Your Cancer Report — Triangle Unified

Biomarker	Value	What it means
TMB	1.5 mut/Mb — low	WES-derived TMB is immune context here, not a stand-alone pembrolizumab eligibility call. Use assay-calibrated testing and tumor-type review for clinical decisions.
MSI	MSS	215 unstable sites / 25755 tested. MSI is rendered as a biomarker signal, not automatic eligibility.
Tumor purity	32%	Estimation method: purity_ploidy_aware. Purity below ~30% reduces variant detection sensitivity.
MGMT RNA expression context	expression_intermediate (context_only)	Intermediate TPM — RNA-only methylation status not assessable Treatment boundary: Not assessable from RNA expression alone; confirm MGMT promoter methylation with a direct assay before using this for temozolomide decisions. RNA expression is context only. Confirm MGMT promoter methylation with direct tumor-DNA testing before using this for temozolomide decisions.
RNA subtype	Clinical override: Low Grade Glioma (classifier p=0.07)	RNA classifier was low-confidence; clinical diagnosis/config supplies the tumor type used downstream.

Tumor type	TCGA code	Probability
Lung Adenocarcinoma		0.067
Lung Squamous Cell Carcinoma		0.067
Breast Invasive Carcinoma		0.067
Colon Adenocarcinoma		0.067
Rectum Adenocarcinoma		0.067

Cell type	Score
Microglia_CNS	5.58
Macrophages	5.22
Endothelial	5.10
Stem_cells	3.92
Neutrophils	3.25
Fibroblasts_CAF	3.11
Cytotoxic_cells	1.54
Treg	1.42

Gene	Change	Evidence	VAF	ClinVar	EVEE	COSMIC	DepMap CRISPR	Consequence
IDH1 defining	R→C	pathogenic	22.1%	pathogenic	0.99pathogenic	tier-1 hotspot	knockout not lethal 0/76 tumor-matched lines ⚠ CRISPR knockout not the right model for activating hotspots — see COSMIC column.	missense_variant
ATRX primary	G→D	likely driver	52.2%		—	—	pan-essential (all cells) 1/76 tumor-matched lines	missense_variant,splice_region_variant
CDKN2A primary	G→S	likely driver	—	uncertain significance	0.41	—	unknown	missense_variant
TP53 primary	frameshift	likely driver	56.4%		—	—	knockout not lethal 0/76 tumor-matched lines ⚠ TSG with LOF variant — CRISPR redundant with existing loss. Druggability via synthetic-lethal.	frameshift_variant

Gene	Change	Evidence	VAF	ClinVar	EVEE	COSMIC	DepMap CRISPR	Consequence
DLG3	R→STOP	pathogenic	—	pathogenic	0.99pathogenic	—	unknown	stop_gained
FAM20A	R→STOP	pathogenic	—	pathogenic	0.99pathogenic	—	unknown	stop_gained
IRAK4	R→STOP	pathogenic	1.7%	pathogenic	1.00pathogenic	—	weak dependency 1/76 tumor-matched lines	stop_gained
MRPL3	splice_donor_variant	pathogenic	—	pathogenic	0.97pathogenic	—	unknown	splice_donor_variant
NPC1	S→L	pathogenic	—	pathogenic	0.44pathogenic	—	unknown	missense_variant
PHEX	splice_donor_variant	pathogenic	—	pathogenic	1.00pathogenic	—	unknown	splice_donor_variant
PLCG2	D→N	pathogenic	—	pathogenic	0.14pathogenic	—	unknown	missense_variant
PNPLA6	R→Q	pathogenic	—	pathogenic	0.70pathogenic	—	unknown	missense_variant
SLC20A2	Y→STOP	pathogenic	—	pathogenic	1.00pathogenic	—	unknown	stop_gained
VKORC1	R→W	pathogenic	—	pathogenic	0.21pathogenic	—	unknown	missense_variant
ARHGEF10L	R→C	likely driver	—		—	—	unknown	missense_variant
AXIN1	D→E	likely driver	—		—	—	unknown	missense_variant
BCL6	T→M	likely driver	—	not_provided	0.31	—	unknown	missense_variant
CASZ1	V→L	likely driver	—		—	—	unknown	missense_variant
CASZ1	R→H	likely driver	—	uncertain significance	0.19	—	unknown	missense_variant
CUX1	L→M	likely driver	—		—	—	unknown	missense_variant
CYP2C8	P→S	likely driver	—		—	—	unknown	missense_variant
DOT1L	E→STOP	likely driver	—		—	—	unknown	stop_gained
ERBB3	R→L	likely driver	—		—	—	unknown	missense_variant
FAT3	G→V	likely driver	—		—	—	unknown	missense_variant
FMNL1	V→A	likely driver	27.5%		—	—	knockout not lethal 0/74 tumor-matched lines	missense_variant
HEPACAM2	G→R	likely driver	34.9%		—	—	knockout not lethal 0/74 tumor-matched lines	missense_variant
HLA-B	A→T	likely driver	—		—	—	unknown	missense_variant
KDM3B	R→Q	likely driver	—		—	—	unknown	missense_variant
KDR	W→STOP	likely driver	14.5%		—	—	knockout not lethal 0/76 tumor-matched lines	stop_gained
NBEA	R→STOP	likely driver	—		—	—	unknown	stop_gained
NVL	R→L	likely driver	—		—	—	unknown	missense_variant
RNF213	R→W	likely driver	—		0.11benign	—	unknown	missense_variant
SPEN	R→Q	likely driver	—		—	—	unknown	missense_variant
STK11	P→T	likely driver	—		—	—	unknown	missense_variant

Gene	Change	ClinVar / notes
LGR4	D/G	pathogenic
PRSS1	A/V	pathogenic,uncertain_significance,pathogenic/likely_pathogenic
TP53	C/R	uncertain_significance,likely_pathogenic

Fusion	Breakpoints	Type	Confidence	Frame
USP13 ⟶ SLC33A1	3:179683177 / 3:155826710	inversion	medium	.
DIO2 ⟶ CEP128	14:80387678 / 14:80530886	duplication	medium	.
MYT1L ⟶ MYT1L	2:1922292 / 2:1923263	duplication/non-canonical_splicing	low	in-frame
CLMP ⟶ FHIT	11:123194913 / 3:61042099	translocation	low	out-of-frame
MB21D2 ⟶ FGF12	3:192917630 / 3:192360538	deletion	low	in-frame
KDM5D ⟶ KDM5C	Y:19709451 / X:53196054	translocation	low	in-frame
KDM5D ⟶ KDM5C	Y:19720872 / X:53201973	translocation	low	in-frame
WNK2 ⟶ ITPR2	9:93185610 / 12:26495260	translocation	low	in-frame

4. Dysregulated pathways

Plain English: genes don't act alone — they work in pathways. A drug that targets a mutated gene is one angle; a drug that targets a different gene in the same pathway can have similar biological effect. This section shows you both views. The tumor-type-specific section below is curated from the literature of your diagnosis (LGG); the generic enrichment section is computed from your data.

Canonical LGG-specific pathways

Plain English: the biology that defines your tumor type, curated from the literature (not inferred from your data). These are the pathways every oncologist discusses for this diagnosis — whether or not your specific mutations happen to light them up in a generic enrichment score. Genes in red are altered in your tumor; greyed-out genes are the theme's defining members that are NOT altered in you.

IDH / α-ketoglutarate metabolism

Mutant IDH1/2 produces 2-hydroxyglutarate (2-HG) oncometabolite → inhibits α-KG-dependent enzymes (TET2, histone demethylases, HIF prolyl hydroxylases). Druggable: vorasidenib, ivosidenib, enasidenib.

Theme genes: D2HGDHCNV IDH1pathogenic IDH2 L2HGDH SLC25A11

2 of 5 key genes altered in your tumor · 417 drugs catalogued for this theme (417 hit YOUR mutations directly, 0 modulate the theme indirectly).

30 drugs hitting your mutated genes directly

Drug	Phase	Target
OLUTASIDENIB CHEMBL4297610	FDA approved	IDH1 (your mutation) INHIBITOR
IVOSIDENIB CHEMBL3989958	FDA approved	IDH1 (your mutation) INHIBITOR
VORASIDENIB CHEMBL4279047	FDA approved	IDH1 (your mutation) INHIBITOR
CETUXIMAB DGIDB:rxcui:318341	FDA approved	IDH1 (your mutation) INTERACTS
PROTRIPTYLINE HYDROCHLORIDE DGIDB:rxcui:203199	FDA approved	IDH1 (your mutation) INTERACTS
DABRAFENIB DGIDB:rxcui:1424911	FDA approved	IDH1 (your mutation) INTERACTS
VANDETANIB DGIDB:rxcui:1098413	FDA approved	IDH1 (your mutation) INTERACTS
MITOXANTRONE HYDROCHLORIDE DGIDB:rxcui:203129	FDA approved	IDH1 (your mutation) INTERACTS
PIMOZIDE DGIDB:rxcui:8331	FDA approved	IDH1 (your mutation) INTERACTS
LOVASTATIN DGIDB:rxcui:6472	FDA approved	IDH1 (your mutation) INTERACTS
MOMETASONE DGIDB:rxcui:108118	FDA approved	IDH1 (your mutation) INTERACTS
OLUTASIDENIB DGIDB:rxcui:2623641	FDA approved	IDH1 (your mutation) inhibitor
IVOSIDENIB DGIDB:rxcui:2049873	FDA approved	IDH1 (your mutation) inhibitor
DIGOXIN DGIDB:rxcui:3407	FDA approved	IDH1 (your mutation) INTERACTS
ENASIDENIB MESYLATE DGIDB:rxcui:1940331	FDA approved	IDH1 (your mutation) INTERACTS

DNA methylation / G-CIMP / MGMT

IDH-mutant gliomas have G-CIMP (glioma CpG island methylator phenotype). MGMT promoter methylation predicts temozolomide response.

Theme genes: DNMT1 DNMT3A DNMT3B MGMT TET1 TET2 TET3

0 of 7 key genes altered in your tumor · 0 drugs catalogued for this theme (0 hit YOUR mutations directly, 0 modulate the theme indirectly).

Histone methylation / chromatin

Mutant IDH's 2-HG inhibits histone demethylases → globally increased H3K27 / H3K9 methylation. EZH2 inhibitors (tazemetostat) and EZH2-aware strategies are relevant.

Theme genes: EZH1somatic EZH2CNV H3F3A HIST1H3B KDM6A KDM6B KMT2A KMT2C KMT2D SETD2

2 of 10 key genes altered in your tumor · 21 drugs catalogued for this theme (21 hit YOUR mutations directly, 0 modulate the theme indirectly).

21 drugs hitting your mutated genes directly

Drug	Phase	Target
TAZEMETOSTAT CHEMBL3414621	FDA approved	EZH2 (your mutation) INHIBITOR
TAZEMETOSTAT HYDROBROMIDE CHEMBL4594260	FDA approved	EZH2 (your mutation) INHIBITOR
TAZEMETOSTAT DGIDB:rxcui:2274378	FDA approved	EZH2 (your mutation) inhibitor
TAZEMETOSTAT HYDROBROMIDE DGIDB:rxcui:2274379	FDA approved	EZH2 (your mutation) inhibitor
GSK2816126 CHEMBL3287735	Phase 1	EZH2 (your mutation) INHIBITOR
ZEPRUMETOSTAT DGIDB:iuphar.ligand:13512		EZH2 (your mutation) inhibitor
JQEZ5 DGIDB:iuphar.ligand:9332		EZH2 (your mutation) inhibitor
GSK126 DGIDB:iuphar.ligand:7012		EZH2 (your mutation) inhibitor
COMPOUND 15A [PMID: 36642961] DGIDB:iuphar.ligand:12352		EZH2 (your mutation) inhibitor
EPZ005687 DGIDB:iuphar.ligand:8387		EZH2 (your mutation) inhibitor
SKLB-03220 DGIDB:iuphar.ligand:12353		EZH2 (your mutation) inhibitor
VALEMETOSTAT DGIDB:ncit:C127114		EZH2 (your mutation) inhibitor
CPI-1205 DGIDB:drugbank:DB14581		EZH2 (your mutation) INTERACTS
EBI-2511 DGIDB:iuphar.ligand:9881		EZH2 (your mutation) inhibitor
UNC1999 DGIDB:iuphar.ligand:8237		EZH2 (your mutation) inhibitor

ATRX / Alternative Lengthening of Telomeres (ALT)

ATRX loss-of-function drives the ALT phenotype in IDH-mut astrocytoma (vs TERT promoter mutation in oligodendroglioma). Synthetic-lethal opportunities: ATR inhibitors in ATRX-mutant cells.

Theme genes: ATRXdriver DAXX H3F3A TERTCNV

2 of 4 key genes altered in your tumor · 2 drugs catalogued for this theme (2 hit YOUR mutations directly, 0 modulate the theme indirectly).

2 drugs hitting your mutated genes directly

Drug	Phase	Target	Mechanism
IMETELSTAT SODIUM CHEMBL2108702	FDA approved	TERT (your mutation) INHIBITOR	Telomerase reverse transcriptase inhibitor
IMETELSTAT CHEMBL2107856	Phase 3	TERT (your mutation) INHIBITOR	Telomerase reverse transcriptase inhibitor

p53 / cell cycle / CDKN2A

TP53 mutation is the classic second hit in IDH-mut astrocytoma. CDKN2A homozygous deletion drives grade 2 → 3/4 progression. CDK4/6 inhibitors (palbociclib, ribociclib, abemaciclib) are plausible.

Theme genes: CCND1 CDK4 CDK6CNV CDKN2A CDKN2BCNV MDM2 TP53driver

3 of 7 key genes altered in your tumor · 550 drugs catalogued for this theme (482 hit YOUR mutations directly, 68 modulate the theme indirectly).

30 drugs hitting your mutated genes directly

Drug	Phase	Target
RIBOCICLIB CHEMBL3545110	FDA approved	CDK6 (your mutation) INHIBITOR
TRILACICLIB DIHYDROCHLORIDE CHEMBL4650272	FDA approved	CDK6 (your mutation) INHIBITOR
ABEMACICLIB CHEMBL3301610	FDA approved	CDK6 (your mutation) INHIBITOR
RIBOCICLIB SUCCINATE CHEMBL3707266	FDA approved	CDK6 (your mutation) INHIBITOR
TRILACICLIB CHEMBL3894860	FDA approved	CDK6 (your mutation) INHIBITOR
PALBOCICLIB CHEMBL189963	FDA approved	CDK6 (your mutation) INHIBITOR
PALBOCICLIB DGIDB:rxcui:1601374	FDA approved	CDK6 (your mutation) inhibitor
ABEMACICLIB DGIDB:rxcui:1946825	FDA approved	CDK6 (your mutation) inhibitor
TRILACICLIB DIHYDROCHLORIDE DGIDB:rxcui:2479691	FDA approved	CDK6 (your mutation) inhibitor
APREMILAST DGIDB:rxcui:1492727	FDA approved	CDK6 (your mutation) INTERACTS
RIBOCICLIB SUCCINATE DGIDB:rxcui:1873978	FDA approved	CDK6 (your mutation) inhibitor
FULVESTRANT DGIDB:rxcui:282357	FDA approved	CDK6 (your mutation) INTERACTS
TRILACICLIB DGIDB:rxcui:2479690	FDA approved	CDK6 (your mutation) inhibitor
RIBOCICLIB DGIDB:rxcui:1873916	FDA approved	CDK6 (your mutation) inhibitor
FLUOROURACIL DGIDB:rxcui:4492	FDA approved	TP53 (your mutation) INTERACTS

PI3K / AKT / mTOR

PI3K pathway activation is common in progressive glioma. Alpelisib, everolimus, temsirolimus are relevant.

Theme genes: AKT1CNV AKT2CNV AKT3 MTOR PIK3CA PIK3R1RNA outlier PTEN TSC1 TSC2

3 of 9 key genes altered in your tumor · 145 drugs catalogued for this theme (140 hit YOUR mutations directly, 5 modulate the theme indirectly).

