@erosolaraijs/cure 2.1.0 → 2.2.0

package/dist/bin/cure.js

@@ -19,7 +19,7 @@ import * as path from 'path';
 import * as os from 'os';
 import { CancerTreatmentCapabilityModule } from '../capabilities/cancerTreatmentCapability.js';
 import { createRealWorldOncologyService } from '../orchestrator/realWorldOncology.js';
-const VERSION = '2.1.0';
+const VERSION = '2.2.0';
 const PACKAGE_NAME = '@erosolaraijs/cure';
 const XAI_MODEL = 'grok-4-1-fast-reasoning';
 const UPDATE_CHECK_INTERVAL = 24 * 60 * 60 * 1000; // 24 hours

package/dist/capabilities/cancerTreatmentCapability.d.ts.map

@@ -1 +1 @@
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package/dist/capabilities/cancerTreatmentCapability.js

@@ -688,7 +688,307 @@ export class CancerTreatmentCapabilityModule {
             cancerTypes: ['Any cancer with autoimmune comorbidity'],
             approvedDrugs: ['Checkpoint inhibitors with caution', 'Targeted therapy preferred', 'Close monitoring'],
             mechanismOfAction: 'Risk-benefit assessment for immunotherapy',
-            evidenceLevel: 'FDA-Approved', biomarker: 'Pre-existing autoimmune disease' }
+            evidenceLevel: 'FDA-Approved', biomarker: 'Pre-existing autoimmune disease' },
+        // === LIQUID BIOPSY AND ctDNA MONITORING ===
+        { gene: 'ctDNA', protein: 'Circulating Tumor DNA', pathway: 'Monitoring',
+            cancerTypes: ['All Solid Tumors'],
+            approvedDrugs: ['Guardant360', 'FoundationOne Liquid CDx', 'Signatera'],
+            mechanismOfAction: 'Non-invasive tumor genotyping and monitoring',
+            evidenceLevel: 'FDA-Approved', biomarker: 'ctDNA for treatment selection and MRD' },
+        { gene: 'CTC', protein: 'Circulating Tumor Cells', pathway: 'Monitoring',
+            cancerTypes: ['Breast', 'Prostate', 'Colorectal'],
+            approvedDrugs: ['CellSearch'],
+            mechanismOfAction: 'Enumerate CTCs for prognosis',
+            evidenceLevel: 'FDA-Approved', biomarker: 'CTC count ≥5 (breast/prostate)' },
+        { gene: 'MRD-Heme', protein: 'Minimal Residual Disease (Hematologic)', pathway: 'Monitoring',
+            cancerTypes: ['ALL', 'AML', 'CLL', 'Multiple Myeloma', 'Lymphoma'],
+            approvedDrugs: ['Flow cytometry', 'NGS-MRD', 'clonoSEQ'],
+            mechanismOfAction: 'Detect residual disease at 10^-6 sensitivity',
+            evidenceLevel: 'FDA-Approved', biomarker: 'MRD negativity predicts outcomes' },
+        { gene: 'MRD-Solid', protein: 'Molecular Residual Disease (Solid)', pathway: 'Monitoring',
+            cancerTypes: ['Colorectal', 'Breast', 'NSCLC', 'Bladder'],
+            approvedDrugs: ['Signatera', 'Guardant Reveal'],
+            mechanismOfAction: 'ctDNA-based MRD detection post-surgery',
+            evidenceLevel: 'FDA-Approved', biomarker: 'ctDNA MRD guides adjuvant therapy' },
+        // === FERTILITY PRESERVATION ===
+        { gene: 'Fertility-Female', protein: 'Female Fertility Preservation', pathway: 'Supportive',
+            cancerTypes: ['Any in reproductive-age female'],
+            approvedDrugs: ['Oocyte cryopreservation', 'Embryo cryopreservation', 'Ovarian tissue cryopreservation', 'GnRH agonist ovarian suppression'],
+            mechanismOfAction: 'Preserve reproductive potential before gonadotoxic therapy',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Pre-menopausal, desires future fertility' },
+        { gene: 'Fertility-Male', protein: 'Male Fertility Preservation', pathway: 'Supportive',
+            cancerTypes: ['Any in reproductive-age male'],
+            approvedDrugs: ['Sperm cryopreservation', 'Testicular tissue cryopreservation (pediatric)', 'Testicular sperm extraction'],
