EN · OpenOnco · Ovarian · Advanced HRD+ (PARPi maintenance)
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OpenOnco · Treatment Plan
Treatment plan — DIS-OVARIAN
PLAN-OVAR-HRD-001-V1 · v1 · 2026-04-27
Patient
OVAR-HRD-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
BiomarkerVariantESCATOncoKBClinical significanceDrugsSources
BIO-HRD-STATUSHRD-positive — BRCA1/2 mutation OR genomic instability score (GIS) above validated threshold (Myriad MyChoice ≥42 or equivalent FoundationOne CDx HRD signature); ~50% of high-grade serous ovarian carcinomaIA1HRD-positive high-grade serous ovarian carcinoma (~50% — encompassing BRCA1/2-mutated and BRCA-WT/HRD+): PARP inhibitor maintenance after platinum response is FDA-approved 1L. Olaparib monotherapy maintenance for BRCA1/2-mutated newly-diagnosed advanced ovarian after CR/PR to platinum (SOLO-1 Moore NEJM 2018 — mPFS not reached vs 13.8 mo, HR 0.30) per SRC-NCCN-OVARIAN-2025, SRC-ESMO-OVARIAN-2024. Olaparib + bevacizumab maintenance for HRD-positive (BRCA-mut OR HRD-genomic) post-1L platinum + bevacizumab (PAOLA-1 Ray-Coquard NEJM 2019 — HRD subgroup mPFS 37 vs 17 mo, HR 0.33). Niraparib monotherapy maintenance is approved for all-comers (PRIMA Gonzalez-Martin NEJM 2019), with the strongest benefit in HRD-positive subgroup.olaparib monotherapy maintenance (1L BRCA1/2-mut per SRC-NCCN-OVARIAN-2025, SRC-ESMO-OVARIAN-2024)
olaparib + bevacizumab maintenance (1L HRD-positive non-BRCA per SRC-NCCN-OVARIAN-2025)
niraparib monotherapy maintenance (1L per SRC-NCCN-OVARIAN-2025, all-comers benefit, HRD-positive strongest)
rucaparib monotherapy (2L maintenance / treatment per SRC-NCCN-OVARIAN-2025)
  • SRC-NCCN-OVARIAN-2025
  • SRC-ESMO-OVARIAN-2024
  • SRC-ONCOKB

Treatment options (2 tracks)

Aggressive plan
★ DEFAULT
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
Engine default per algorithm ALGO-OVARIAN-ADVANCED-1L: {'step': 3, 'outcome': True, 'branch': {'result': 'IND-OVARIAN-ADVANCED-1L-CARBO-PACLI-HRD-OLAP'}, 'fired_red_flags': ['RF-OVARIAN-BRCA-MUT-ACTIONABLE'], 'winner_red_flag': 'RF-OVARIAN-BRCA-MUT-ACTIONABLE'}
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

Why this branch was chosen

Triggers from the patient profile that fired and drove the chosen branch.
Step 3 → branch IND-OVARIAN-ADVANCED-1L-CARBO-PACLI-HRD-OLAP
  • RF-OVARIAN-BRCA-MUT-ACTIONABLE ★ winner: 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. SRC-NCCN-OVARIAN-2025SRC-ESMO-OVARIAN-2024SRC-SOLO1-MOORE-2018SRC-SOLO2-PUJADE-LAURAINE-2017

Pre-treatment investigations

Investigations before treatment start · critical / standard / desired · merged across tracks
IDNamePriorityCategoryNeeded for
TEST-CBCЗагальний аналіз крові з лейкоцитарною формулоюCriticallaball tracks

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
  • 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

CONTRA-AGGRESSIVE

Hard contraindications to escalation
  • —

What NOT to do

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

Aggressive 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 (2, 1 blocking)