30 drugs hitting your mutated genes directly

Drug	Phase	Target
CAPIVASERTIB CHEMBL2325741	FDA approved	AKT1 (your mutation) INHIBITOR
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	AKT1 (your mutation) inhibitor
DESIPRAMINE DGIDB:rxcui:3247	FDA approved	AKT1 (your mutation) INTERACTS
NELFINAVIR DGIDB:rxcui:134527	FDA approved	AKT1 (your mutation) inhibitor
RESVERATROL DGIDB:rxcui:1000492	FDA approved	AKT1 (your mutation) INTERACTS
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	AKT1 (your mutation) INTERACTS
CLOMIPRAMINE DGIDB:rxcui:2597	FDA approved	AKT1 (your mutation) INTERACTS
DOXEPIN HYDROCHLORIDE DGIDB:rxcui:203179	FDA approved	AKT1 (your mutation) INTERACTS
TRIMIPRAMINE DGIDB:rxcui:10834	FDA approved	AKT1 (your mutation) INTERACTS
LOVASTATIN DGIDB:rxcui:6472	FDA approved	AKT1 (your mutation) INTERACTS
TOPOTECAN HYDROCHLORIDE DGIDB:rxcui:266573	FDA approved	AKT1 (your mutation) INTERACTS
NORTRIPTYLINE DGIDB:rxcui:7531	FDA approved	AKT1 (your mutation) INTERACTS
DABRAFENIB DGIDB:rxcui:1424911	FDA approved	AKT1 (your mutation) INTERACTS
FULVESTRANT DGIDB:rxcui:282357	FDA approved	AKT1 (your mutation) INTERACTS
NINTEDANIB ESYLATE DGIDB:rxcui:1592736	FDA approved	AKT1 (your mutation) INTERACTS

RAS / MAPK

Less common in IDH-mutant glioma than IDH-wildtype, but BRAF V600E is targetable (dabrafenib+trametinib). NF1 loss also drives MAPK.

Theme genes: BRAFCNV HRAS KRAS MAP2K1 NF1 NRAS

1 of 6 key genes altered in your tumor · 213 drugs catalogued for this theme (213 hit YOUR mutations directly, 0 modulate the theme indirectly).

30 drugs hitting your mutated genes directly

Drug	Phase	Target
SORAFENIB CHEMBL1336	FDA approved	BRAF (your mutation) INHIBITOR
REGORAFENIB CHEMBL1946170	FDA approved	BRAF (your mutation) INHIBITOR
TOVORAFENIB CHEMBL3348923	FDA approved	BRAF (your mutation) INHIBITOR
DABRAFENIB MESYLATE CHEMBL2105729	FDA approved	BRAF (your mutation) INHIBITOR
DABRAFENIB CHEMBL2028663	FDA approved	BRAF (your mutation) INHIBITOR
ENCORAFENIB CHEMBL3301612	FDA approved	BRAF (your mutation) INHIBITOR
SORAFENIB TOSYLATE CHEMBL1200485	FDA approved	BRAF (your mutation) INHIBITOR
VEMURAFENIB CHEMBL1229517	FDA approved	BRAF (your mutation) INHIBITOR
SORAFENIB DGIDB:rxcui:495881	FDA approved	BRAF (your mutation) inhibitor
BINIMETINIB DGIDB:rxcui:2049122	FDA approved	BRAF (your mutation) INTERACTS
TOVORAFENIB DGIDB:rxcui:2682434	FDA approved	BRAF (your mutation) inhibitor
DABRAFENIB DGIDB:rxcui:1424911	FDA approved	BRAF (your mutation) inhibitor
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	BRAF (your mutation) inhibitor
DASATINIB ANHYDROUS DGIDB:rxcui:1546019	FDA approved	BRAF (your mutation) inhibitor
OXALIPLATIN DGIDB:rxcui:32592	FDA approved	BRAF (your mutation) INTERACTS

Homologous recombination / DNA damage response

HR-deficient tumors (BRCA-mut, ATM-mut) are PARP-inhibitor sensitive. Relevant for synthetic-lethal angle with ATRX loss.

Theme genes: ATM ATR BRCA1 BRCA2 CHEK2 PALB2 RAD51

0 of 7 key genes altered in your tumor · 0 drugs catalogued for this theme (0 hit YOUR mutations directly, 0 modulate the theme indirectly).

Universal oncogenic signaling pathways (pan-cancer)

Plain English: these 10 pathways are recurrently disrupted in almost every cancer type — Sanchez-Vega et al. identified them across all 33 TCGA tumor types (Cell 2018). Even if the tumor-type- specific view above didn't light up a particular biology, any hit in these universal pathways is worth discussing. For tumor types not yet curated in Layer 1, this section IS the canonical biology view.

Cell cycle (RB / CDKN2A)

Cell-cycle dysregulation (CDKN2A/B loss, CDK4/6 amplification, RB1 loss) is common across almost every cancer. Palbociclib, ribociclib, abemaciclib inhibit CDK4/6 in RB-intact tumors.

Theme genes: CCND1 CCND2 CCND3 CCNE1 CDK4 CDK6CNV CDKN1A CDKN1B CDKN2A CDKN2BCNV CDKN2C E2F1 E2F3 RB1

2 of 14 key genes altered in your tumor · 107 drugs catalogued for this theme (27 hit YOUR mutations directly, 80 modulate the theme indirectly).

27 drugs hitting your mutated genes directly

Drug	Phase	Target
RIBOCICLIB CHEMBL3545110	FDA approved	CDK6 (your mutation) INHIBITOR
TRILACICLIB DIHYDROCHLORIDE CHEMBL4650272	FDA approved	CDK6 (your mutation) INHIBITOR
ABEMACICLIB CHEMBL3301610	FDA approved	CDK6 (your mutation) INHIBITOR
RIBOCICLIB SUCCINATE CHEMBL3707266	FDA approved	CDK6 (your mutation) INHIBITOR
TRILACICLIB CHEMBL3894860	FDA approved	CDK6 (your mutation) INHIBITOR
PALBOCICLIB CHEMBL189963	FDA approved	CDK6 (your mutation) INHIBITOR
PALBOCICLIB DGIDB:rxcui:1601374	FDA approved	CDK6 (your mutation) inhibitor
ABEMACICLIB DGIDB:rxcui:1946825	FDA approved	CDK6 (your mutation) inhibitor
TRILACICLIB DIHYDROCHLORIDE DGIDB:rxcui:2479691	FDA approved	CDK6 (your mutation) inhibitor
APREMILAST DGIDB:rxcui:1492727	FDA approved	CDK6 (your mutation) INTERACTS
RIBOCICLIB SUCCINATE DGIDB:rxcui:1873978	FDA approved	CDK6 (your mutation) inhibitor
FULVESTRANT DGIDB:rxcui:282357	FDA approved	CDK6 (your mutation) INTERACTS
TRILACICLIB DGIDB:rxcui:2479690	FDA approved	CDK6 (your mutation) inhibitor
RIBOCICLIB DGIDB:rxcui:1873916	FDA approved	CDK6 (your mutation) inhibitor
ALVOCIDIB CHEMBL428690	Phase 3	CDK6 (your mutation) INHIBITOR

3 drugs modulating this theme via other targets

Drug	Phase	Target
ACETAMINOPHEN DGIDB:rxcui:161	FDA approved	via CCND1 INTERACTS
SELADELPAR DGIDB:rxcui:2690869	FDA approved	via CCND1 agonist
TROGLITAZONE DGIDB:rxcui:72610	FDA approved	via CCND1 agonist

Hippo (YAP / TAZ)

Hippo signaling controls organ size and regeneration. FAT1-4, LATS1/2, and NF2 are the main tumor suppressors; YAP1/WWTR1 are the downstream effectors. Targetable with YAP/TEAD inhibitors (emerging class).

Theme genes: FAT1 FAT2 FAT3 FAT4 LATS1 LATS2 MOB1A MOB1B NF2 SAV1 STK3 STK4 TAOK1 TAOK2 TAOK3CNV WWC1 WWTR1 YAP1

1 of 18 key genes altered in your tumor · 0 drugs catalogued for this theme (0 hit YOUR mutations directly, 0 modulate the theme indirectly).

Notch

Notch is context-dependent — oncogene in T-ALL (activating NOTCH1), tumor suppressor in many solid tumors (inactivating NOTCH1 in SCC). γ-secretase inhibitors and DLL3-targeted therapies (tarlatamab) are relevant.

Theme genes: DLL1 DLL3RNA outlier DLL4 FBXW7 HES1 HES2CNV HES3CNV HES4CNV HES5 HEY1 HEY2 HEYL JAG1 JAG2CNV MAML1 MAML2CNV MAML3 NCOR1 NCOR2CNV NOTCH1CNV NOTCH2 NOTCH3 NOTCH4 SPEN

8 of 24 key genes altered in your tumor · 12 drugs catalogued for this theme (4 hit YOUR mutations directly, 8 modulate the theme indirectly).

4 drugs hitting your mutated genes directly

Drug	Phase	Target
TARLATAMAB CHEMBL5095292	FDA approved	DLL3 (your mutation) BINDING AGENT
ROVALPITUZUMAB TESIRINE CHEMBL3990011	Phase 3	DLL3 (your mutation) BINDING AGENT
CAR T-CELLS AMG 119 DGIDB:ncit:C150586		DLL3 (your mutation) INTERACTS
ROVALPITUZUMAB TESIRINE DGIDB:ncit:C107678		DLL3 (your mutation) binder

8 drugs modulating this theme via other targets

Drug	Phase	Target
NIROGACESTAT DGIDB:rxcui:2670631	FDA approved	via NOTCH2 other/unknown
ODEVIXIBAT DGIDB:rxcui:2563966	FDA approved	via NOTCH2 INTERACTS
TAREXTUMAB CHEMBL3301588	Phase 2	via NOTCH2 INHIBITOR
TAREXTUMAB DGIDB:ncit:C95719		via NOTCH2 inhibitor
NOTCH SIGNALING PATHWAY INHIBITOR MK0752 DGIDB:ncit:C49175		via NOTCH2 other/unknown
MK-0752 DGIDB:drugbank:DB12852		via NOTCH2 INTERACTS
ENOTICUMAB DGIDB:ncit:C82367		via NOTCH2 other/unknown
RO4929097 DGIDB:iuphar.ligand:7338		via NOTCH2 other/unknown

PI3K / AKT / mTOR

PI3K signaling is the most frequently mutated pathway across cancers. Alpelisib (PIK3CA-mutant HR+ breast), capivasertib (AKT), everolimus/temsirolimus (mTOR) are approved.

Theme genes: AKT1CNV AKT2CNV AKT3 INPP4B MTOR PIK3CA PIK3R1RNA outlier PIK3R2 PIK3R3 PPP2R1ACNV PTEN RHEB STK11 TSC1 TSC2

4 of 15 key genes altered in your tumor · 145 drugs catalogued for this theme (140 hit YOUR mutations directly, 5 modulate the theme indirectly).

30 drugs hitting your mutated genes directly

Drug	Phase	Target
CAPIVASERTIB CHEMBL2325741	FDA approved	AKT1 (your mutation) INHIBITOR
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	AKT1 (your mutation) inhibitor
DESIPRAMINE DGIDB:rxcui:3247	FDA approved	AKT1 (your mutation) INTERACTS
NELFINAVIR DGIDB:rxcui:134527	FDA approved	AKT1 (your mutation) inhibitor
RESVERATROL DGIDB:rxcui:1000492	FDA approved	AKT1 (your mutation) INTERACTS
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	AKT1 (your mutation) INTERACTS
CLOMIPRAMINE DGIDB:rxcui:2597	FDA approved	AKT1 (your mutation) INTERACTS
DOXEPIN HYDROCHLORIDE DGIDB:rxcui:203179	FDA approved	AKT1 (your mutation) INTERACTS
TRIMIPRAMINE DGIDB:rxcui:10834	FDA approved	AKT1 (your mutation) INTERACTS
LOVASTATIN DGIDB:rxcui:6472	FDA approved	AKT1 (your mutation) INTERACTS
TOPOTECAN HYDROCHLORIDE DGIDB:rxcui:266573	FDA approved	AKT1 (your mutation) INTERACTS
NORTRIPTYLINE DGIDB:rxcui:7531	FDA approved	AKT1 (your mutation) INTERACTS
DABRAFENIB DGIDB:rxcui:1424911	FDA approved	AKT1 (your mutation) INTERACTS
FULVESTRANT DGIDB:rxcui:282357	FDA approved	AKT1 (your mutation) INTERACTS
NINTEDANIB ESYLATE DGIDB:rxcui:1592736	FDA approved	AKT1 (your mutation) INTERACTS

RTK / RAS / MAPK

The most druggable pathway in oncology. Covers EGFR inhibitors (osimertinib, erlotinib), HER2 (trastuzumab, T-DXd), ALK (alectinib, lorlatinib), KRAS G12C (sotorasib, adagrasib), BRAF V600E (dabrafenib+trametinib), NTRK fusions (larotrectinib, entrectinib), MEK (trametinib, cobimetinib), and many more.

Theme genes: ALK ARAF BRAFCNV EGFR ERBB2 ERBB3 ERBB4 FGFR1 FGFR2 FGFR3CNV FGFR4 FLT3 HRAS IGF1R KIT KRAS MAP2K1 MAP2K2 MAPK1 METCNV NF1 NRAS NTRK1 NTRK2RNA outlier NTRK3 PDGFRA PDGFRB RAF1CNV RASA1 RET RIT1 ROS1 SOS1

5 of 33 key genes altered in your tumor · 599 drugs catalogued for this theme (391 hit YOUR mutations directly, 208 modulate the theme indirectly).

30 drugs hitting your mutated genes directly

Drug	Phase	Target
LESTAURTINIB CHEMBL603469	FDA approved	NTRK2 (your mutation) INHIBITOR
LAROTRECTINIB SULFATE CHEMBL3989939	FDA approved	NTRK2 (your mutation) INHIBITOR
LAROTRECTINIB CHEMBL3889654	FDA approved	NTRK2 (your mutation) INHIBITOR
CENEGERMIN CHEMBL4297852	FDA approved	NTRK2 (your mutation) AGONIST
ENTRECTINIB CHEMBL1983268	FDA approved	NTRK2 (your mutation) INHIBITOR
REPOTRECTINIB CHEMBL4298138	FDA approved	NTRK2 (your mutation) INHIBITOR
CYCLOSPORINE DGIDB:rxcui:3008	FDA approved	NTRK2 (your mutation) INTERACTS
CLOZAPINE DGIDB:rxcui:2626	FDA approved	NTRK2 (your mutation) INTERACTS
CENEGERMIN DGIDB:rxcui:2104332	FDA approved	NTRK2 (your mutation) agonist
ENTRECTINIB DGIDB:rxcui:2197862	FDA approved	NTRK2 (your mutation) inhibitor
SORAFENIB DGIDB:rxcui:495881	FDA approved	NTRK2 (your mutation) INTERACTS
LITHIUM DGIDB:rxcui:6448	FDA approved	NTRK2 (your mutation) INTERACTS
REPOTRECTINIB DGIDB:rxcui:2670644	FDA approved	NTRK2 (your mutation) inhibitor
CRIZOTINIB DGIDB:rxcui:1148495	FDA approved	NTRK2 (your mutation) INTERACTS
DOXORUBICIN HYDROCHLORIDE DGIDB:rxcui:142433	FDA approved	NTRK2 (your mutation) INTERACTS

TGF-β

TGF-β is a context-dependent tumor suppressor/promoter. SMAD4 loss (especially in pancreatic/colon cancer) defines an aggressive subgroup. Targetable with galunisertib-class inhibitors in trials.

Theme genes: ACVR1 ACVR1B ACVR2A SMAD2 SMAD3 SMAD4 TGFBR1 TGFBR2CNV

1 of 8 key genes altered in your tumor · 4 drugs catalogued for this theme (0 hit YOUR mutations directly, 4 modulate the theme indirectly).

4 drugs modulating this theme via other targets

Drug	Phase	Target	Mechanism
EPTOTERMIN ALFA CHEMBL2108594	FDA approved	via ACVR1 AGONIST	Activin receptor type-1 agonist
DIBOTERMIN ALFA CHEMBL2109171	FDA approved	via ACVR1 AGONIST	Activin receptor type-1 agonist
MOMELOTINIB DIHYDROCHLORIDE MONOHYDRATE CHEMBL6068336	FDA approved	via ACVR1 INHIBITOR	Activin receptor type-1 inhibitor
PACRITINIB CITRATE CHEMBL5095049	FDA approved	via ACVR1 INHIBITOR	Activin receptor type-1 inhibitor

p53 / ATM / MDM2

TP53 is mutated in ~50% of all cancers. MDM2-amplified TP53-wildtype tumors are sensitive to MDM2 inhibitors (idasanutlin, AMG-232). ATM-deficient tumors respond to PARP+ATR inhibitors.

Theme genes: ATM CDKN2A CHEK2 MDM2 MDM4 RPS6KA3 TP53driver

1 of 7 key genes altered in your tumor · 458 drugs catalogued for this theme (458 hit YOUR mutations directly, 0 modulate the theme indirectly).