+            mechanismOfAction: 'Bank sperm before gonadotoxic therapy',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Post-pubertal male, desires future fertility' },
+        { gene: 'Gonadotoxicity', protein: 'Gonadotoxicity Assessment', pathway: 'Supportive',
+            cancerTypes: ['Any receiving gonadotoxic therapy'],
+            approvedDrugs: ['AMH testing', 'FSH/LH monitoring', 'Semen analysis'],
+            mechanismOfAction: 'Assess fertility status before/after treatment',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Alkylating agents, pelvic radiation' },
+        // === INTEGRATIVE ONCOLOGY ===
+        { gene: 'Integrative', protein: 'Integrative Oncology Approaches', pathway: 'Supportive',
+            cancerTypes: ['Any'],
+            approvedDrugs: ['Acupuncture (CINV, pain)', 'Meditation/mindfulness', 'Yoga', 'Massage therapy', 'Music therapy'],
+            mechanismOfAction: 'Evidence-based complementary approaches',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Patient preference, symptom management' },
+        { gene: 'Cannabis', protein: 'Medical Cannabis', pathway: 'Supportive',
+            cancerTypes: ['Any with symptoms'],
+            approvedDrugs: ['Dronabinol', 'Nabilone', 'CBD/THC products (where legal)'],
+            mechanismOfAction: 'Appetite stimulation, nausea, pain',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Refractory symptoms' },
+        { gene: 'Exercise-Onc', protein: 'Exercise Oncology', pathway: 'Supportive',
+            cancerTypes: ['Any'],
+            approvedDrugs: ['Aerobic exercise prescription', 'Resistance training', 'Prehabilitation', 'Cancer rehabilitation'],
+            mechanismOfAction: 'Improve outcomes, reduce fatigue, enhance QoL',
+            evidenceLevel: 'FDA-Approved', biomarker: 'All patients who can exercise' },
+        // === ADVANCED RADIATION TECHNIQUES ===
+        { gene: 'SBRT', protein: 'Stereotactic Body Radiotherapy', pathway: 'Radiation',
+            cancerTypes: ['NSCLC (early)', 'Liver mets', 'Spine mets', 'Oligometastatic'],
+            approvedDrugs: ['SBRT 3-5 fractions', 'High BED delivery'],
+            mechanismOfAction: 'Ablative doses with steep dose gradients',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Limited metastatic burden, good PS' },
+        { gene: 'SRS', protein: 'Stereotactic Radiosurgery', pathway: 'Radiation',
+            cancerTypes: ['Brain metastases', 'Meningioma', 'Acoustic neuroma'],
+            approvedDrugs: ['Single fraction SRS', 'Fractionated SRS', 'Gamma Knife', 'CyberKnife'],
+            mechanismOfAction: 'Precise high-dose brain radiation',
+            evidenceLevel: 'FDA-Approved', biomarker: '1-10 brain metastases' },
+        { gene: 'Proton', protein: 'Proton Beam Therapy', pathway: 'Radiation',
+            cancerTypes: ['Pediatric tumors', 'Skull base', 'Spine', 'Prostate', 'Ocular melanoma'],
+            approvedDrugs: ['Proton therapy', 'Pencil beam scanning'],
+            mechanismOfAction: 'Bragg peak spares distal tissues',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Pediatric, re-irradiation, critical structure proximity' },
+        { gene: 'Brachytherapy', protein: 'Brachytherapy', pathway: 'Radiation',
+            cancerTypes: ['Prostate', 'Cervical', 'Breast', 'Skin'],
+            approvedDrugs: ['LDR seeds', 'HDR brachytherapy', 'Intracavitary', 'Interstitial'],
+            mechanismOfAction: 'Internal radiation source placement',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Localized disease amenable to implant' },
+        { gene: 'FLASH-RT', protein: 'FLASH Radiotherapy', pathway: 'Radiation',
+            cancerTypes: ['Investigational for all'],
