RCC, 1L all-risk)

Drugs + NSZU

Pembrolizumab (DRUG-PEMBROLIZUMAB) 200 mg IV q3w · Up to 2 years · IV ⚠ NSZU — not for this indication
Axitinib (DRUG-AXITINIB) 5 mg PO BID continuous · Continuous · PO ⚠ NSZU — not for this indication

Reason

Engine default per algorithm ALGO-RCC-METASTATIC-1L: {'step': 1, 'outcome': False, 'branch': {'result': 'IND-RCC-METASTATIC-1L-PEMBRO-AXI'}, 'fired_red_flags': [], 'winner_red_flag': None}

Aggressive plan

Indication

IND-RCC-METASTATIC-1L-NIVO-IPI

Regimen

Nivolumab + ipilimumab (RCC, 1L IMDC intermediate/poor)

Drugs + NSZU

Nivolumab (DRUG-NIVOLUMAB) 3 mg/kg IV induction → 480 mg flat IV q4w maintenance · Induction q3w x 4 + ipi · IV ✓ NSZU covered
Ipilimumab (DRUG-IPILIMUMAB) 1 mg/kg IV · Days 1 of cycles 1-4 only · IV ⚠ NSZU — not for this indication

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-BRAIN-MRI-CONTRAST	МРТ головного мозку з контрастом	Standard	—	aggressive

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Pembrolizumab + axitinib (RCC,

21-day cycles × Pembro up to 2 years; axitinib until progression

Aggressive plan

Induction · Nivolumab + ipilimumab (RCC, 1

21-day cycles × 4 induction; nivo maintenance until progression

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-RCC-FRAILTY-AGE, RF-RCC-HIGH-RISK-BIOLOGY, RF-RCC-INFECTION-SCREENING, RF-RCC-ORGAN-DYSFUNCTION, RF-RCC-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-ESMO-RCC-2024: ESMO Renal Cell Carcinoma (2024)
SRC-NCCN-KIDNEY-2025: NCCN Kidney Cancer (2025.v3)

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
NCT04974671	Trial Of Stereotactic Body Radiation Therapy (SBRT) for Oligoprogression on Immune Checkpoint Inhibitors (ICI) in Metastatic Renal Cell Carcinoma	PHASE2	RECRUITING	Yale University	—
NCT06065852	National Registry of Rare Kidney Diseases	N/A	RECRUITING	UK Kidney Association	—
NCT03382158	International PPB/DICER1 Registry	N/A	RECRUITING	Children's Hospitals and Clinics of Minnesota	—
NCT06451497	This is a Phase 1 Trial of ZM008, an Anti-LLT1 Antibody, Used as Single Agent Followed by Combination Treatment With Toripalimab in Patients With Advanced Solid Tumors	PHASE1	RECRUITING	Zumutor Biologics Inc.	—
NCT05176483	Study of Zanzalintinib in Combination With Immuno-Oncology Agents in Participants With Solid Tumors	PHASE1	RECRUITING	Exelixis	—
NCT07038733	Investigation of Lymph Node Biology in Kidney Cancer	NA	RECRUITING	Yale University	—
NCT06270706	A Phase 1 Study of PLN-101095 in Adults With Advanced or Metastatic Solid Tumors	PHASE1	RECRUITING	Pliant Therapeutics, Inc.	—
NCT03288532	Renal Adjuvant MultiPle Arm Randomised Trial	PHASE3	RECRUITING	University College, London	—
NCT06211114	Study to Evaluate the Efficacy and Safety of Immunotherapy With Axitinib in Advanced Collecting Duct Carcinoma	PHASE2	RECRUITING	Peking University Cancer Hospital & Institute	—
NCT05520099	Observational Basket Trial to Collect Tissue to Develop and Train a Live Tumor Diagnostic Platform	N/A	RECRUITING	Elephas	—

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 Pembrolizumab + axitinib (RCC, 1L all-risk) (REG-PEMBRO-AXI-RCC)	✓ зареєстровано	✓ покривається	₴-? — verify pathway	НСЗУ formulary
Aggressive plan Nivolumab + ipilimumab (RCC, 1L IMDC intermediate/poor) (REG-NIVO-IPI-RCC)	✓ зареєстровано	✓ покривається	₴-? — verify pathway	НСЗУ formulary
Trial · NCT04974671 Trial Of Stereotactic Body Radiation Therapy (SBRT) for Oligoprogression on Immune Checkpoint Inhibitors (ICI) in Metastatic Renal Cell Carcinoma No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT06065852 National Registry of Rare Kidney Diseases 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 · NCT06451497 This is a Phase 1 Trial of ZM008, an Anti-LLT1 Antibody, Used as Single Agent Followed by Combination Treatment With Toripalimab in Patients With Advanced Solid Tumors No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT05176483 Study of Zanzalintinib in Combination With Immuno-Oncology Agents in Participants With Solid Tumors No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT07038733 Investigation of Lymph Node Biology in Kidney Cancer No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT06270706 A Phase 1 Study of PLN-101095 in Adults With Advanced or Metastatic Solid Tumors No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT03288532 Renal Adjuvant MultiPle Arm Randomised Trial No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT06211114 Study to Evaluate the Efficacy and Safety of Immunotherapy With Axitinib in Advanced Collecting Duct Carcinoma No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT05520099 Observational Basket Trial to Collect Tissue to Develop and Train a Live Tumor Diagnostic Platform 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-RCC-001-V1 | version: 1 | generated: 2026-04-27T10:14:01.647421+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.