30 drugs hitting your mutated genes directly

Drug	Phase	Target
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	TP53 (your mutation) INTERACTS
PACLITAXEL DGIDB:rxcui:56946	FDA approved	TP53 (your mutation) INTERACTS
ERLOTINIB DGIDB:rxcui:337525	FDA approved	TP53 (your mutation) INTERACTS
HEXACHLOROPHENE DGIDB:rxcui:5293	FDA approved	TP53 (your mutation) INTERACTS
BORTEZOMIB DGIDB:rxcui:358258	FDA approved	TP53 (your mutation) INTERACTS
SERTRALINE HYDROCHLORIDE DGIDB:rxcui:155137	FDA approved	TP53 (your mutation) INTERACTS
THIMEROSAL DGIDB:rxcui:10472	FDA approved	TP53 (your mutation) INTERACTS
ABIRATERONE ACETATE DGIDB:rxcui:1100071	FDA approved	TP53 (your mutation) INTERACTS
ENZALUTAMIDE DGIDB:rxcui:1307298	FDA approved	TP53 (your mutation) INTERACTS
VENETOCLAX DGIDB:rxcui:1747556	FDA approved	TP53 (your mutation) INTERACTS
EPIRUBICIN DGIDB:rxcui:3995	FDA approved	TP53 (your mutation) INTERACTS
SULCONAZOLE NITRATE DGIDB:rxcui:56798	FDA approved	TP53 (your mutation) INTERACTS
AZACITIDINE DGIDB:rxcui:1251	FDA approved	TP53 (your mutation) INTERACTS
CINNARIZINE DGIDB:rxcui:2549	FDA approved	TP53 (your mutation) INTERACTS
PAROXETINE HYDROCHLORIDE, HEMIHYDRATE DGIDB:rxcui:1298842	FDA approved	TP53 (your mutation) INTERACTS

WNT / β-catenin

Early driving event in colorectal (APC), hepatocellular (CTNNB1), endometrial cancers. Porcupine inhibitors (ETC-159, WNT974) and tankyrase inhibitors are in trials.

Theme genes: AMER1 APC AXIN1CNV AXIN2 CTNNB1 DKK1 DKK2 DKK3 DKK4 GSK3B RNF43 TCF7 TCF7L1 TCF7L2CNV ZNRF3

2 of 15 key genes altered in your tumor · 67 drugs catalogued for this theme (0 hit YOUR mutations directly, 67 modulate the theme indirectly).

30 drugs modulating this theme via other targets

Drug	Phase	Target
IMATINIB DGIDB:rxcui:282388	FDA approved	via CTNNB1 INTERACTS
NIROGACESTAT DGIDB:rxcui:2670631	FDA approved	via CTNNB1 INTERACTS
LENALIDOMIDE DGIDB:rxcui:342369	FDA approved	via CTNNB1 INTERACTS
CELECOXIB DGIDB:rxcui:140587	FDA approved	via CTNNB1 INTERACTS
TRAMETINIB DIMETHYL SULFOXIDE DGIDB:rxcui:1425098	FDA approved	via CTNNB1 INTERACTS
TEMSIROLIMUS DGIDB:rxcui:657797	FDA approved	via CTNNB1 INTERACTS
LETROZOLE DGIDB:rxcui:72965	FDA approved	via CTNNB1 INTERACTS
FLUORESCEIN SODIUM DGIDB:rxcui:57789	FDA approved	via CTNNB1 INTERACTS
CETUXIMAB DGIDB:rxcui:318341	FDA approved	via CTNNB1 INTERACTS
DEXAMETHASONE DGIDB:rxcui:3264	FDA approved	via CTNNB1 INTERACTS
CABOZANTINIB S-MALATE DGIDB:rxcui:1363267	FDA approved	via CTNNB1 INTERACTS
THALIDOMIDE DGIDB:rxcui:10432	FDA approved	via CTNNB1 INTERACTS
SORAFENIB DGIDB:rxcui:495881	FDA approved	via CTNNB1 INTERACTS
OSIMERTINIB DGIDB:rxcui:1721560	FDA approved	via CTNNB1 INTERACTS
CYCLOPHOSPHAMIDE ANHYDROUS DGIDB:rxcui:1545988	FDA approved	via CTNNB1 INTERACTS

Myc (MYC / MAX)

Myc amplification is one of the most common oncogenic events. Historically undruggable, but BET inhibitors (JQ1, OTX015) and Myc-Max dimerization inhibitors are in development.

Theme genes: MAX MGA MNT MXD1 MXI1RNA outlier MYC MYCL MYCN

1 of 8 key genes altered in your tumor · 0 drugs catalogued for this theme (0 hit YOUR mutations directly, 0 modulate the theme indirectly).

Oxidative stress (NRF2 / KEAP1)

NRF2 pathway activation (via KEAP1 loss-of-function or NFE2L2 activating mutation) confers chemo and radio resistance, particularly in lung squamous cell carcinoma. Emerging NRF2-targeted therapies.

Theme genes: CUL3 KEAP1 NFE2L2

0 of 3 key genes altered in your tumor · 0 drugs catalogued for this theme (0 hit YOUR mutations directly, 0 modulate the theme indirectly).

Statistically most-disrupted pathways (generic enrichment)

Plain English: ranked by how many of your cancer-relevant altered genes land in each pathway, weighted by evidence tier (pathogenic driver > likely_driver > CNV ≈ RNA outlier > somatic). Expand any row to see which drugs modulate that pathway.

Score

Pathway

Gene overlap

Patient genes in pathway

Drugs

51.0

Pathways in cancer
kegg · kegg:hsa05200

24 / 52
1 drivers

AKT1 AKT2 AXIN1 BRAF CDK6 CDKN2B +18

1324
912 direct · 363 approved

Show top 15 drugs modulating this pathway

Drug	Phase	Target	Mechanism
COPANLISIB DGIDB:rxcui:1945077	FDA approved	PIK3R1 (your mutation) inhibitor
LENIOLISIB DGIDB:rxcui:2633005	FDA approved	PIK3R1 (your mutation) INTERACTS
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	PIK3R1 (your mutation) INTERACTS
INFIGRATINIB DGIDB:rxcui:2550729	FDA approved	PIK3R1 (your mutation) inhibitor
QUERCETIN DGIDB:rxcui:9060	FDA approved	PIK3R1 (your mutation) inhibitor
ALPELISIB DGIDB:rxcui:2169285	FDA approved	PIK3R1 (your mutation) inhibitor
PACLITAXEL DGIDB:rxcui:56946	FDA approved	TP53 (your mutation) INTERACTS
IMETELSTAT SODIUM CHEMBL2108702	FDA approved	TERT (your mutation) INHIBITOR	Telomerase reverse transcriptase inhibitor
CAPIVASERTIB CHEMBL2325741	FDA approved	AKT1 (your mutation) INHIBITOR
DESIPRAMINE DGIDB:rxcui:3247	FDA approved	AKT1 (your mutation) INTERACTS
NELFINAVIR DGIDB:rxcui:134527	FDA approved	AKT1 (your mutation) inhibitor
RESVERATROL DGIDB:rxcui:1000492	FDA approved	AKT1 (your mutation) INTERACTS
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	AKT1 (your mutation) INTERACTS
CLOMIPRAMINE DGIDB:rxcui:2597	FDA approved	AKT1 (your mutation) INTERACTS
DOXEPIN HYDROCHLORIDE DGIDB:rxcui:203179	FDA approved	AKT1 (your mutation) INTERACTS

34.0

PI3K-Akt signaling pathway
kegg · kegg:hsa04151

14 / 35
2 drivers

AKT1 AKT2 CDK6 FGFR3 FLT4 KDR +8

1334
936 direct · 379 approved

Show top 15 drugs modulating this pathway

Drug	Phase	Target
COPANLISIB DGIDB:rxcui:1945077	FDA approved	PIK3R1 (your mutation) inhibitor
LENIOLISIB DGIDB:rxcui:2633005	FDA approved	PIK3R1 (your mutation) INTERACTS
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	PIK3R1 (your mutation) INTERACTS
INFIGRATINIB DGIDB:rxcui:2550729	FDA approved	PIK3R1 (your mutation) inhibitor
QUERCETIN DGIDB:rxcui:9060	FDA approved	PIK3R1 (your mutation) inhibitor
ALPELISIB DGIDB:rxcui:2169285	FDA approved	PIK3R1 (your mutation) inhibitor
LESTAURTINIB CHEMBL603469	FDA approved	NTRK2 (your mutation) INHIBITOR
LAROTRECTINIB SULFATE CHEMBL3989939	FDA approved	NTRK2 (your mutation) INHIBITOR
LAROTRECTINIB CHEMBL3889654	FDA approved	NTRK2 (your mutation) INHIBITOR
CENEGERMIN CHEMBL4297852	FDA approved	NTRK2 (your mutation) AGONIST
ENTRECTINIB CHEMBL1983268	FDA approved	NTRK2 (your mutation) INHIBITOR
REPOTRECTINIB CHEMBL4298138	FDA approved	NTRK2 (your mutation) INHIBITOR
CYCLOSPORINE DGIDB:rxcui:3008	FDA approved	NTRK2 (your mutation) INTERACTS
CLOZAPINE DGIDB:rxcui:2626	FDA approved	NTRK2 (your mutation) INTERACTS
CENEGERMIN DGIDB:rxcui:2104332	FDA approved	NTRK2 (your mutation) agonist

30.0

MAPK signaling pathway
kegg · kegg:hsa04010

12 / 25
2 drivers

AKT1 AKT2 BRAF FGFR3 FLT4 KDR +6

1212
986 direct · 333 approved

Show top 15 drugs modulating this pathway

Drug	Phase	Target
GEFITINIB DGIDB:rxcui:328134	FDA approved	BRAF (your mutation) INTERACTS
DASATINIB ANHYDROUS DGIDB:rxcui:1546019	FDA approved	BRAF (your mutation) INTERACTS
LESTAURTINIB CHEMBL603469	FDA approved	NTRK2 (your mutation) INHIBITOR
LAROTRECTINIB SULFATE CHEMBL3989939	FDA approved	NTRK2 (your mutation) INHIBITOR
LAROTRECTINIB CHEMBL3889654	FDA approved	NTRK2 (your mutation) INHIBITOR
CENEGERMIN CHEMBL4297852	FDA approved	NTRK2 (your mutation) AGONIST
ENTRECTINIB CHEMBL1983268	FDA approved	NTRK2 (your mutation) INHIBITOR
REPOTRECTINIB CHEMBL4298138	FDA approved	NTRK2 (your mutation) INHIBITOR
CYCLOSPORINE DGIDB:rxcui:3008	FDA approved	NTRK2 (your mutation) INTERACTS
CLOZAPINE DGIDB:rxcui:2626	FDA approved	NTRK2 (your mutation) INTERACTS
CENEGERMIN DGIDB:rxcui:2104332	FDA approved	NTRK2 (your mutation) agonist
ENTRECTINIB DGIDB:rxcui:2197862	FDA approved	NTRK2 (your mutation) inhibitor
SORAFENIB DGIDB:rxcui:495881	FDA approved	NTRK2 (your mutation) INTERACTS
LITHIUM DGIDB:rxcui:6448	FDA approved	NTRK2 (your mutation) INTERACTS
REPOTRECTINIB DGIDB:rxcui:2670644	FDA approved	NTRK2 (your mutation) inhibitor

29.0

Rap1 signaling pathway
kegg · kegg:hsa04015

13 / 29
1 drivers

AKT1 AKT2 BRAF FGFR3 FLT4 GNAI2 +7

872
611 direct · 231 approved

Show top 15 drugs modulating this pathway

Drug	Phase	Target
COPANLISIB DGIDB:rxcui:1945077	FDA approved	PIK3R1 (your mutation) inhibitor
LENIOLISIB DGIDB:rxcui:2633005	FDA approved	PIK3R1 (your mutation) INTERACTS
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	PIK3R1 (your mutation) INTERACTS
INFIGRATINIB DGIDB:rxcui:2550729	FDA approved	PIK3R1 (your mutation) inhibitor
QUERCETIN DGIDB:rxcui:9060	FDA approved	PIK3R1 (your mutation) inhibitor
ALPELISIB DGIDB:rxcui:2169285	FDA approved	PIK3R1 (your mutation) inhibitor
CAPIVASERTIB CHEMBL2325741	FDA approved	AKT1 (your mutation) INHIBITOR
DESIPRAMINE DGIDB:rxcui:3247	FDA approved	AKT1 (your mutation) INTERACTS
NELFINAVIR DGIDB:rxcui:134527	FDA approved	AKT1 (your mutation) inhibitor
RESVERATROL DGIDB:rxcui:1000492	FDA approved	AKT1 (your mutation) INTERACTS
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	AKT1 (your mutation) INTERACTS
CLOMIPRAMINE DGIDB:rxcui:2597	FDA approved	AKT1 (your mutation) INTERACTS
DOXEPIN HYDROCHLORIDE DGIDB:rxcui:203179	FDA approved	AKT1 (your mutation) INTERACTS
TRIMIPRAMINE DGIDB:rxcui:10834	FDA approved	AKT1 (your mutation) INTERACTS
LOVASTATIN DGIDB:rxcui:6472	FDA approved	AKT1 (your mutation) INTERACTS

28.0

Proteoglycans in cancer
kegg · kegg:hsa05205

11 / 29
2 drivers

AKT1 AKT2 BRAF KDR MET PIK3R1 +5

1376
1018 direct · 349 approved

Show top 15 drugs modulating this pathway

Drug	Phase	Target
COPANLISIB DGIDB:rxcui:1945077	FDA approved	PIK3R1 (your mutation) inhibitor
LENIOLISIB DGIDB:rxcui:2633005	FDA approved	PIK3R1 (your mutation) INTERACTS
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	PIK3R1 (your mutation) INTERACTS
INFIGRATINIB DGIDB:rxcui:2550729	FDA approved	PIK3R1 (your mutation) inhibitor
QUERCETIN DGIDB:rxcui:9060	FDA approved	PIK3R1 (your mutation) inhibitor
ALPELISIB DGIDB:rxcui:2169285	FDA approved	PIK3R1 (your mutation) inhibitor
CAPIVASERTIB CHEMBL2325741	FDA approved	AKT1 (your mutation) INHIBITOR
DESIPRAMINE DGIDB:rxcui:3247	FDA approved	AKT1 (your mutation) INTERACTS
NELFINAVIR DGIDB:rxcui:134527	FDA approved	AKT1 (your mutation) inhibitor
RESVERATROL DGIDB:rxcui:1000492	FDA approved	AKT1 (your mutation) INTERACTS
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	AKT1 (your mutation) INTERACTS
CLOMIPRAMINE DGIDB:rxcui:2597	FDA approved	AKT1 (your mutation) INTERACTS
DOXEPIN HYDROCHLORIDE DGIDB:rxcui:203179	FDA approved	AKT1 (your mutation) INTERACTS
TRIMIPRAMINE DGIDB:rxcui:10834	FDA approved	AKT1 (your mutation) INTERACTS
LOVASTATIN DGIDB:rxcui:6472	FDA approved	AKT1 (your mutation) INTERACTS

27.0

Central carbon metabolism in cancer
kegg · kegg:hsa05230

8 / 14
2 drivers

AKT1 AKT2 FGFR3 IDH1 MET PIK3R1 +2

1301
1077 direct · 326 approved

Show top 15 drugs modulating this pathway

Drug	Phase	Target
CAPIVASERTIB CHEMBL2325741	FDA approved	AKT1 (your mutation) INHIBITOR
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	AKT1 (your mutation) inhibitor
DESIPRAMINE DGIDB:rxcui:3247	FDA approved	AKT1 (your mutation) INTERACTS
NELFINAVIR DGIDB:rxcui:134527	FDA approved	AKT1 (your mutation) inhibitor
RESVERATROL DGIDB:rxcui:1000492	FDA approved	AKT1 (your mutation) INTERACTS
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	AKT1 (your mutation) INTERACTS
CLOMIPRAMINE DGIDB:rxcui:2597	FDA approved	AKT1 (your mutation) INTERACTS
DOXEPIN HYDROCHLORIDE DGIDB:rxcui:203179	FDA approved	AKT1 (your mutation) INTERACTS
TRIMIPRAMINE DGIDB:rxcui:10834	FDA approved	AKT1 (your mutation) INTERACTS
LOVASTATIN DGIDB:rxcui:6472	FDA approved	AKT1 (your mutation) INTERACTS
TOPOTECAN HYDROCHLORIDE DGIDB:rxcui:266573	FDA approved	AKT1 (your mutation) INTERACTS
NORTRIPTYLINE DGIDB:rxcui:7531	FDA approved	AKT1 (your mutation) INTERACTS
DABRAFENIB DGIDB:rxcui:1424911	FDA approved	AKT1 (your mutation) INTERACTS
FULVESTRANT DGIDB:rxcui:282357	FDA approved	AKT1 (your mutation) INTERACTS
NINTEDANIB ESYLATE DGIDB:rxcui:1592736	FDA approved	AKT1 (your mutation) INTERACTS