+            approvedDrugs: ['Ultra-high dose rate RT (investigational)'],
+            mechanismOfAction: 'Spares normal tissue at ultra-high dose rates',
+            evidenceLevel: 'Phase I', biomarker: 'Emerging technology' },
+        // === INTERVENTIONAL ONCOLOGY ===
+        { gene: 'RFA', protein: 'Radiofrequency Ablation', pathway: 'Interventional',
+            cancerTypes: ['HCC', 'Colorectal liver mets', 'RCC', 'Lung nodules'],
+            approvedDrugs: ['RFA probe', 'CT/US guidance'],
+            mechanismOfAction: 'Thermal ablation of tumors',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Tumor ≤3cm, not near critical structures' },
+        { gene: 'MWA', protein: 'Microwave Ablation', pathway: 'Interventional',
+            cancerTypes: ['HCC', 'Liver mets', 'Lung', 'Kidney'],
+            approvedDrugs: ['MWA antenna', 'CT guidance'],
+            mechanismOfAction: 'Microwave-induced coagulative necrosis',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Larger tumors than RFA' },
+        { gene: 'Cryoablation', protein: 'Cryoablation', pathway: 'Interventional',
+            cancerTypes: ['RCC', 'Prostate', 'Breast', 'Bone mets'],
+            approvedDrugs: ['Argon-helium cryoprobe'],
+            mechanismOfAction: 'Freeze-thaw cycles cause cell death',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Small renal masses, bone metastases' },
+        { gene: 'TACE', protein: 'Transarterial Chemoembolization', pathway: 'Interventional',
+            cancerTypes: ['HCC', 'Liver metastases', 'NET liver mets'],
+            approvedDrugs: ['Drug-eluting beads', 'Lipiodol + chemo'],
+            mechanismOfAction: 'Intra-arterial chemo + embolization',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Unresectable HCC, Child-Pugh A/B' },
+        { gene: 'Y90', protein: 'Yttrium-90 Radioembolization', pathway: 'Interventional',
+            cancerTypes: ['HCC', 'Colorectal liver mets', 'NET liver mets'],
+            approvedDrugs: ['TheraSphere', 'SIR-Spheres'],
+            mechanismOfAction: 'Intra-arterial radioactive microspheres',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Liver-predominant disease' },
+        { gene: 'IRE', protein: 'Irreversible Electroporation', pathway: 'Interventional',
+            cancerTypes: ['Pancreatic (locally advanced)', 'Liver', 'Prostate'],
+            approvedDrugs: ['NanoKnife'],
+            mechanismOfAction: 'Non-thermal ablation near vessels',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Tumors near critical vessels' },
+        // === END-OF-LIFE AND HOSPICE ===
+        { gene: 'Palliative-Goals', protein: 'Goals of Care Discussions', pathway: 'Palliative',
+            cancerTypes: ['Any advanced cancer'],
+            approvedDrugs: ['Serious illness conversation', 'Advance directives', 'POLST/MOLST'],
+            mechanismOfAction: 'Align treatment with patient values',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Advanced cancer, prognosis <1 year' },
+        { gene: 'Hospice', protein: 'Hospice Care', pathway: 'Palliative',
+            cancerTypes: ['Any with prognosis ≤6 months'],
+            approvedDrugs: ['Symptom management', 'Psychosocial support', 'Spiritual care', 'Bereavement'],
+            mechanismOfAction: 'Comfort-focused care at end of life',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Prognosis ≤6 months, comfort focus' },
+        { gene: 'Palliative-Sedation', protein: 'Palliative Sedation', pathway: 'Palliative',
+            cancerTypes: ['Refractory suffering at end of life'],
+            approvedDrugs: ['Midazolam', 'Propofol', 'Phenobarbital'],