  • BLOCKING OQ-HBV-SEROLOGY
    Чи проведена серологія HBV (HBsAg, anti-HBc total)? До початку anti-CD20 терапії статус має бути відомий.
    Anti-CD20 без HBV профілактики при HBsAg+/anti-HBc+ несе значний ризик реактивації (CI-HBV-NO-PROPHYLAXIS).
    → infectious_disease_hepatology
  • 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-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).
Specialistskill_idVersionLast reviewedSign-offsDomain
Specialist з клітинної терапії (CAR-T)cellular_therapy_specialistv0.1.02026-04-250cellular_therapy
Клінічний фармацевтclinical_pharmacistv0.1.02026-04-250clinical_pharmacy
Гематолог / онкогематологhematologistv0.1.02026-04-250hematology_oncology
Гематопатолог (специфічно для лімфом / лейкозів / мієломи)hematopathologistv0.1.02026-04-250hematopathology
Інфекціоніст / гепатологinfectious_disease_hepatologyv0.1.02026-04-250infectious_diseases
Медичний онколог (хіміотерапевт солідних пухлин)medical_oncologistv0.1.02026-04-250solid_oncology
Молекулярний генетик / молекулярний онкологmolecular_geneticistv0.1.02026-04-250molecular_oncology
Паліативна допомогаpalliative_carev0.1.02026-04-250palliative_care
Патолог (загальний)pathologistv0.1.02026-04-250pathology
Сімейний лікар / терапевтprimary_carev0.1.02026-04-250primary_care
Психолог / онкопсихологpsychologistv0.1.02026-04-250psychosocial
Радіотерапевт (променева терапія)radiation_oncologistv0.1.02026-04-250radiation_oncology
Лікар-радіологradiologistv0.1.02026-04-250diagnostic_imaging
Соціальний працівник / кейс-менеджерsocial_worker_case_managerv0.1.02026-04-250psychosocial
Хірург-онкологsurgical_oncologistv0.1.02026-04-250surgical_oncology
Specialist з трансплантації (BMT)transplant_specialistv0.1.02026-04-250cellular_therapy

Sources cited

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).
NCTNamePhaseСтатусСпонсорUAВключення (фрагмент)
NCT06778863A Study of CLSP-1025 in Adult Patients With Solid Tumors That Harbor the p53 R175H MutationPHASE1RECRUITINGClasp Therapeutics, Inc.—
NCT06533332A Phase 1 Trial of ERX-315 in Participants With Advanced Solid TumorsPHASE1RECRUITINGEtiraRx Australia Pty Ltd—
NCT03382158International PPB/DICER1 RegistryN/ARECRUITINGChildren's Hospitals and Clinics of Minnesota—
NCT06445621Early Detection of Relapse in Ovarian Cancer Using Capillary Home-sampling and a Protein Biomarker TestN/ARECRUITINGUppsala University Hospital—
NCT06572735Study on the Relative Dose Intensity of PARP Inhibitors in Real-life on a Population of Patients Over 70 Years With Advanced Ovarian CancerN/ARECRUITINGHospices Civils de Lyon—
NCT0502587813C-Glucose Tracing of Tumour and T Cells in the Ascites of Ovarian Cancer Patients.N/ARECRUITINGBritish Columbia Cancer Agency—
NCT04585750The Evaluation of PC14586 in Patients With Advanced Solid Tumors Harboring a TP53 Y220C Mutation (PYNNACLE)PHASE1 / PHASE2RECRUITINGPMV Pharmaceuticals, Inc—
NCT06215950A Clinical Research About CD70-targeted CAR-T in the Treatment of CD70-positive Advanced/Metastatic Gynecologic CancerPHASE1RECRUITINGChongqing Precision Biotech Co., Ltd—
NCT06962059Healthy Volunteers StudyN/ARECRUITINGAbramson Cancer Center at Penn Medicine—
NCT06469281A 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 CancersPHASE1RECRUITINGRegeneron 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).
ОпціяРеєстрація UAНСЗУCost orientationAccess pathway
Aggressive plan
Carboplatin + Paclitaxel (ovarian 3-weekly) (REG-CARBO-PACLI-OVARIAN)
✓ зареєстровано✓ покривається₴-? — verify pathwayНСЗУ formulary
Aggressive plan
Olaparib maintenance (HRD+ ovarian post-platinum response) (REG-OLAPARIB-MAINT-OVARIAN)
✓ зареєстровано✓ покривається₴-? — verify pathwayНСЗУ 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-OVAR-HRD-001-V1 | version: 1 | generated: 2026-04-27T12:36:01.384542+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.