27.0

Gastric cancer
kegg · kegg:hsa05226

12 / 20
1 drivers

AKT1 AKT2 AXIN1 BRAF CDKN2B MET +6

1190
853 direct · 305 approved

Show top 15 drugs modulating this pathway

Drug	Phase	Target	Mechanism
COPANLISIB DGIDB:rxcui:1945077	FDA approved	PIK3R1 (your mutation) inhibitor
LENIOLISIB DGIDB:rxcui:2633005	FDA approved	PIK3R1 (your mutation) INTERACTS
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	PIK3R1 (your mutation) INTERACTS
INFIGRATINIB DGIDB:rxcui:2550729	FDA approved	PIK3R1 (your mutation) inhibitor
QUERCETIN DGIDB:rxcui:9060	FDA approved	PIK3R1 (your mutation) inhibitor
ALPELISIB DGIDB:rxcui:2169285	FDA approved	PIK3R1 (your mutation) inhibitor
IMETELSTAT SODIUM CHEMBL2108702	FDA approved	TERT (your mutation) INHIBITOR	Telomerase reverse transcriptase inhibitor
CAPIVASERTIB CHEMBL2325741	FDA approved	AKT1 (your mutation) INHIBITOR
DESIPRAMINE DGIDB:rxcui:3247	FDA approved	AKT1 (your mutation) INTERACTS
NELFINAVIR DGIDB:rxcui:134527	FDA approved	AKT1 (your mutation) inhibitor
RESVERATROL DGIDB:rxcui:1000492	FDA approved	AKT1 (your mutation) INTERACTS
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	AKT1 (your mutation) INTERACTS
CLOMIPRAMINE DGIDB:rxcui:2597	FDA approved	AKT1 (your mutation) INTERACTS
DOXEPIN HYDROCHLORIDE DGIDB:rxcui:203179	FDA approved	AKT1 (your mutation) INTERACTS
TRIMIPRAMINE DGIDB:rxcui:10834	FDA approved	AKT1 (your mutation) INTERACTS

27.0

Hepatocellular carcinoma
kegg · kegg:hsa05225

12 / 25
1 drivers

AKT1 AKT2 AXIN1 BRAF CDK6 MET +6

1226
876 direct · 320 approved

Show top 15 drugs modulating this pathway

Drug	Phase	Target	Mechanism
COPANLISIB DGIDB:rxcui:1945077	FDA approved	PIK3R1 (your mutation) inhibitor
LENIOLISIB DGIDB:rxcui:2633005	FDA approved	PIK3R1 (your mutation) INTERACTS
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	PIK3R1 (your mutation) INTERACTS
INFIGRATINIB DGIDB:rxcui:2550729	FDA approved	PIK3R1 (your mutation) inhibitor
QUERCETIN DGIDB:rxcui:9060	FDA approved	PIK3R1 (your mutation) inhibitor
ALPELISIB DGIDB:rxcui:2169285	FDA approved	PIK3R1 (your mutation) inhibitor
IMETELSTAT SODIUM CHEMBL2108702	FDA approved	TERT (your mutation) INHIBITOR	Telomerase reverse transcriptase inhibitor
CAPIVASERTIB CHEMBL2325741	FDA approved	AKT1 (your mutation) INHIBITOR
DESIPRAMINE DGIDB:rxcui:3247	FDA approved	AKT1 (your mutation) INTERACTS
NELFINAVIR DGIDB:rxcui:134527	FDA approved	AKT1 (your mutation) inhibitor
RESVERATROL DGIDB:rxcui:1000492	FDA approved	AKT1 (your mutation) INTERACTS
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	AKT1 (your mutation) INTERACTS
CLOMIPRAMINE DGIDB:rxcui:2597	FDA approved	AKT1 (your mutation) INTERACTS
DOXEPIN HYDROCHLORIDE DGIDB:rxcui:203179	FDA approved	AKT1 (your mutation) INTERACTS
TRIMIPRAMINE DGIDB:rxcui:10834	FDA approved	AKT1 (your mutation) INTERACTS

27.0

Human papillomavirus infection
kegg · kegg:hsa05165

12 / 34
1 drivers

AKT1 AKT2 AXIN1 CDK6 GNAS NOTCH1 +6

1103
634 direct · 306 approved

Show top 15 drugs modulating this pathway

Drug	Phase	Target	Mechanism
COPANLISIB DGIDB:rxcui:1945077	FDA approved	PIK3R1 (your mutation) inhibitor
LENIOLISIB DGIDB:rxcui:2633005	FDA approved	PIK3R1 (your mutation) INTERACTS
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	PIK3R1 (your mutation) INTERACTS
INFIGRATINIB DGIDB:rxcui:2550729	FDA approved	PIK3R1 (your mutation) inhibitor
QUERCETIN DGIDB:rxcui:9060	FDA approved	PIK3R1 (your mutation) inhibitor
ALPELISIB DGIDB:rxcui:2169285	FDA approved	PIK3R1 (your mutation) inhibitor
IMETELSTAT SODIUM CHEMBL2108702	FDA approved	TERT (your mutation) INHIBITOR	Telomerase reverse transcriptase inhibitor
CAPIVASERTIB CHEMBL2325741	FDA approved	AKT1 (your mutation) INHIBITOR
DESIPRAMINE DGIDB:rxcui:3247	FDA approved	AKT1 (your mutation) INTERACTS
NELFINAVIR DGIDB:rxcui:134527	FDA approved	AKT1 (your mutation) inhibitor
RESVERATROL DGIDB:rxcui:1000492	FDA approved	AKT1 (your mutation) INTERACTS
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	AKT1 (your mutation) INTERACTS
CLOMIPRAMINE DGIDB:rxcui:2597	FDA approved	AKT1 (your mutation) INTERACTS
DOXEPIN HYDROCHLORIDE DGIDB:rxcui:203179	FDA approved	AKT1 (your mutation) INTERACTS
TRIMIPRAMINE DGIDB:rxcui:10834	FDA approved	AKT1 (your mutation) INTERACTS

26.0

Human cytomegalovirus infection
kegg · kegg:hsa05163

12 / 30
1 drivers

AKAP13 AKT1 AKT2 B2M CDK6 GNAI2 +6

1028
632 direct · 287 approved

Show top 15 drugs modulating this pathway

Drug	Phase	Target
COPANLISIB DGIDB:rxcui:1945077	FDA approved	PIK3R1 (your mutation) inhibitor
LENIOLISIB DGIDB:rxcui:2633005	FDA approved	PIK3R1 (your mutation) INTERACTS
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	PIK3R1 (your mutation) INTERACTS
INFIGRATINIB DGIDB:rxcui:2550729	FDA approved	PIK3R1 (your mutation) inhibitor
QUERCETIN DGIDB:rxcui:9060	FDA approved	PIK3R1 (your mutation) inhibitor
ALPELISIB DGIDB:rxcui:2169285	FDA approved	PIK3R1 (your mutation) inhibitor
CAPIVASERTIB CHEMBL2325741	FDA approved	AKT1 (your mutation) INHIBITOR
DESIPRAMINE DGIDB:rxcui:3247	FDA approved	AKT1 (your mutation) INTERACTS
NELFINAVIR DGIDB:rxcui:134527	FDA approved	AKT1 (your mutation) inhibitor
RESVERATROL DGIDB:rxcui:1000492	FDA approved	AKT1 (your mutation) INTERACTS
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	AKT1 (your mutation) INTERACTS
CLOMIPRAMINE DGIDB:rxcui:2597	FDA approved	AKT1 (your mutation) INTERACTS
DOXEPIN HYDROCHLORIDE DGIDB:rxcui:203179	FDA approved	AKT1 (your mutation) INTERACTS
TRIMIPRAMINE DGIDB:rxcui:10834	FDA approved	AKT1 (your mutation) INTERACTS
LOVASTATIN DGIDB:rxcui:6472	FDA approved	AKT1 (your mutation) INTERACTS

25.0

Colorectal cancer
kegg · kegg:hsa05210

11 / 19
1 drivers

AKT1 AKT2 AXIN1 BRAF PIK3R1 RAC1 +5

1092
742 direct · 293 approved

Show top 15 drugs modulating this pathway

Drug	Phase	Target
COPANLISIB DGIDB:rxcui:1945077	FDA approved	PIK3R1 (your mutation) inhibitor
LENIOLISIB DGIDB:rxcui:2633005	FDA approved	PIK3R1 (your mutation) INTERACTS
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	PIK3R1 (your mutation) INTERACTS
INFIGRATINIB DGIDB:rxcui:2550729	FDA approved	PIK3R1 (your mutation) inhibitor
QUERCETIN DGIDB:rxcui:9060	FDA approved	PIK3R1 (your mutation) inhibitor
ALPELISIB DGIDB:rxcui:2169285	FDA approved	PIK3R1 (your mutation) inhibitor
CAPIVASERTIB CHEMBL2325741	FDA approved	AKT1 (your mutation) INHIBITOR
DESIPRAMINE DGIDB:rxcui:3247	FDA approved	AKT1 (your mutation) INTERACTS
NELFINAVIR DGIDB:rxcui:134527	FDA approved	AKT1 (your mutation) inhibitor
RESVERATROL DGIDB:rxcui:1000492	FDA approved	AKT1 (your mutation) INTERACTS
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	AKT1 (your mutation) INTERACTS
CLOMIPRAMINE DGIDB:rxcui:2597	FDA approved	AKT1 (your mutation) INTERACTS
DOXEPIN HYDROCHLORIDE DGIDB:rxcui:203179	FDA approved	AKT1 (your mutation) INTERACTS
TRIMIPRAMINE DGIDB:rxcui:10834	FDA approved	AKT1 (your mutation) INTERACTS
LOVASTATIN DGIDB:rxcui:6472	FDA approved	AKT1 (your mutation) INTERACTS

25.0

Breast cancer
kegg · kegg:hsa05224

11 / 21
1 drivers

AKT1 AKT2 AXIN1 BRAF CDK6 FLT4 +5

1126
768 direct · 306 approved

Show top 15 drugs modulating this pathway

Drug	Phase	Target
COPANLISIB DGIDB:rxcui:1945077	FDA approved	PIK3R1 (your mutation) inhibitor
LENIOLISIB DGIDB:rxcui:2633005	FDA approved	PIK3R1 (your mutation) INTERACTS
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	PIK3R1 (your mutation) INTERACTS
INFIGRATINIB DGIDB:rxcui:2550729	FDA approved	PIK3R1 (your mutation) inhibitor
QUERCETIN DGIDB:rxcui:9060	FDA approved	PIK3R1 (your mutation) inhibitor
ALPELISIB DGIDB:rxcui:2169285	FDA approved	PIK3R1 (your mutation) inhibitor
CAPIVASERTIB CHEMBL2325741	FDA approved	AKT1 (your mutation) INHIBITOR
DESIPRAMINE DGIDB:rxcui:3247	FDA approved	AKT1 (your mutation) INTERACTS
NELFINAVIR DGIDB:rxcui:134527	FDA approved	AKT1 (your mutation) inhibitor
RESVERATROL DGIDB:rxcui:1000492	FDA approved	AKT1 (your mutation) INTERACTS
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	AKT1 (your mutation) INTERACTS
CLOMIPRAMINE DGIDB:rxcui:2597	FDA approved	AKT1 (your mutation) INTERACTS
DOXEPIN HYDROCHLORIDE DGIDB:rxcui:203179	FDA approved	AKT1 (your mutation) INTERACTS
TRIMIPRAMINE DGIDB:rxcui:10834	FDA approved	AKT1 (your mutation) INTERACTS
LOVASTATIN DGIDB:rxcui:6472	FDA approved	AKT1 (your mutation) INTERACTS

25.0

Ras signaling pathway
kegg · kegg:hsa04014

11 / 23
1 drivers

AKT1 AKT2 FGFR3 FLT4 KDR MET +5

730
490 direct · 212 approved

Show top 15 drugs modulating this pathway

Drug	Phase	Target
COPANLISIB DGIDB:rxcui:1945077	FDA approved	PIK3R1 (your mutation) inhibitor
LENIOLISIB DGIDB:rxcui:2633005	FDA approved	PIK3R1 (your mutation) INTERACTS
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	PIK3R1 (your mutation) INTERACTS
INFIGRATINIB DGIDB:rxcui:2550729	FDA approved	PIK3R1 (your mutation) inhibitor
QUERCETIN DGIDB:rxcui:9060	FDA approved	PIK3R1 (your mutation) inhibitor
ALPELISIB DGIDB:rxcui:2169285	FDA approved	PIK3R1 (your mutation) inhibitor
LESTAURTINIB CHEMBL603469	FDA approved	NTRK2 (your mutation) INHIBITOR
LAROTRECTINIB SULFATE CHEMBL3989939	FDA approved	NTRK2 (your mutation) INHIBITOR
LAROTRECTINIB CHEMBL3889654	FDA approved	NTRK2 (your mutation) INHIBITOR
CENEGERMIN CHEMBL4297852	FDA approved	NTRK2 (your mutation) AGONIST
ENTRECTINIB CHEMBL1983268	FDA approved	NTRK2 (your mutation) INHIBITOR
REPOTRECTINIB CHEMBL4298138	FDA approved	NTRK2 (your mutation) INHIBITOR
CYCLOSPORINE DGIDB:rxcui:3008	FDA approved	NTRK2 (your mutation) INTERACTS
CLOZAPINE DGIDB:rxcui:2626	FDA approved	NTRK2 (your mutation) INTERACTS
CENEGERMIN DGIDB:rxcui:2104332	FDA approved	NTRK2 (your mutation) agonist

25.0

Focal adhesion
kegg · kegg:hsa04510

11 / 26
1 drivers

AKT1 AKT2 ARHGAP5 BRAF FLT4 KDR +5

966
605 direct · 245 approved

Show top 15 drugs modulating this pathway

Drug	Phase	Target
COPANLISIB DGIDB:rxcui:1945077	FDA approved	PIK3R1 (your mutation) inhibitor
LENIOLISIB DGIDB:rxcui:2633005	FDA approved	PIK3R1 (your mutation) INTERACTS
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	PIK3R1 (your mutation) INTERACTS
INFIGRATINIB DGIDB:rxcui:2550729	FDA approved	PIK3R1 (your mutation) inhibitor
QUERCETIN DGIDB:rxcui:9060	FDA approved	PIK3R1 (your mutation) inhibitor
ALPELISIB DGIDB:rxcui:2169285	FDA approved	PIK3R1 (your mutation) inhibitor
CAPIVASERTIB CHEMBL2325741	FDA approved	AKT1 (your mutation) INHIBITOR
DESIPRAMINE DGIDB:rxcui:3247	FDA approved	AKT1 (your mutation) INTERACTS
NELFINAVIR DGIDB:rxcui:134527	FDA approved	AKT1 (your mutation) inhibitor
RESVERATROL DGIDB:rxcui:1000492	FDA approved	AKT1 (your mutation) INTERACTS
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	AKT1 (your mutation) INTERACTS
CLOMIPRAMINE DGIDB:rxcui:2597	FDA approved	AKT1 (your mutation) INTERACTS
DOXEPIN HYDROCHLORIDE DGIDB:rxcui:203179	FDA approved	AKT1 (your mutation) INTERACTS
TRIMIPRAMINE DGIDB:rxcui:10834	FDA approved	AKT1 (your mutation) INTERACTS
LOVASTATIN DGIDB:rxcui:6472	FDA approved	AKT1 (your mutation) INTERACTS