+            mechanismOfAction: 'Reduce consciousness for refractory symptoms',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Refractory symptoms, imminent death' },
+        // === CAREGIVER SUPPORT ===
+        { gene: 'Caregiver', protein: 'Caregiver Support', pathway: 'Supportive',
+            cancerTypes: ['Any'],
+            approvedDrugs: ['Caregiver assessment', 'Respite care', 'Support groups', 'Counseling', 'Financial assistance'],
+            mechanismOfAction: 'Support informal caregivers',
+            evidenceLevel: 'FDA-Approved', biomarker: 'All cancer patients with caregivers' },
+        // === FINANCIAL TOXICITY ===
+        { gene: 'Financial', protein: 'Financial Toxicity Mitigation', pathway: 'Supportive',
+            cancerTypes: ['Any'],
+            approvedDrugs: ['Copay assistance', 'Patient assistance programs', 'Social work', 'Financial navigation', 'Generic alternatives'],
+            mechanismOfAction: 'Reduce financial burden of cancer care',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Any patient with cost concerns' },
+        // === RARE HISTOLOGIC SUBTYPES ===
+        { gene: 'Carcinosarcoma', protein: 'Carcinosarcoma/MMMT', pathway: 'Multiple',
+            cancerTypes: ['Uterine carcinosarcoma', 'Ovarian carcinosarcoma'],
+            approvedDrugs: ['Carboplatin/Paclitaxel', 'Ifosfamide', 'Pembrolizumab'],
+            mechanismOfAction: 'Treat as high-grade carcinoma',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Biphasic tumor' },
+        { gene: 'Adenoid-Cystic', protein: 'Adenoid Cystic Carcinoma', pathway: 'Multiple',
+            cancerTypes: ['Salivary gland', 'Breast', 'Skin', 'Tracheobronchial'],
+            approvedDrugs: ['Surgery + radiation', 'Lenvatinib (investigational)', 'Axitinib'],
+            mechanismOfAction: 'Slow-growing but persistent disease',
+            evidenceLevel: 'Phase II', biomarker: 'MYB-NFIB fusion common' },
+        { gene: 'Clear-Cell-Sarc', protein: 'Clear Cell Sarcoma', pathway: 'Fusion',
+            cancerTypes: ['Soft tissue (tendons)'],
+            approvedDrugs: ['Surgery', 'Chemotherapy (limited efficacy)', 'Clinical trials'],
+            mechanismOfAction: 'EWSR1-ATF1 fusion driven',
+            evidenceLevel: 'Phase II', biomarker: 'EWSR1-ATF1/CREB1 fusion' },
+        { gene: 'Alveolar-Soft', protein: 'Alveolar Soft Part Sarcoma', pathway: 'Fusion',
+            cancerTypes: ['Soft tissue (extremities)'],
+            approvedDrugs: ['Atezolizumab', 'Sunitinib', 'Axitinib'],
+            mechanismOfAction: 'ASPL-TFE3 fusion, responds to anti-angiogenics/IO',
+            evidenceLevel: 'FDA-Approved', biomarker: 'ASPL-TFE3 fusion' },
+        { gene: 'PEComa', protein: 'Perivascular Epithelioid Cell Tumor', pathway: 'mTOR',
+            cancerTypes: ['Soft tissue', 'GI', 'Gynecologic'],
+            approvedDrugs: ['Sirolimus', 'Nab-sirolimus'],
+            mechanismOfAction: 'TSC/mTOR pathway driven',
+            evidenceLevel: 'FDA-Approved', biomarker: 'TSC1/2 alteration' },
+        { gene: 'GNET', protein: 'Gastrointestinal Neuroectodermal Tumor', pathway: 'Fusion',
+            cancerTypes: ['GI tract (rare)'],
+            approvedDrugs: ['Surgery', 'Sarcoma-type chemotherapy'],
+            mechanismOfAction: 'EWSR1-CREB1 fusion',
+            evidenceLevel: 'Phase II', biomarker: 'EWSR1 rearrangement' },
+        { gene: 'Phyllodes', protein: 'Phyllodes Tumor', pathway: 'Breast',
+            cancerTypes: ['Breast (fibroepithelial)'],
+            approvedDrugs: ['Wide excision', 'Mastectomy if needed', 'Radiation (borderline/malignant)'],
+            mechanismOfAction: 'Surgical resection primary',
+            evidenceLevel: 'FDA-Approved', biomarker: 'MED12 mutation common' },