22.0

IgSF CAM signaling
kegg · kegg:hsa04517

10 / 39
1 drivers

AKT1 AKT2 CADM2 KDR NLGN1 PIK3R1 +4

676
337 direct · 163 approved

Show top 15 drugs modulating this pathway

Drug	Phase	Target
RESVERATROL DGIDB:rxcui:1000492	FDA approved	AKT1 (your mutation) INTERACTS
COPANLISIB DGIDB:rxcui:1945077	FDA approved	PIK3R1 (your mutation) inhibitor
LENIOLISIB DGIDB:rxcui:2633005	FDA approved	PIK3R1 (your mutation) INTERACTS
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	PIK3R1 (your mutation) INTERACTS
INFIGRATINIB DGIDB:rxcui:2550729	FDA approved	PIK3R1 (your mutation) inhibitor
QUERCETIN DGIDB:rxcui:9060	FDA approved	PIK3R1 (your mutation) inhibitor
ALPELISIB DGIDB:rxcui:2169285	FDA approved	PIK3R1 (your mutation) inhibitor
CAPIVASERTIB CHEMBL2325741	FDA approved	AKT1 (your mutation) INHIBITOR
DESIPRAMINE DGIDB:rxcui:3247	FDA approved	AKT1 (your mutation) INTERACTS
NELFINAVIR DGIDB:rxcui:134527	FDA approved	AKT1 (your mutation) inhibitor
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	AKT1 (your mutation) INTERACTS
CLOMIPRAMINE DGIDB:rxcui:2597	FDA approved	AKT1 (your mutation) INTERACTS
DOXEPIN HYDROCHLORIDE DGIDB:rxcui:203179	FDA approved	AKT1 (your mutation) INTERACTS
TRIMIPRAMINE DGIDB:rxcui:10834	FDA approved	AKT1 (your mutation) INTERACTS
LOVASTATIN DGIDB:rxcui:6472	FDA approved	AKT1 (your mutation) INTERACTS

21.0

Pancreatic cancer
kegg · kegg:hsa05212

9 / 13
1 drivers

AKT1 AKT2 BRAF CDK6 PIK3R1 RAC1 +3

1062
765 direct · 297 approved

Show top 15 drugs modulating this pathway

Drug	Phase	Target
CAPIVASERTIB CHEMBL2325741	FDA approved	AKT1 (your mutation) INHIBITOR
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	AKT1 (your mutation) inhibitor
DESIPRAMINE DGIDB:rxcui:3247	FDA approved	AKT1 (your mutation) INTERACTS
NELFINAVIR DGIDB:rxcui:134527	FDA approved	AKT1 (your mutation) inhibitor
RESVERATROL DGIDB:rxcui:1000492	FDA approved	AKT1 (your mutation) INTERACTS
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	AKT1 (your mutation) INTERACTS
CLOMIPRAMINE DGIDB:rxcui:2597	FDA approved	AKT1 (your mutation) INTERACTS
DOXEPIN HYDROCHLORIDE DGIDB:rxcui:203179	FDA approved	AKT1 (your mutation) INTERACTS
TRIMIPRAMINE DGIDB:rxcui:10834	FDA approved	AKT1 (your mutation) INTERACTS
LOVASTATIN DGIDB:rxcui:6472	FDA approved	AKT1 (your mutation) INTERACTS
TOPOTECAN HYDROCHLORIDE DGIDB:rxcui:266573	FDA approved	AKT1 (your mutation) INTERACTS
NORTRIPTYLINE DGIDB:rxcui:7531	FDA approved	AKT1 (your mutation) INTERACTS
DABRAFENIB DGIDB:rxcui:1424911	FDA approved	AKT1 (your mutation) INTERACTS
FULVESTRANT DGIDB:rxcui:282357	FDA approved	AKT1 (your mutation) INTERACTS
NINTEDANIB ESYLATE DGIDB:rxcui:1592736	FDA approved	AKT1 (your mutation) INTERACTS

21.0

Sphingolipid signaling pathway
kegg · kegg:hsa04071

9 / 14
1 drivers

AKT1 AKT2 GNAI2 PIK3R1 PPP2R1A RAC1 +3

656
608 direct · 185 approved

Show top 15 drugs modulating this pathway

Drug	Phase	Target
CAPIVASERTIB CHEMBL2325741	FDA approved	AKT1 (your mutation) INHIBITOR
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	AKT1 (your mutation) inhibitor
DESIPRAMINE DGIDB:rxcui:3247	FDA approved	AKT1 (your mutation) INTERACTS
NELFINAVIR DGIDB:rxcui:134527	FDA approved	AKT1 (your mutation) inhibitor
RESVERATROL DGIDB:rxcui:1000492	FDA approved	AKT1 (your mutation) INTERACTS
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	AKT1 (your mutation) INTERACTS
CLOMIPRAMINE DGIDB:rxcui:2597	FDA approved	AKT1 (your mutation) INTERACTS
DOXEPIN HYDROCHLORIDE DGIDB:rxcui:203179	FDA approved	AKT1 (your mutation) INTERACTS
TRIMIPRAMINE DGIDB:rxcui:10834	FDA approved	AKT1 (your mutation) INTERACTS
LOVASTATIN DGIDB:rxcui:6472	FDA approved	AKT1 (your mutation) INTERACTS
TOPOTECAN HYDROCHLORIDE DGIDB:rxcui:266573	FDA approved	AKT1 (your mutation) INTERACTS
NORTRIPTYLINE DGIDB:rxcui:7531	FDA approved	AKT1 (your mutation) INTERACTS
DABRAFENIB DGIDB:rxcui:1424911	FDA approved	AKT1 (your mutation) INTERACTS
FULVESTRANT DGIDB:rxcui:282357	FDA approved	AKT1 (your mutation) INTERACTS
NINTEDANIB ESYLATE DGIDB:rxcui:1592736	FDA approved	AKT1 (your mutation) INTERACTS

21.0

Neurotrophin signaling pathway
kegg · kegg:hsa04722

9 / 18
1 drivers

AKT1 AKT2 BRAF NTRK2 PIK3R1 RAC1 +3

823
794 direct · 238 approved

Show top 15 drugs modulating this pathway

Drug	Phase	Target
CAPIVASERTIB CHEMBL2325741	FDA approved	AKT1 (your mutation) INHIBITOR
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	AKT1 (your mutation) inhibitor
DESIPRAMINE DGIDB:rxcui:3247	FDA approved	AKT1 (your mutation) INTERACTS
NELFINAVIR DGIDB:rxcui:134527	FDA approved	AKT1 (your mutation) inhibitor
RESVERATROL DGIDB:rxcui:1000492	FDA approved	AKT1 (your mutation) INTERACTS
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	AKT1 (your mutation) INTERACTS
CLOMIPRAMINE DGIDB:rxcui:2597	FDA approved	AKT1 (your mutation) INTERACTS
DOXEPIN HYDROCHLORIDE DGIDB:rxcui:203179	FDA approved	AKT1 (your mutation) INTERACTS
TRIMIPRAMINE DGIDB:rxcui:10834	FDA approved	AKT1 (your mutation) INTERACTS
LOVASTATIN DGIDB:rxcui:6472	FDA approved	AKT1 (your mutation) INTERACTS
TOPOTECAN HYDROCHLORIDE DGIDB:rxcui:266573	FDA approved	AKT1 (your mutation) INTERACTS
NORTRIPTYLINE DGIDB:rxcui:7531	FDA approved	AKT1 (your mutation) INTERACTS
DABRAFENIB DGIDB:rxcui:1424911	FDA approved	AKT1 (your mutation) INTERACTS
FULVESTRANT DGIDB:rxcui:282357	FDA approved	AKT1 (your mutation) INTERACTS
NINTEDANIB ESYLATE DGIDB:rxcui:1592736	FDA approved	AKT1 (your mutation) INTERACTS

21.0

Hepatitis C
kegg · kegg:hsa05160

9 / 22
1 drivers

AKT1 AKT2 BRAF CDK6 EIF3E PIK3R1 +3

1184
765 direct · 321 approved

Show top 15 drugs modulating this pathway

Drug	Phase	Target
COPANLISIB DGIDB:rxcui:1945077	FDA approved	PIK3R1 (your mutation) inhibitor
LENIOLISIB DGIDB:rxcui:2633005	FDA approved	PIK3R1 (your mutation) INTERACTS
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	PIK3R1 (your mutation) INTERACTS
INFIGRATINIB DGIDB:rxcui:2550729	FDA approved	PIK3R1 (your mutation) inhibitor
QUERCETIN DGIDB:rxcui:9060	FDA approved	PIK3R1 (your mutation) inhibitor
ALPELISIB DGIDB:rxcui:2169285	FDA approved	PIK3R1 (your mutation) inhibitor
CAPIVASERTIB CHEMBL2325741	FDA approved	AKT1 (your mutation) INHIBITOR
DESIPRAMINE DGIDB:rxcui:3247	FDA approved	AKT1 (your mutation) INTERACTS
NELFINAVIR DGIDB:rxcui:134527	FDA approved	AKT1 (your mutation) inhibitor
RESVERATROL DGIDB:rxcui:1000492	FDA approved	AKT1 (your mutation) INTERACTS
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	AKT1 (your mutation) INTERACTS
CLOMIPRAMINE DGIDB:rxcui:2597	FDA approved	AKT1 (your mutation) INTERACTS
DOXEPIN HYDROCHLORIDE DGIDB:rxcui:203179	FDA approved	AKT1 (your mutation) INTERACTS
TRIMIPRAMINE DGIDB:rxcui:10834	FDA approved	AKT1 (your mutation) INTERACTS
LOVASTATIN DGIDB:rxcui:6472	FDA approved	AKT1 (your mutation) INTERACTS

21.0

Cellular senescence
kegg · kegg:hsa04218

9 / 23
1 drivers

AKT1 AKT2 CDK6 CDKN2B PIK3R1 RAF1 +3

721
632 direct · 211 approved

Show top 15 drugs modulating this pathway

Drug	Phase	Target
COPANLISIB DGIDB:rxcui:1945077	FDA approved	PIK3R1 (your mutation) inhibitor
LENIOLISIB DGIDB:rxcui:2633005	FDA approved	PIK3R1 (your mutation) INTERACTS
EVEROLIMUS DGIDB:rxcui:141704	FDA approved	PIK3R1 (your mutation) INTERACTS
INFIGRATINIB DGIDB:rxcui:2550729	FDA approved	PIK3R1 (your mutation) inhibitor
QUERCETIN DGIDB:rxcui:9060	FDA approved	PIK3R1 (your mutation) inhibitor
ALPELISIB DGIDB:rxcui:2169285	FDA approved	PIK3R1 (your mutation) inhibitor
CAPIVASERTIB CHEMBL2325741	FDA approved	AKT1 (your mutation) INHIBITOR
DESIPRAMINE DGIDB:rxcui:3247	FDA approved	AKT1 (your mutation) INTERACTS
NELFINAVIR DGIDB:rxcui:134527	FDA approved	AKT1 (your mutation) inhibitor
RESVERATROL DGIDB:rxcui:1000492	FDA approved	AKT1 (your mutation) INTERACTS
VEMURAFENIB DGIDB:rxcui:1147220	FDA approved	AKT1 (your mutation) INTERACTS
CLOMIPRAMINE DGIDB:rxcui:2597	FDA approved	AKT1 (your mutation) INTERACTS
DOXEPIN HYDROCHLORIDE DGIDB:rxcui:203179	FDA approved	AKT1 (your mutation) INTERACTS
TRIMIPRAMINE DGIDB:rxcui:10834	FDA approved	AKT1 (your mutation) INTERACTS
LOVASTATIN DGIDB:rxcui:6472	FDA approved	AKT1 (your mutation) INTERACTS

Full pathway + drug data at cache/pathway_enrichment.json. Pathway membership from KEGG + Reactome; drug-target mappings from ChEMBL, OpenTargets, and DGIdb.

Drug	Regimen	Evidence	Notes for you
VORASIDENIB ⭐ already taking	Vorasidenib monotherapy (INDIGO trial)	FDA 2024; grade 2 IDH-mut astrocytoma/oligodendroglioma s/p surgery	brain CNS — BBB-penetrant, oral. Standard first-line when residual disease without need for immediate radiation.
TEMOZOLOMIDE	TMZ + radiation (Stupp protocol) or TMZ alone	RTOG 0424, NCCN	Particularly active when MGMT promoter methylated. IDH-mut tumors typically methylated → TMZ highly active.
PCV	Procarbazine + CCNU (lomustine) + Vincristine	RTOG 9802 — survival benefit over RT alone in grade 2/3 glioma	Particularly strong benefit in 1p/19q-codeleted oligodendroglioma. Older regimen; TMZ often preferred for tolerability.
LOMUSTINE	Lomustine (CCNU) monotherapy or component of PCV	Multiple trials	BBB-penetrant nitrosourea; part of PCV above.
PROCARBAZINE	Component of PCV; alternative in some protocols	RTOG 9802	MAO inhibitor activity — food/drug interactions matter.
VINCRISTINE	Component of PCV	RTOG 9802	Neurotoxicity is dose-limiting.

Drug	Regimen	Evidence
BEVACIZUMAB	Bevacizumab ± irinotecan for recurrent high-grade transformation	FDA 2009 for recurrent GBM
REGORAFENIB	REGOMA trial — recurrent GBM	Phase 2 positive 2019
IVOSIDENIB	IDH1 R132H inhibitor	Phase 1/2 in IDH-mut glioma; vorasidenib now preferred
OLUTASIDENIB	IDH1 inhibitor (FT-2102)	FDA approved 2022 for IDH1-mut AML; glioma use emerging

Drug	Regimen	Evidence	Notes for you
ENASIDENIB	IDH2 R140/R172 inhibitor — only for IDH2-mutant
TAZEMETOSTAT	EZH2 inhibitor — biology rationale in H3K27 dysregulation

6. Targeted therapy

Plain English: every ChEMBL-catalogued drug that hits a gene mutated / amplified / over-expressed in your tumor, ranked by a composite score that rewards: (1) developmental phase (FDA-approved > Phase 3 > 2 > 1 > preclinical), (2) multiple hits on your specific mutations, (3) published evidence in your tumor type, and (4) favorable pharmacology (e.g. blood-brain barrier penetration for brain tumors). Scores are penalized by NegBioDB hits (failed trials, binding negatives).

200 compounds scored against your specific mutations · 187 FDA approved 9 Phase 3 3 Phase 2 1 Phase 1 0 preclinical 0 natural product
Showing top 20. Approval in one indication doesn't mean benefit in yours — these are starting points for an oncology discussion, not recommendations. Phase categories are mutually exclusive (187+9+3+1+0=200). Natural product count overlaps with phase categories.

Score	Drug	Targets (viability)	Evidence against	Why it ranked
99.0	VORASIDENIB ⭐ already taking CHEMBL4279047 FDA approved BBB: good	IDH1activating hotspot	none flagged	["⭐ on patient's current medication list", 'FDA-approved', '72 tumor-type PubMed papers', '39 driver-gene PubMed papers', '12 clinical trials', 'targets 1 of your genes (pathogenic: IDH1) [canonical for lgg_astrocytoma: IDH1]']
88.0	IVOSIDENIB CHEMBL3989958 FDA approved BBB: good	IDH1activating hotspot	none flagged	['FDA-approved', '39 tumor-type PubMed papers', '261 driver-gene PubMed papers', '6 clinical trials', 'targets 1 of your genes (pathogenic: IDH1) [canonical for lgg_astrocytoma: IDH1]']
78.0	OLUTASIDENIB CHEMBL4297610 FDA approved BBB: good	IDH1activating hotspot	none flagged	['FDA-approved', '5 tumor-type PubMed papers', '34 driver-gene PubMed papers', '3 clinical trials', 'targets 1 of your genes (pathogenic: IDH1) [canonical for lgg_astrocytoma: IDH1]']
75.0	SORAFENIB CHEMBL1336 FDA approved BBB: poor	BRAFno data FLT1no data FLT4no data KDRnon viable RAF1no data	5 failed trials verify ↗ 1 binding negatives	['FDA-approved', '363 tumor-type PubMed papers', '7 driver-gene PubMed papers', '22 clinical trials', 'targets 5 of your genes (likely_driver: KDR; vus_uncertain: FLT1) [canonical for lgg_astrocytoma: BRAF]', '⚠ NegBioDB: 5 failed trial(s) in tumor type, failed to bind 1 driver(s) (-3)']
71.5	VANDETANIB CHEMBL24828 FDA approved BBB: good	EPHA2no data EPHB1no data ERBB3no data FLT1no data FLT4no data +1	1 binding negatives	['FDA-approved', '24 tumor-type PubMed papers', '1 driver-gene PubMed papers', '10 clinical trials', 'targets 6 of your genes (likely_driver: ERBB3, KDR; vus_uncertain: EPHA2, FLT1)']
70.0	DABRAFENIB CHEMBL2028663 FDA approved BBB: poor	BRAFno data	1 binding negatives	['FDA-approved', '101 tumor-type PubMed papers', '13 driver-gene PubMed papers', '15 clinical trials', 'targets 1 of your genes (low-signal — no driver-tier hit)']
70.0	METFORMIN CHEMBL1431 FDA approved BBB: good	MT-ND1no data MT-ND3no data MT-ND4no data MT-ND4Lno data MT-ND5no data +4	4 failed trials verify ↗	['FDA-approved', '97 tumor-type PubMed papers', '13 driver-gene PubMed papers', '12 clinical trials', 'targets 9 of your genes (vus_uncertain: MT-ND5)']
68.5	VINCRISTINE CHEMBL90555 FDA approved BBB: poor	TUBA1Ano data TUBA1Bno data TUBB4Ano data TUBB6no data	none flagged	['FDA-approved', '613 tumor-type PubMed papers', '34 driver-gene PubMed papers', '65 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']
67.0	REGORAFENIB CHEMBL1946170 FDA approved BBB: poor	BRAFno data EPHA2no data FLT1no data FLT4no data KDRnon viable +1	1 binding negatives	['FDA-approved', '40 tumor-type PubMed papers', '2 driver-gene PubMed papers', '6 clinical trials', 'targets 6 of your genes (likely_driver: KDR; vus_uncertain: EPHA2, FLT1) [canonical for lgg_astrocytoma: BRAF]']
67.0	HYDROXYUREA CHEMBL467 FDA approved BBB: good	RRM2Bno data	none flagged	['FDA-approved', '56 tumor-type PubMed papers', '7 driver-gene PubMed papers', '9 clinical trials', 'targets 1 of your genes (vus_uncertain: RRM2B)']
66.5	EPINEPHRINE CHEMBL679 FDA approved BBB: good	ADRA1Bno data	none flagged	['FDA-approved', '43 tumor-type PubMed papers', '42 clinical trials', 'targets 1 of your genes (low-signal — no driver-tier hit)']
63.0	VEMURAFENIB CHEMBL1229517 FDA approved BBB: moderate	BRAFno data	1 binding negatives	['FDA-approved', '33 tumor-type PubMed papers', '1 driver-gene PubMed papers', '5 clinical trials', 'targets 1 of your genes (low-signal — no driver-tier hit)']
63.0	GEMCITABINE CHEMBL888 FDA approved BBB: poor	RRM2Bno data	2 failed trials verify ↗	['FDA-approved', '71 tumor-type PubMed papers', '80 driver-gene PubMed papers', '14 clinical trials', 'targets 1 of your genes (vus_uncertain: RRM2B)']
62.5	CRIZOTINIB CHEMBL601719 FDA approved BBB: moderate CYP interaction	METno data NPM1no data ROS1no data	1 binding negatives	['FDA-approved', '24 tumor-type PubMed papers', '5 driver-gene PubMed papers', '4 clinical trials', '⚠ CYP3A4_inhibition (affects atorvastatin, vorasidenib)', 'targets 3 of your genes (low-signal — no driver-tier hit)']
61.5	SUNITINIB CHEMBL535 FDA approved BBB: poor	CSF1Rno data FLT1no data FLT4no data KDRnon viable	1 failed trial verify ↗	['FDA-approved', '59 tumor-type PubMed papers', '2 driver-gene PubMed papers', '18 clinical trials', 'targets 4 of your genes (likely_driver: KDR; vus_uncertain: FLT1)']
61.0	AXITINIB CHEMBL1289926 FDA approved BBB: good	FLT1no data FLT4no data KDRnon viable	1 binding negatives	['FDA-approved', '10 tumor-type PubMed papers', '1 driver-gene PubMed papers', '6 clinical trials', 'targets 3 of your genes (likely_driver: KDR; vus_uncertain: FLT1)']
61.0	NIVOLUMAB CHEMBL2108738 FDA approved BBB: poor	PDCD1no data	none flagged	['FDA-approved', '39 tumor-type PubMed papers', '7 driver-gene PubMed papers', '60 clinical trials']
60.0	CEDIRANIB CHEMBL491473 FDA approved BBB: moderate	FLT1no data FLT4no data KDRnon viable	3 failed trials verify ↗ 1 binding negatives	['FDA-approved', '22 tumor-type PubMed papers', '3 driver-gene PubMed papers', '11 clinical trials', 'targets 3 of your genes (likely_driver: KDR; vus_uncertain: FLT1)', '⚠ NegBioDB: 3 failed trial(s) in tumor type, failed to bind 1 driver(s) (-2)']
60.0	PERAMPANEL CHEMBL1214124 FDA approved BBB: good	GRIA2no data GRIA4no data	3 failed trials verify ↗	['FDA-approved', '37 tumor-type PubMed papers', '5 driver-gene PubMed papers', '5 clinical trials', '⚠ NegBioDB: 3 failed trial(s) in tumor type (-1)']
60.0	CABOZANTINIB CHEMBL2105717 FDA approved BBB: poor	KDRnon viable METno data	3 failed trials verify ↗ 1 binding negatives	['FDA-approved', '13 tumor-type PubMed papers', '2 driver-gene PubMed papers', '5 clinical trials', 'targets 2 of your genes (likely_driver: KDR) [canonical for lgg_astrocytoma: MET]', '⚠ NegBioDB: 3 failed trial(s) in tumor type, failed to bind 1 driver(s) (-1)']

Drugs organized by your mutated gene

Plain English: same compounds, organized differently — expand a gene to see every drug in the database that hits it. Useful when discussing "are we trying anything that targets this specific mutation?"

ADRA1B — 45 compound(s)

Drug	Score	Phase	Rationale
EPINEPHRINE	66.5	FDA approved	['FDA-approved', '43 tumor-type PubMed papers', '42 clinical trials', 'targets 1 of your genes (low-signal — no driver-tier hit)']
NOREPINEPHRINE	54.5	FDA approved	['FDA-approved', '97 tumor-type PubMed papers', '1 driver-gene PubMed papers', 'targets 1 of your genes (low-signal — no driver-tier hit)']
PHENTOLAMINE	48.5	FDA approved	['FDA-approved', '15 tumor-type PubMed papers', 'targets 1 of your genes (low-signal — no driver-tier hit)']
PRAZOSIN	47.5	FDA approved	['FDA-approved', '12 tumor-type PubMed papers', 'targets 1 of your genes (low-signal — no driver-tier hit)']
PHENYLEPHRINE	46.5	FDA approved	['FDA-approved', '8 tumor-type PubMed papers', 'targets 1 of your genes (low-signal — no driver-tier hit)']
CARVEDILOL	46.5	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', '2 clinical trials', 'targets 1 of your genes (low-signal — no driver-tier hit)']
DOXAZOSIN	45.5	FDA approved	['FDA-approved', '6 tumor-type PubMed papers', 'targets 1 of your genes (low-signal — no driver-tier hit)']
PHENOXYBENZAMINE	45.5	FDA approved	['FDA-approved', '5 tumor-type PubMed papers', 'targets 1 of your genes (low-signal — no driver-tier hit)']

AGTR1 — 5 compound(s)

Drug	Score	Phase	Rationale
LOSARTAN	50.5	FDA approved	['FDA-approved', '9 tumor-type PubMed papers', '2 clinical trials', 'targets 1 of your genes (low-signal — no driver-tier hit)']
ANGIOTENSIN II	45.5	FDA approved	['FDA-approved', '52 tumor-type PubMed papers', '2 clinical trials', 'targets 1 of your genes (low-signal — no driver-tier hit)']
LOSARTAN POTASSIUM	44.5	FDA approved	['FDA-approved', '2 clinical trials', 'targets 1 of your genes (low-signal — no driver-tier hit)']
VALSARTAN	43.5	FDA approved	['FDA-approved', '2 tumor-type PubMed papers', 'targets 1 of your genes (low-signal — no driver-tier hit)']
CANDESARTAN	42.5	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', 'targets 1 of your genes (low-signal — no driver-tier hit)']

AKT1 — 1 compound(s)

Drug	Score	Phase	Rationale
CAPIVASERTIB	50.0	FDA approved	['FDA-approved', '8 tumor-type PubMed papers', '2 clinical trials']

AKT2 — 1 compound(s)

Drug	Score	Phase	Rationale
CAPIVASERTIB	50.0	FDA approved	['FDA-approved', '8 tumor-type PubMed papers', '2 clinical trials']

BRAF — 8 compound(s)

Drug	Score	Phase	Rationale
SORAFENIB	75.0	FDA approved	['FDA-approved', '363 tumor-type PubMed papers', '7 driver-gene PubMed papers', '22 clinical trials', 'targets 5 of your genes (likely_driver: KDR; vus_uncertain: FLT1) [canonical for lgg_astrocytoma: BRAF]', '⚠ NegBioDB: 5 failed trial(s) in tumor type, failed to bind 1 driver(s) (-3)']
DABRAFENIB	70.0	FDA approved	['FDA-approved', '101 tumor-type PubMed papers', '13 driver-gene PubMed papers', '15 clinical trials', 'targets 1 of your genes (low-signal — no driver-tier hit)']
REGORAFENIB	67.0	FDA approved	['FDA-approved', '40 tumor-type PubMed papers', '2 driver-gene PubMed papers', '6 clinical trials', 'targets 6 of your genes (likely_driver: KDR; vus_uncertain: EPHA2, FLT1) [canonical for lgg_astrocytoma: BRAF]']
VEMURAFENIB	63.0	FDA approved	['FDA-approved', '33 tumor-type PubMed papers', '1 driver-gene PubMed papers', '5 clinical trials', 'targets 1 of your genes (low-signal — no driver-tier hit)']
SORAFENIB TOSYLATE	56.0	FDA approved	['FDA-approved', '2 tumor-type PubMed papers', '6 clinical trials', 'targets 5 of your genes (likely_driver: KDR; vus_uncertain: FLT1) [canonical for lgg_astrocytoma: BRAF]']
TOVORAFENIB	46.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', '2 driver-gene PubMed papers', '1 clinical trials', 'targets 2 of your genes (low-signal — no driver-tier hit)']
DABRAFENIB MESYLATE	46.0	FDA approved	['FDA-approved', '4 clinical trials', 'targets 1 of your genes (low-signal — no driver-tier hit)']
ENCORAFENIB	46.0	FDA approved	['FDA-approved', '4 tumor-type PubMed papers', '1 driver-gene PubMed papers', '1 clinical trials', 'targets 1 of your genes (low-signal — no driver-tier hit)', '⚠ NegBioDB: 5 failed trial(s) in tumor type, failed to bind 1 driver(s) (-1)']

CALM1 — 1 compound(s)

Drug	Score	Phase	Rationale
PRENYLAMINE	43.0	FDA approved	['FDA-approved', '2 tumor-type PubMed papers']

CD74 — 1 compound(s)

Drug	Score	Phase	Rationale
REPOTRECTINIB	47.5	FDA approved	['FDA-approved', '3 tumor-type PubMed papers', '1 driver-gene PubMed papers', '1 clinical trials', 'targets 3 of your genes (low-signal — no driver-tier hit)']

CDK6 — 4 compound(s)

Drug	Score	Phase	Rationale
RIBOCICLIB	55.0	FDA approved	['FDA-approved', '10 tumor-type PubMed papers', '11 clinical trials', '⚠ NegBioDB: 4 failed trial(s) in tumor type, failed to bind 1 driver(s) (-1)']
PALBOCICLIB	55.0	FDA approved	['FDA-approved', '27 tumor-type PubMed papers', '1 driver-gene PubMed papers', '11 clinical trials', '⚠ NegBioDB: 6 failed trial(s) in tumor type, failed to bind 1 driver(s) (-4)']
ABEMACICLIB	51.0	FDA approved	['FDA-approved', '13 tumor-type PubMed papers', '14 clinical trials', '⚠ NegBioDB: 2 failed trial(s) in tumor type, failed to bind 1 driver(s) (-1)']
TRILACICLIB	42.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers']

CHRNA3 — 3 compound(s)

Drug	Score	Phase	Rationale
MECAMYLAMINE	43.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', 'targets 2 of your genes (vus_uncertain: CHRNA3)']
PENTOLINIUM	41.0	FDA approved	['FDA-approved', 'targets 2 of your genes (vus_uncertain: CHRNA3)']
TRIMETHAPHAN	41.0	FDA approved	['FDA-approved', 'targets 2 of your genes (vus_uncertain: CHRNA3)']

CHRNB4 — 3 compound(s)

Drug	Score	Phase	Rationale
MECAMYLAMINE	43.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', 'targets 2 of your genes (vus_uncertain: CHRNA3)']
PENTOLINIUM	41.0	FDA approved	['FDA-approved', 'targets 2 of your genes (vus_uncertain: CHRNA3)']
TRIMETHAPHAN	41.0	FDA approved	['FDA-approved', 'targets 2 of your genes (vus_uncertain: CHRNA3)']

CPT1B — 2 compound(s)

Drug	Score	Phase	Rationale
PERHEXILINE	44.0	FDA approved	['FDA-approved', '2 tumor-type PubMed papers', 'targets 1 of your genes (vus_uncertain: CPT1B)']
PERHEXILINE MALEATE	43.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', 'targets 1 of your genes (vus_uncertain: CPT1B)']

CSF1R — 5 compound(s)

Drug	Score	Phase	Rationale
SUNITINIB	61.5	FDA approved	['FDA-approved', '59 tumor-type PubMed papers', '2 driver-gene PubMed papers', '18 clinical trials', 'targets 4 of your genes (likely_driver: KDR; vus_uncertain: FLT1)']
PAZOPANIB	59.5	FDA approved	['FDA-approved', '2 tumor-type PubMed papers', '3 driver-gene PubMed papers', '7 clinical trials', 'targets 5 of your genes (likely_driver: KDR; vus_uncertain: FLT1)', '⚠ NegBioDB: 3 failed trial(s) in tumor type, failed to bind 1 driver(s) (-1)']
SUNITINIB MALATE	53.5	FDA approved	['FDA-approved', '5 tumor-type PubMed papers', '1 driver-gene PubMed papers', '17 clinical trials', 'targets 4 of your genes (likely_driver: KDR; vus_uncertain: FLT1)']
PAZOPANIB HYDROCHLORIDE	50.5	FDA approved	['FDA-approved', '2 clinical trials', 'targets 5 of your genes (likely_driver: KDR; vus_uncertain: FLT1)']
PEXIDARTINIB	48.5	FDA approved	['FDA-approved', '4 tumor-type PubMed papers', '2 clinical trials', 'targets 1 of your genes (low-signal — no driver-tier hit)']

EDNRB — 1 compound(s)

Drug	Score	Phase	Rationale
MACITENTAN	41.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', '2 clinical trials']

EPAS1 — 1 compound(s)

Drug	Score	Phase	Rationale
BELZUTIFAN	44.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', '1 clinical trials']

EPHA2 — 3 compound(s)

Drug	Score	Phase	Rationale
VANDETANIB	71.5	FDA approved	['FDA-approved', '24 tumor-type PubMed papers', '1 driver-gene PubMed papers', '10 clinical trials', 'targets 6 of your genes (likely_driver: ERBB3, KDR; vus_uncertain: EPHA2, FLT1)']
REGORAFENIB	67.0	FDA approved	['FDA-approved', '40 tumor-type PubMed papers', '2 driver-gene PubMed papers', '6 clinical trials', 'targets 6 of your genes (likely_driver: KDR; vus_uncertain: EPHA2, FLT1) [canonical for lgg_astrocytoma: BRAF]']
DASATINIB ANHYDROUS	41.0	FDA approved	['FDA-approved', 'targets 2 of your genes (vus_uncertain: EPHA2)']

EPHB1 — 1 compound(s)

Drug	Score	Phase	Rationale
VANDETANIB	71.5	FDA approved	['FDA-approved', '24 tumor-type PubMed papers', '1 driver-gene PubMed papers', '10 clinical trials', 'targets 6 of your genes (likely_driver: ERBB3, KDR; vus_uncertain: EPHA2, FLT1)']

ERBB3 — 1 compound(s)

Drug	Score	Phase	Rationale
VANDETANIB	71.5	FDA approved	['FDA-approved', '24 tumor-type PubMed papers', '1 driver-gene PubMed papers', '10 clinical trials', 'targets 6 of your genes (likely_driver: ERBB3, KDR; vus_uncertain: EPHA2, FLT1)']

EZH2 — 1 compound(s)

Drug	Score	Phase	Rationale
TAZEMETOSTAT	46.0	FDA approved	['FDA-approved', '5 tumor-type PubMed papers', '2 driver-gene PubMed papers', '2 clinical trials']

FGFR3 — 8 compound(s)