+        { gene: 'Secretory-Breast', protein: 'Secretory Breast Carcinoma', pathway: 'Fusion',
+            cancerTypes: ['Breast (rare, often pediatric)'],
+            approvedDrugs: ['Surgery', 'Larotrectinib/Entrectinib if TRK+'],
+            mechanismOfAction: 'ETV6-NTRK3 fusion in most cases',
+            evidenceLevel: 'FDA-Approved', biomarker: 'ETV6-NTRK3 fusion' },
+        { gene: 'Inflammatory-Breast', protein: 'Inflammatory Breast Cancer', pathway: 'Aggressive',
+            cancerTypes: ['Breast (IBC)'],
+            approvedDrugs: ['Neoadjuvant chemo mandatory', 'Mastectomy', 'Radiation', 'Targeted/IO per subtype'],
+            mechanismOfAction: 'Trimodality therapy required',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Clinical diagnosis (peau d\'orange)' },
+        { gene: 'Small-Cell-Ovarian', protein: 'Small Cell Ovarian (Hypercalcemic)', pathway: 'SMARCA4',
+            cancerTypes: ['Ovary (young women)'],
+            approvedDrugs: ['Intensive chemo', 'EZH2 inhibitors (investigational)', 'Clinical trials'],
+            mechanismOfAction: 'SMARCA4/BRG1 loss',
+            evidenceLevel: 'Phase II', biomarker: 'SMARCA4 mutation' },
+        { gene: 'Signet-Ring', protein: 'Signet Ring Cell Carcinoma', pathway: 'Aggressive',
+            cancerTypes: ['Gastric', 'Colorectal', 'Appendiceal', 'Breast'],
+            approvedDrugs: ['Chemotherapy (often resistant)', 'HIPEC (appendiceal)'],
+            mechanismOfAction: 'Aggressive, chemoresistant histology',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Signet ring morphology' },
+        { gene: 'Plasmablastic', protein: 'Plasmablastic Lymphoma', pathway: 'Aggressive',
+            cancerTypes: ['NHL (HIV-associated, oral)'],
+            approvedDrugs: ['EPOCH', 'CODOX-M/IVAC', 'Bortezomib-based', 'CAR-T (investigational)'],
+            mechanismOfAction: 'Aggressive, often EBV+',
+            evidenceLevel: 'Phase II', biomarker: 'HIV+, EBV+' },
+        { gene: 'Blastic-NK', protein: 'Blastic Plasmacytoid Dendritic Cell Neoplasm', pathway: 'Aggressive',
+            cancerTypes: ['Skin/hematologic'],
+            approvedDrugs: ['Tagraxofusp', 'ALL-type induction', 'Transplant'],
+            mechanismOfAction: 'CD123-targeting therapy',
+            evidenceLevel: 'FDA-Approved', biomarker: 'CD123+ BPDCN' },
+        // === CLINICAL TRIAL MATCHING OPTIMIZATION ===
+        { gene: 'TrialMatch-Biomarker', protein: 'Biomarker-Driven Trial Matching', pathway: 'Clinical Trials',
+            cancerTypes: ['All Solid Tumors', 'All Hematologic'],
+            approvedDrugs: ['NCI-MATCH', 'NCI-MPACT', 'TAPUR', 'My Pathway', 'Molecular Analysis for Therapy Choice'],
+            mechanismOfAction: 'Match patients to trials based on actionable alterations',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Any actionable genomic alteration' },
+        { gene: 'TrialMatch-Immunotherapy', protein: 'Immunotherapy Trial Matching', pathway: 'Clinical Trials',
+            cancerTypes: ['All Solid Tumors'],
+            approvedDrugs: ['I-SPY 2', 'KEYNOTE trials', 'CheckMate trials', 'LEAP trials', 'MORPHEUS trials'],
+            mechanismOfAction: 'Novel immunotherapy combinations and sequences',
+            evidenceLevel: 'Phase III', biomarker: 'PD-L1, TMB-H, MSI-H, TILs' },
+        { gene: 'TrialMatch-ADC', protein: 'ADC Clinical Trial Matching', pathway: 'Clinical Trials',
+            cancerTypes: ['Breast', 'NSCLC', 'Bladder', 'Ovarian', 'Gastric'],
+            approvedDrugs: ['DESTINY trials', 'TROPION trials', 'PADCEV trials', 'Dato-DXd trials'],
+            mechanismOfAction: 'Next-generation antibody-drug conjugates',