Drug	Score	Phase	Rationale
PAZOPANIB	59.5	FDA approved	['FDA-approved', '2 tumor-type PubMed papers', '3 driver-gene PubMed papers', '7 clinical trials', 'targets 5 of your genes (likely_driver: KDR; vus_uncertain: FLT1)', '⚠ NegBioDB: 3 failed trial(s) in tumor type, failed to bind 1 driver(s) (-1)']
ERDAFITINIB	52.0	FDA approved	['FDA-approved', '7 tumor-type PubMed papers', '4 clinical trials']
PEMIGATINIB	52.0	FDA approved	['FDA-approved', '2 tumor-type PubMed papers', '1 clinical trials', '1 CIViC tumor-specific entries']
PAZOPANIB HYDROCHLORIDE	50.5	FDA approved	['FDA-approved', '2 clinical trials', 'targets 5 of your genes (likely_driver: KDR; vus_uncertain: FLT1)']
NINTEDANIB	48.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', '1 driver-gene PubMed papers', '3 clinical trials', 'targets 4 of your genes (likely_driver: KDR; vus_uncertain: FLT1)', '⚠ NegBioDB: 1 failed trial(s) in tumor type, failed to bind 1 driver(s) (-1)']
NINTEDANIB ESYLATE	46.0	FDA approved	['FDA-approved', '3 clinical trials', 'targets 4 of your genes (likely_driver: KDR; vus_uncertain: FLT1)']
FUTIBATINIB	43.0	FDA approved	['FDA-approved', '2 tumor-type PubMed papers']
DOVITINIB	42.0	Phase 3	['Phase 3', '1 tumor-type PubMed papers', '2 clinical trials', 'targets 4 of your genes (likely_driver: KDR; vus_uncertain: FLT1)']

FLT1 — 19 compound(s)

Drug	Score	Phase	Rationale
SORAFENIB	75.0	FDA approved	['FDA-approved', '363 tumor-type PubMed papers', '7 driver-gene PubMed papers', '22 clinical trials', 'targets 5 of your genes (likely_driver: KDR; vus_uncertain: FLT1) [canonical for lgg_astrocytoma: BRAF]', '⚠ NegBioDB: 5 failed trial(s) in tumor type, failed to bind 1 driver(s) (-3)']
VANDETANIB	71.5	FDA approved	['FDA-approved', '24 tumor-type PubMed papers', '1 driver-gene PubMed papers', '10 clinical trials', 'targets 6 of your genes (likely_driver: ERBB3, KDR; vus_uncertain: EPHA2, FLT1)']
REGORAFENIB	67.0	FDA approved	['FDA-approved', '40 tumor-type PubMed papers', '2 driver-gene PubMed papers', '6 clinical trials', 'targets 6 of your genes (likely_driver: KDR; vus_uncertain: EPHA2, FLT1) [canonical for lgg_astrocytoma: BRAF]']
SUNITINIB	61.5	FDA approved	['FDA-approved', '59 tumor-type PubMed papers', '2 driver-gene PubMed papers', '18 clinical trials', 'targets 4 of your genes (likely_driver: KDR; vus_uncertain: FLT1)']
AXITINIB	61.0	FDA approved	['FDA-approved', '10 tumor-type PubMed papers', '1 driver-gene PubMed papers', '6 clinical trials', 'targets 3 of your genes (likely_driver: KDR; vus_uncertain: FLT1)']
CEDIRANIB	60.0	FDA approved	['FDA-approved', '22 tumor-type PubMed papers', '3 driver-gene PubMed papers', '11 clinical trials', 'targets 3 of your genes (likely_driver: KDR; vus_uncertain: FLT1)', '⚠ NegBioDB: 3 failed trial(s) in tumor type, failed to bind 1 driver(s) (-2)']
PAZOPANIB	59.5	FDA approved	['FDA-approved', '2 tumor-type PubMed papers', '3 driver-gene PubMed papers', '7 clinical trials', 'targets 5 of your genes (likely_driver: KDR; vus_uncertain: FLT1)', '⚠ NegBioDB: 3 failed trial(s) in tumor type, failed to bind 1 driver(s) (-1)']
LENVATINIB	59.0	FDA approved	['FDA-approved', '4 tumor-type PubMed papers', '3 driver-gene PubMed papers', '4 clinical trials', 'targets 3 of your genes (likely_driver: KDR; vus_uncertain: FLT1)']

FLT4 — 20 compound(s)

Drug	Score	Phase	Rationale
SORAFENIB	75.0	FDA approved	['FDA-approved', '363 tumor-type PubMed papers', '7 driver-gene PubMed papers', '22 clinical trials', 'targets 5 of your genes (likely_driver: KDR; vus_uncertain: FLT1) [canonical for lgg_astrocytoma: BRAF]', '⚠ NegBioDB: 5 failed trial(s) in tumor type, failed to bind 1 driver(s) (-3)']
VANDETANIB	71.5	FDA approved	['FDA-approved', '24 tumor-type PubMed papers', '1 driver-gene PubMed papers', '10 clinical trials', 'targets 6 of your genes (likely_driver: ERBB3, KDR; vus_uncertain: EPHA2, FLT1)']
REGORAFENIB	67.0	FDA approved	['FDA-approved', '40 tumor-type PubMed papers', '2 driver-gene PubMed papers', '6 clinical trials', 'targets 6 of your genes (likely_driver: KDR; vus_uncertain: EPHA2, FLT1) [canonical for lgg_astrocytoma: BRAF]']
SUNITINIB	61.5	FDA approved	['FDA-approved', '59 tumor-type PubMed papers', '2 driver-gene PubMed papers', '18 clinical trials', 'targets 4 of your genes (likely_driver: KDR; vus_uncertain: FLT1)']
AXITINIB	61.0	FDA approved	['FDA-approved', '10 tumor-type PubMed papers', '1 driver-gene PubMed papers', '6 clinical trials', 'targets 3 of your genes (likely_driver: KDR; vus_uncertain: FLT1)']
CEDIRANIB	60.0	FDA approved	['FDA-approved', '22 tumor-type PubMed papers', '3 driver-gene PubMed papers', '11 clinical trials', 'targets 3 of your genes (likely_driver: KDR; vus_uncertain: FLT1)', '⚠ NegBioDB: 3 failed trial(s) in tumor type, failed to bind 1 driver(s) (-2)']
PAZOPANIB	59.5	FDA approved	['FDA-approved', '2 tumor-type PubMed papers', '3 driver-gene PubMed papers', '7 clinical trials', 'targets 5 of your genes (likely_driver: KDR; vus_uncertain: FLT1)', '⚠ NegBioDB: 3 failed trial(s) in tumor type, failed to bind 1 driver(s) (-1)']
LENVATINIB	59.0	FDA approved	['FDA-approved', '4 tumor-type PubMed papers', '3 driver-gene PubMed papers', '4 clinical trials', 'targets 3 of your genes (likely_driver: KDR; vus_uncertain: FLT1)']

FYN — 1 compound(s)

Drug	Score	Phase	Rationale
DASATINIB ANHYDROUS	41.0	FDA approved	['FDA-approved', 'targets 2 of your genes (vus_uncertain: EPHA2)']

GABBR1 — 1 compound(s)

Drug	Score	Phase	Rationale
BACLOFEN	44.0	FDA approved	['FDA-approved', '4 tumor-type PubMed papers']

GRIA2 — 2 compound(s)

Drug	Score	Phase	Rationale
PERAMPANEL	60.0	FDA approved	['FDA-approved', '37 tumor-type PubMed papers', '5 driver-gene PubMed papers', '5 clinical trials', '⚠ NegBioDB: 3 failed trial(s) in tumor type (-1)']
TOPIRAMATE	50.0	FDA approved	['FDA-approved', '5 tumor-type PubMed papers', '3 clinical trials']

GRIA4 — 2 compound(s)

Drug	Score	Phase	Rationale
PERAMPANEL	60.0	FDA approved	['FDA-approved', '37 tumor-type PubMed papers', '5 driver-gene PubMed papers', '5 clinical trials', '⚠ NegBioDB: 3 failed trial(s) in tumor type (-1)']
TOPIRAMATE	50.0	FDA approved	['FDA-approved', '5 tumor-type PubMed papers', '3 clinical trials']

GRIK2 — 1 compound(s)

Drug	Score	Phase	Rationale
TOPIRAMATE	50.0	FDA approved	['FDA-approved', '5 tumor-type PubMed papers', '3 clinical trials']

GRIN2D — 14 compound(s)

Drug	Score	Phase	Rationale
MEMANTINE	56.0	FDA approved	['FDA-approved', '19 tumor-type PubMed papers', '4 clinical trials', 'targets 2 of your genes (vus_uncertain: GRIN2D, GRIN3B)']
AMANTADINE	54.0	FDA approved	['FDA-approved', '6 tumor-type PubMed papers', '5 clinical trials', 'targets 2 of your genes (vus_uncertain: GRIN2D, GRIN3B)']
KETAMINE	50.0	FDA approved	['FDA-approved', '19 tumor-type PubMed papers', 'targets 2 of your genes (vus_uncertain: GRIN2D, GRIN3B)']
AMANTADINE HYDROCHLORIDE	49.0	FDA approved	['FDA-approved', '5 clinical trials', 'targets 2 of your genes (vus_uncertain: GRIN2D, GRIN3B)']
MEMANTINE HYDROCHLORIDE	48.0	FDA approved	['FDA-approved', '4 clinical trials', 'targets 2 of your genes (vus_uncertain: GRIN2D, GRIN3B)']
FELBAMATE	44.0	FDA approved	['FDA-approved', '1 clinical trials', 'targets 2 of your genes (vus_uncertain: GRIN2D, GRIN3B)']
ORPHENADRINE CITRATE	42.0	FDA approved	['FDA-approved', 'targets 2 of your genes (vus_uncertain: GRIN2D, GRIN3B)']
KETAMINE HYDROCHLORIDE	42.0	FDA approved	['FDA-approved', 'targets 2 of your genes (vus_uncertain: GRIN2D, GRIN3B)']

GRIN3B — 14 compound(s)

Drug	Score	Phase	Rationale
MEMANTINE	56.0	FDA approved	['FDA-approved', '19 tumor-type PubMed papers', '4 clinical trials', 'targets 2 of your genes (vus_uncertain: GRIN2D, GRIN3B)']
AMANTADINE	54.0	FDA approved	['FDA-approved', '6 tumor-type PubMed papers', '5 clinical trials', 'targets 2 of your genes (vus_uncertain: GRIN2D, GRIN3B)']
KETAMINE	50.0	FDA approved	['FDA-approved', '19 tumor-type PubMed papers', 'targets 2 of your genes (vus_uncertain: GRIN2D, GRIN3B)']
AMANTADINE HYDROCHLORIDE	49.0	FDA approved	['FDA-approved', '5 clinical trials', 'targets 2 of your genes (vus_uncertain: GRIN2D, GRIN3B)']
MEMANTINE HYDROCHLORIDE	48.0	FDA approved	['FDA-approved', '4 clinical trials', 'targets 2 of your genes (vus_uncertain: GRIN2D, GRIN3B)']
FELBAMATE	44.0	FDA approved	['FDA-approved', '1 clinical trials', 'targets 2 of your genes (vus_uncertain: GRIN2D, GRIN3B)']
ORPHENADRINE CITRATE	42.0	FDA approved	['FDA-approved', 'targets 2 of your genes (vus_uncertain: GRIN2D, GRIN3B)']
KETAMINE HYDROCHLORIDE	42.0	FDA approved	['FDA-approved', 'targets 2 of your genes (vus_uncertain: GRIN2D, GRIN3B)']

HBA2 — 1 compound(s)

Drug	Score	Phase	Rationale
EFAPROXIRAL	44.0	FDA approved	['FDA-approved', '2 clinical trials']

HBB — 1 compound(s)

Drug	Score	Phase	Rationale
EFAPROXIRAL	44.0	FDA approved	['FDA-approved', '2 clinical trials']

HTR1E — 5 compound(s)

Drug	Score	Phase	Rationale
AMISULPRIDE	45.0	FDA approved	['FDA-approved', '3 tumor-type PubMed papers', 'targets 1 of your genes (vus_uncertain: HTR1E)']
ZIMELDINE HYDROCHLORIDE	41.0	FDA approved	['FDA-approved', 'targets 1 of your genes (vus_uncertain: HTR1E)']
DEXFENFLURAMINE	41.0	FDA approved	['FDA-approved', 'targets 1 of your genes (vus_uncertain: HTR1E)']
DEXFENFLURAMINE HYDROCHLORIDE	41.0	FDA approved	['FDA-approved', 'targets 1 of your genes (vus_uncertain: HTR1E)']
ZIMELDINE	41.0	FDA approved	['FDA-approved', 'targets 1 of your genes (vus_uncertain: HTR1E)']

IDH1 — 6 compound(s)

Drug	Score	Phase	Rationale
VORASIDENIB	99.0	FDA approved	["⭐ on patient's current medication list", 'FDA-approved', '72 tumor-type PubMed papers', '39 driver-gene PubMed papers', '12 clinical trials', 'targets 1 of your genes (pathogenic: IDH1) [canonical for lgg_astrocytoma: IDH1]']
IVOSIDENIB	88.0	FDA approved	['FDA-approved', '39 tumor-type PubMed papers', '261 driver-gene PubMed papers', '6 clinical trials', 'targets 1 of your genes (pathogenic: IDH1) [canonical for lgg_astrocytoma: IDH1]']
OLUTASIDENIB	78.0	FDA approved	['FDA-approved', '5 tumor-type PubMed papers', '34 driver-gene PubMed papers', '3 clinical trials', 'targets 1 of your genes (pathogenic: IDH1) [canonical for lgg_astrocytoma: IDH1]']
DS-1001B	49.0	Phase 2	['Phase 2', '2 tumor-type PubMed papers', '4 driver-gene PubMed papers', '3 clinical trials', 'targets 1 of your genes (pathogenic: IDH1) [canonical for lgg_astrocytoma: IDH1]']
IDH305	48.0	Phase 2	['Phase 2', '1 tumor-type PubMed papers', '6 driver-gene PubMed papers', '3 clinical trials', 'targets 1 of your genes (pathogenic: IDH1) [canonical for lgg_astrocytoma: IDH1]']
BAY1436032	43.0	Phase 1	['Phase 1', '5 tumor-type PubMed papers', '7 driver-gene PubMed papers', '1 clinical trials', 'targets 1 of your genes (pathogenic: IDH1) [canonical for lgg_astrocytoma: IDH1]']

KCNG2 — 6 compound(s)

Drug	Score	Phase	Rationale
GUANIDINE HYDROCHLORIDE	49.0	FDA approved	['FDA-approved', '3 tumor-type PubMed papers', '2 clinical trials', 'targets 1 of your genes (vus_uncertain: KCNG2)']
GUANIDINE	48.0	Phase 3	['Phase 3', '19 tumor-type PubMed papers', '11 clinical trials', 'targets 1 of your genes (vus_uncertain: KCNG2)']
AMIFAMPRIDINE	43.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', 'targets 1 of your genes (vus_uncertain: KCNG2)']
DALFAMPRIDINE	41.0	FDA approved	['FDA-approved', 'targets 1 of your genes (vus_uncertain: KCNG2)']
TEDISAMIL	41.0	FDA approved	['FDA-approved', 'targets 1 of your genes (vus_uncertain: KCNG2)']
AMIFAMPRIDINE PHOSPHATE	41.0	FDA approved	['FDA-approved', 'targets 1 of your genes (vus_uncertain: KCNG2)']

KDR — 25 compound(s)

Drug	Score	Phase	Rationale
SORAFENIB	75.0	FDA approved	['FDA-approved', '363 tumor-type PubMed papers', '7 driver-gene PubMed papers', '22 clinical trials', 'targets 5 of your genes (likely_driver: KDR; vus_uncertain: FLT1) [canonical for lgg_astrocytoma: BRAF]', '⚠ NegBioDB: 5 failed trial(s) in tumor type, failed to bind 1 driver(s) (-3)']
VANDETANIB	71.5	FDA approved	['FDA-approved', '24 tumor-type PubMed papers', '1 driver-gene PubMed papers', '10 clinical trials', 'targets 6 of your genes (likely_driver: ERBB3, KDR; vus_uncertain: EPHA2, FLT1)']
REGORAFENIB	67.0	FDA approved	['FDA-approved', '40 tumor-type PubMed papers', '2 driver-gene PubMed papers', '6 clinical trials', 'targets 6 of your genes (likely_driver: KDR; vus_uncertain: EPHA2, FLT1) [canonical for lgg_astrocytoma: BRAF]']
SUNITINIB	61.5	FDA approved	['FDA-approved', '59 tumor-type PubMed papers', '2 driver-gene PubMed papers', '18 clinical trials', 'targets 4 of your genes (likely_driver: KDR; vus_uncertain: FLT1)']
AXITINIB	61.0	FDA approved	['FDA-approved', '10 tumor-type PubMed papers', '1 driver-gene PubMed papers', '6 clinical trials', 'targets 3 of your genes (likely_driver: KDR; vus_uncertain: FLT1)']
CEDIRANIB	60.0	FDA approved	['FDA-approved', '22 tumor-type PubMed papers', '3 driver-gene PubMed papers', '11 clinical trials', 'targets 3 of your genes (likely_driver: KDR; vus_uncertain: FLT1)', '⚠ NegBioDB: 3 failed trial(s) in tumor type, failed to bind 1 driver(s) (-2)']
CABOZANTINIB	60.0	FDA approved	['FDA-approved', '13 tumor-type PubMed papers', '2 driver-gene PubMed papers', '5 clinical trials', 'targets 2 of your genes (likely_driver: KDR) [canonical for lgg_astrocytoma: MET]', '⚠ NegBioDB: 3 failed trial(s) in tumor type, failed to bind 1 driver(s) (-1)']
PAZOPANIB	59.5	FDA approved	['FDA-approved', '2 tumor-type PubMed papers', '3 driver-gene PubMed papers', '7 clinical trials', 'targets 5 of your genes (likely_driver: KDR; vus_uncertain: FLT1)', '⚠ NegBioDB: 3 failed trial(s) in tumor type, failed to bind 1 driver(s) (-1)']