+            evidenceLevel: 'Phase II', biomarker: 'HER2-low, TROP2, Nectin-4, FRα' },
+        { gene: 'TrialMatch-Bispecific', protein: 'Bispecific Antibody Trial Matching', pathway: 'Clinical Trials',
+            cancerTypes: ['Multiple Myeloma', 'Lymphoma', 'Solid Tumors'],
+            approvedDrugs: ['GPRC5D trials', 'FcRH5 trials', 'PSMA bispecific trials', 'DLL3 trials'],
+            mechanismOfAction: 'T-cell engaging bispecific antibodies',
+            evidenceLevel: 'Phase II', biomarker: 'Target antigen expression' },
+        { gene: 'TrialMatch-CART', protein: 'CAR-T/Cell Therapy Trial Matching', pathway: 'Clinical Trials',
+            cancerTypes: ['B-ALL', 'DLBCL', 'Multiple Myeloma', 'Solid Tumors'],
+            approvedDrugs: ['Allogeneic CAR-T trials', 'CAR-NK trials', 'TIL expansion trials', 'TCR-T trials'],
+            mechanismOfAction: 'Next-generation cellular therapies',
+            evidenceLevel: 'Phase I', biomarker: 'Relapsed/refractory, target antigen+' },
+        { gene: 'TrialMatch-Targeted', protein: 'Novel Targeted Therapy Trials', pathway: 'Clinical Trials',
+            cancerTypes: ['All Solid Tumors'],
+            approvedDrugs: ['KRAS G12D trials', 'SHP2 inhibitor trials', 'SOS1 inhibitor trials', 'CDK2 trials', 'WRN trials'],
+            mechanismOfAction: 'Emerging targeted therapy combinations',
+            evidenceLevel: 'Phase I', biomarker: 'KRAS G12D, STK11, KEAP1, MSS' },
+        { gene: 'TrialMatch-Degrader', protein: 'Protein Degrader Trial Matching', pathway: 'Clinical Trials',
+            cancerTypes: ['Breast', 'Prostate', 'Hematologic'],
+            approvedDrugs: ['PROTAC trials', 'Molecular glue trials', 'ER degrader trials', 'AR degrader trials'],
+            mechanismOfAction: 'Targeted protein degradation strategies',
+            evidenceLevel: 'Phase I', biomarker: 'ER+, AR+, undruggable targets' },
+        { gene: 'TrialMatch-RadioLigand', protein: 'Radioligand Therapy Trials', pathway: 'Clinical Trials',
+            cancerTypes: ['Prostate', 'NET', 'Gastric', 'Multiple Myeloma'],
+            approvedDrugs: ['FAP-targeted trials', 'PSMA tandem trials', 'Alpha-emitter trials', 'Actinium-225 trials'],
+            mechanismOfAction: 'Next-generation radiopharmaceuticals',
+            evidenceLevel: 'Phase II', biomarker: 'PSMA+, SSTR2+, FAP+' },
+        { gene: 'TrialMatch-Vaccine', protein: 'Cancer Vaccine Trial Matching', pathway: 'Clinical Trials',
+            cancerTypes: ['Melanoma', 'NSCLC', 'Pancreatic', 'Colorectal'],
+            approvedDrugs: ['mRNA neoantigen trials', 'Personalized vaccine trials', 'Viral vector trials', 'DC vaccine trials'],
+            mechanismOfAction: 'Therapeutic cancer vaccines',
+            evidenceLevel: 'Phase II', biomarker: 'Neoantigen burden, immunogenic tumors' },
+        { gene: 'TrialMatch-Epigenetic', protein: 'Epigenetic Therapy Trials', pathway: 'Clinical Trials',
+            cancerTypes: ['AML', 'MDS', 'Lymphoma', 'Solid Tumors'],
+            approvedDrugs: ['Menin inhibitor trials', 'EZH2 inhibitor trials', 'LSD1 inhibitor trials', 'BET inhibitor trials'],
+            mechanismOfAction: 'Epigenetic modulation strategies',
+            evidenceLevel: 'Phase II', biomarker: 'MLL-rearranged, NPM1, IDH' },
+        { gene: 'TrialMatch-Rare', protein: 'Rare Cancer Trial Matching', pathway: 'Clinical Trials',
+            cancerTypes: ['Rare Cancers', 'Ultra-Rare Histologies'],
+            approvedDrugs: ['CREATE trials', 'DART trials', 'NCI-COG Pediatric MATCH', 'RARE-1 trials'],
+            mechanismOfAction: 'Dedicated rare cancer trial networks',
+            evidenceLevel: 'Phase II', biomarker: 'Rare histology, limited treatment options' },
+        { gene: 'TrialMatch-Combo', protein: 'Rational Combination Trials', pathway: 'Clinical Trials',
+            cancerTypes: ['All Solid Tumors'],
+            approvedDrugs: ['IO + targeted trials', 'Dual checkpoint trials', 'Chemo + IO + targeted trials'],
+            mechanismOfAction: 'Synergistic combination development',
+            evidenceLevel: 'Phase II', biomarker: 'Based on mechanism and biomarker' },
+        { gene: 'TrialMatch-Neoadjuvant', protein: 'Neoadjuvant/Adjuvant Trials', pathway: 'Clinical Trials',
+            cancerTypes: ['Breast', 'NSCLC', 'Melanoma', 'RCC', 'Bladder'],
+            approvedDrugs: ['Perioperative IO trials', 'ctDNA-guided trials', 'De-escalation trials'],
+            mechanismOfAction: 'Optimize perioperative therapy',
+            evidenceLevel: 'Phase III', biomarker: 'Resectable, high-risk features' },
+        { gene: 'TrialMatch-ctDNA', protein: 'ctDNA-Guided Therapy Trials', pathway: 'Clinical Trials',
+            cancerTypes: ['Colorectal', 'Breast', 'NSCLC', 'Bladder', 'All Solid'],
+            approvedDrugs: ['CIRCULATE trials', 'DYNAMIC trials', 'ctDNA escalation trials', 'MRD-directed trials'],
+            mechanismOfAction: 'ctDNA-based treatment decisions',
+            evidenceLevel: 'Phase III', biomarker: 'ctDNA MRD status post-surgery' },
+        { gene: 'TrialMatch-Pediatric', protein: 'Pediatric Cancer Trial Matching', pathway: 'Clinical Trials',
+            cancerTypes: ['Pediatric Solid Tumors', 'Pediatric Brain Tumors', 'Pediatric Leukemia'],
+            approvedDrugs: ['COG trials', 'PBTC trials', 'Pediatric MATCH', 'PPTP agent trials'],
+            mechanismOfAction: 'Age-appropriate pediatric trials',
+            evidenceLevel: 'Phase I', biomarker: 'Age ≤21, pediatric-specific alterations' },
+        { gene: 'TrialMatch-AYA', protein: 'AYA-Specific Trial Matching', pathway: 'Clinical Trials',
+            cancerTypes: ['AYA Cancers (15-39 years)'],
+            approvedDrugs: ['AYA-focused protocols', 'Adolescent-friendly trial sites', 'Fertility-preserving trials'],
+            mechanismOfAction: 'Age-appropriate trial design for young adults',
+            evidenceLevel: 'Phase II', biomarker: 'Age 15-39, unique AYA biology' },
+        { gene: 'TrialMatch-Elderly', protein: 'Elderly/Frail Patient Trials', pathway: 'Clinical Trials',
+            cancerTypes: ['All Cancers in Elderly'],
+            approvedDrugs: ['Geriatric oncology trials', 'De-intensification trials', 'Tolerability-focused trials'],
+            mechanismOfAction: 'Appropriate trials for older adults',
+            evidenceLevel: 'Phase II', biomarker: 'Age ≥70, comorbidities, frailty' },
+        { gene: 'TrialMatch-RealWorld', protein: 'Real-World Evidence Integration', pathway: 'Clinical Trials',
+            cancerTypes: ['All Cancers'],
+            approvedDrugs: ['Pragmatic trial designs', 'Registry-embedded trials', 'EHR-integrated trials'],
+            mechanismOfAction: 'Real-world data to expand trial access',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Broader eligibility criteria' },
+        { gene: 'TrialMatch-Access', protein: 'Clinical Trial Access Solutions', pathway: 'Clinical Trials',
+            cancerTypes: ['All Cancers'],
+            approvedDrugs: ['Decentralized trials', 'Travel support programs', 'Community site trials', 'Virtual trial visits'],
+            mechanismOfAction: 'Remove barriers to trial participation',
+            evidenceLevel: 'FDA-Approved', biomarker: 'Geographic/financial barriers' }
     ];
     // ═══════════════════════════════════════════════════════════════════════════════
     // IMMUNOTHERAPY PROTOCOLS