MET — 10 compound(s)

Drug	Score	Phase	Rationale
CRIZOTINIB	62.5	FDA approved	['FDA-approved', '24 tumor-type PubMed papers', '5 driver-gene PubMed papers', '4 clinical trials', '⚠ CYP3A4_inhibition (affects atorvastatin, vorasidenib)', 'targets 3 of your genes (low-signal — no driver-tier hit)']
CABOZANTINIB	60.0	FDA approved	['FDA-approved', '13 tumor-type PubMed papers', '2 driver-gene PubMed papers', '5 clinical trials', 'targets 2 of your genes (likely_driver: KDR) [canonical for lgg_astrocytoma: MET]', '⚠ NegBioDB: 3 failed trial(s) in tumor type, failed to bind 1 driver(s) (-1)']
CAPMATINIB	60.0	FDA approved	['FDA-approved', '2 tumor-type PubMed papers', '1 driver-gene PubMed papers', '4 clinical trials', 'targets 1 of your genes (low-signal — no driver-tier hit)']
CAPMATINIB HYDROCHLORIDE	50.0	FDA approved	['FDA-approved', 'targets 1 of your genes (low-signal — no driver-tier hit)']
TEPOTINIB	47.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', 'targets 1 of your genes (low-signal — no driver-tier hit)']
CABOZANTINIB S-MALATE	45.0	FDA approved	['FDA-approved', 'targets 2 of your genes (likely_driver: KDR) [canonical for lgg_astrocytoma: MET]']
TEPOTINIB HYDROCHLORIDE	45.0	FDA approved	['FDA-approved', 'targets 1 of your genes (low-signal — no driver-tier hit)']
AMIVANTAMAB	44.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', '1 clinical trials', 'targets 1 of your genes (low-signal — no driver-tier hit)']

MT-ND1 — 2 compound(s)

Drug	Score	Phase	Rationale
METFORMIN	70.0	FDA approved	['FDA-approved', '97 tumor-type PubMed papers', '13 driver-gene PubMed papers', '12 clinical trials', 'targets 9 of your genes (vus_uncertain: MT-ND5)']
METFORMIN HYDROCHLORIDE	53.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', '12 clinical trials', 'targets 9 of your genes (vus_uncertain: MT-ND5)']

MT-ND3 — 2 compound(s)

Drug	Score	Phase	Rationale
METFORMIN	70.0	FDA approved	['FDA-approved', '97 tumor-type PubMed papers', '13 driver-gene PubMed papers', '12 clinical trials', 'targets 9 of your genes (vus_uncertain: MT-ND5)']
METFORMIN HYDROCHLORIDE	53.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', '12 clinical trials', 'targets 9 of your genes (vus_uncertain: MT-ND5)']

MT-ND4 — 2 compound(s)

Drug	Score	Phase	Rationale
METFORMIN	70.0	FDA approved	['FDA-approved', '97 tumor-type PubMed papers', '13 driver-gene PubMed papers', '12 clinical trials', 'targets 9 of your genes (vus_uncertain: MT-ND5)']
METFORMIN HYDROCHLORIDE	53.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', '12 clinical trials', 'targets 9 of your genes (vus_uncertain: MT-ND5)']

MT-ND4L — 2 compound(s)

Drug	Score	Phase	Rationale
METFORMIN	70.0	FDA approved	['FDA-approved', '97 tumor-type PubMed papers', '13 driver-gene PubMed papers', '12 clinical trials', 'targets 9 of your genes (vus_uncertain: MT-ND5)']
METFORMIN HYDROCHLORIDE	53.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', '12 clinical trials', 'targets 9 of your genes (vus_uncertain: MT-ND5)']

MT-ND5 — 2 compound(s)

Drug	Score	Phase	Rationale
METFORMIN	70.0	FDA approved	['FDA-approved', '97 tumor-type PubMed papers', '13 driver-gene PubMed papers', '12 clinical trials', 'targets 9 of your genes (vus_uncertain: MT-ND5)']
METFORMIN HYDROCHLORIDE	53.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', '12 clinical trials', 'targets 9 of your genes (vus_uncertain: MT-ND5)']

MYH7 — 2 compound(s)

Drug	Score	Phase	Rationale
OMECAMTIV MECARBIL	41.0	FDA approved	['FDA-approved', 'targets 1 of your genes (vus_uncertain: MYH7)']
MAVACAMTEN	41.0	FDA approved	['FDA-approved', 'targets 1 of your genes (vus_uncertain: MYH7)']

NDUFA1 — 2 compound(s)

Drug	Score	Phase	Rationale
METFORMIN	70.0	FDA approved	['FDA-approved', '97 tumor-type PubMed papers', '13 driver-gene PubMed papers', '12 clinical trials', 'targets 9 of your genes (vus_uncertain: MT-ND5)']
METFORMIN HYDROCHLORIDE	53.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', '12 clinical trials', 'targets 9 of your genes (vus_uncertain: MT-ND5)']

NDUFA13 — 2 compound(s)

Drug	Score	Phase	Rationale
METFORMIN	70.0	FDA approved	['FDA-approved', '97 tumor-type PubMed papers', '13 driver-gene PubMed papers', '12 clinical trials', 'targets 9 of your genes (vus_uncertain: MT-ND5)']
METFORMIN HYDROCHLORIDE	53.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', '12 clinical trials', 'targets 9 of your genes (vus_uncertain: MT-ND5)']

NDUFB9 — 2 compound(s)

Drug	Score	Phase	Rationale
METFORMIN	70.0	FDA approved	['FDA-approved', '97 tumor-type PubMed papers', '13 driver-gene PubMed papers', '12 clinical trials', 'targets 9 of your genes (vus_uncertain: MT-ND5)']
METFORMIN HYDROCHLORIDE	53.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', '12 clinical trials', 'targets 9 of your genes (vus_uncertain: MT-ND5)']

NDUFS5 — 2 compound(s)

Drug	Score	Phase	Rationale
METFORMIN	70.0	FDA approved	['FDA-approved', '97 tumor-type PubMed papers', '13 driver-gene PubMed papers', '12 clinical trials', 'targets 9 of your genes (vus_uncertain: MT-ND5)']
METFORMIN HYDROCHLORIDE	53.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', '12 clinical trials', 'targets 9 of your genes (vus_uncertain: MT-ND5)']

NPM1 — 1 compound(s)

Drug	Score	Phase	Rationale
CRIZOTINIB	62.5	FDA approved	['FDA-approved', '24 tumor-type PubMed papers', '5 driver-gene PubMed papers', '4 clinical trials', '⚠ CYP3A4_inhibition (affects atorvastatin, vorasidenib)', 'targets 3 of your genes (low-signal — no driver-tier hit)']

NTRK2 — 5 compound(s)

Drug	Score	Phase	Rationale
LAROTRECTINIB	60.0	FDA approved	['FDA-approved', '33 tumor-type PubMed papers', '5 driver-gene PubMed papers', '4 clinical trials']
ENTRECTINIB	48.5	FDA approved	['FDA-approved', '19 tumor-type PubMed papers', '7 driver-gene PubMed papers', '3 clinical trials', 'targets 2 of your genes (low-signal — no driver-tier hit)']
REPOTRECTINIB	47.5	FDA approved	['FDA-approved', '3 tumor-type PubMed papers', '1 driver-gene PubMed papers', '1 clinical trials', 'targets 3 of your genes (low-signal — no driver-tier hit)']
LAROTRECTINIB SULFATE	45.0	FDA approved	['FDA-approved', '3 clinical trials']
LESTAURTINIB	44.0	FDA approved	['FDA-approved', '2 tumor-type PubMed papers', '1 driver-gene PubMed papers']

PDCD1 — 2 compound(s)

Drug	Score	Phase	Rationale
NIVOLUMAB	61.0	FDA approved	['FDA-approved', '39 tumor-type PubMed papers', '7 driver-gene PubMed papers', '60 clinical trials']
PEMBROLIZUMAB	56.0	FDA approved	['FDA-approved', '32 tumor-type PubMed papers', '20 driver-gene PubMed papers', '55 clinical trials', '⚠ NegBioDB: 13 failed trial(s) in tumor type (-6)']

PIK3CD — 10 compound(s)

Drug	Score	Phase	Rationale
BUPARLISIB	52.0	Phase 3	['Phase 3', '4 tumor-type PubMed papers', '6 clinical trials', 'targets 2 of your genes (vus_uncertain: PIK3CD) [canonical for lgg_astrocytoma: PIK3R1]']
PAXALISIB	48.0	Phase 2	['Phase 2', '10 tumor-type PubMed papers', '1 driver-gene PubMed papers', '5 clinical trials', 'targets 2 of your genes (vus_uncertain: PIK3CD) [canonical for lgg_astrocytoma: PIK3R1]']
TASELISIB	45.0	Phase 3	['Phase 3', '1 tumor-type PubMed papers', '1 clinical trials', 'targets 2 of your genes (vus_uncertain: PIK3CD) [canonical for lgg_astrocytoma: PIK3R1]']
DACTOLISIB	43.0	Phase 3	['Phase 3', '2 tumor-type PubMed papers', '2 clinical trials', 'targets 2 of your genes (vus_uncertain: PIK3CD) [canonical for lgg_astrocytoma: PIK3R1]']
DUVELISIB	42.0	FDA approved	['FDA-approved', '1 driver-gene PubMed papers', 'targets 1 of your genes (vus_uncertain: PIK3CD)']
LENIOLISIB PHOSPHATE	41.0	FDA approved	['FDA-approved', 'targets 1 of your genes (vus_uncertain: PIK3CD)']
DUVELISIB MONOHYDRATE	41.0	FDA approved	['FDA-approved', 'targets 1 of your genes (vus_uncertain: PIK3CD)']
PARSACLISIB	41.0	FDA approved	['FDA-approved', 'targets 1 of your genes (vus_uncertain: PIK3CD)']

PIK3R1 — 4 compound(s)

Drug	Score	Phase	Rationale
BUPARLISIB	52.0	Phase 3	['Phase 3', '4 tumor-type PubMed papers', '6 clinical trials', 'targets 2 of your genes (vus_uncertain: PIK3CD) [canonical for lgg_astrocytoma: PIK3R1]']
PAXALISIB	48.0	Phase 2	['Phase 2', '10 tumor-type PubMed papers', '1 driver-gene PubMed papers', '5 clinical trials', 'targets 2 of your genes (vus_uncertain: PIK3CD) [canonical for lgg_astrocytoma: PIK3R1]']
TASELISIB	45.0	Phase 3	['Phase 3', '1 tumor-type PubMed papers', '1 clinical trials', 'targets 2 of your genes (vus_uncertain: PIK3CD) [canonical for lgg_astrocytoma: PIK3R1]']
DACTOLISIB	43.0	Phase 3	['Phase 3', '2 tumor-type PubMed papers', '2 clinical trials', 'targets 2 of your genes (vus_uncertain: PIK3CD) [canonical for lgg_astrocytoma: PIK3R1]']

PTGER1 — 2 compound(s)

Drug	Score	Phase	Rationale
DINOPROSTONE	41.0	FDA approved	['FDA-approved', 'targets 1 of your genes (vus_uncertain: PTGER1)']
ALPROSTADIL	41.0	FDA approved	['FDA-approved', 'targets 1 of your genes (vus_uncertain: PTGER1)']

RAF1 — 4 compound(s)

Drug	Score	Phase	Rationale
SORAFENIB	75.0	FDA approved	['FDA-approved', '363 tumor-type PubMed papers', '7 driver-gene PubMed papers', '22 clinical trials', 'targets 5 of your genes (likely_driver: KDR; vus_uncertain: FLT1) [canonical for lgg_astrocytoma: BRAF]', '⚠ NegBioDB: 5 failed trial(s) in tumor type, failed to bind 1 driver(s) (-3)']
REGORAFENIB	67.0	FDA approved	['FDA-approved', '40 tumor-type PubMed papers', '2 driver-gene PubMed papers', '6 clinical trials', 'targets 6 of your genes (likely_driver: KDR; vus_uncertain: EPHA2, FLT1) [canonical for lgg_astrocytoma: BRAF]']
SORAFENIB TOSYLATE	56.0	FDA approved	['FDA-approved', '2 tumor-type PubMed papers', '6 clinical trials', 'targets 5 of your genes (likely_driver: KDR; vus_uncertain: FLT1) [canonical for lgg_astrocytoma: BRAF]']
TOVORAFENIB	46.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', '2 driver-gene PubMed papers', '1 clinical trials', 'targets 2 of your genes (low-signal — no driver-tier hit)']

ROS1 — 3 compound(s)

Drug	Score	Phase	Rationale
CRIZOTINIB	62.5	FDA approved	['FDA-approved', '24 tumor-type PubMed papers', '5 driver-gene PubMed papers', '4 clinical trials', '⚠ CYP3A4_inhibition (affects atorvastatin, vorasidenib)', 'targets 3 of your genes (low-signal — no driver-tier hit)']
ENTRECTINIB	48.5	FDA approved	['FDA-approved', '19 tumor-type PubMed papers', '7 driver-gene PubMed papers', '3 clinical trials', 'targets 2 of your genes (low-signal — no driver-tier hit)']
REPOTRECTINIB	47.5	FDA approved	['FDA-approved', '3 tumor-type PubMed papers', '1 driver-gene PubMed papers', '1 clinical trials', 'targets 3 of your genes (low-signal — no driver-tier hit)']

RRM2B — 5 compound(s)

Drug	Score	Phase	Rationale
HYDROXYUREA	67.0	FDA approved	['FDA-approved', '56 tumor-type PubMed papers', '7 driver-gene PubMed papers', '9 clinical trials', 'targets 1 of your genes (vus_uncertain: RRM2B)']
GEMCITABINE	63.0	FDA approved	['FDA-approved', '71 tumor-type PubMed papers', '80 driver-gene PubMed papers', '14 clinical trials', 'targets 1 of your genes (vus_uncertain: RRM2B)']
FLUDARABINE PHOSPHATE	53.0	FDA approved	['FDA-approved', '5 tumor-type PubMed papers', '22 clinical trials', 'targets 1 of your genes (vus_uncertain: RRM2B)']
MOTEXAFIN GADOLINIUM	46.0	FDA approved	['FDA-approved', '6 tumor-type PubMed papers', '12 clinical trials', 'targets 1 of your genes (vus_uncertain: RRM2B)']
GEMCITABINE HYDROCHLORIDE	41.0	FDA approved	['FDA-approved', '14 clinical trials', 'targets 1 of your genes (vus_uncertain: RRM2B)']

SLC6A1 — 2 compound(s)

Drug	Score	Phase	Rationale
TIAGABINE	46.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', '2 clinical trials']
TIAGABINE HYDROCHLORIDE	44.0	FDA approved	['FDA-approved', '2 clinical trials']

SMO — 3 compound(s)

Drug	Score	Phase	Rationale
VISMODEGIB	58.0	FDA approved	['FDA-approved', '22 tumor-type PubMed papers', '10 clinical trials']
GLASDEGIB	54.0	FDA approved	['FDA-approved', '2 tumor-type PubMed papers', '16 driver-gene PubMed papers', '2 clinical trials']
SONIDEGIB	49.0	FDA approved	['FDA-approved', '8 tumor-type PubMed papers', '7 clinical trials']

TERT — 2 compound(s)

Drug	Score	Phase	Rationale
IMETELSTAT	46.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', '2 clinical trials', 'targets 1 of your genes (low-signal — no driver-tier hit)']
IMETELSTAT SODIUM	44.0	FDA approved	['FDA-approved', '2 clinical trials', 'targets 1 of your genes (low-signal — no driver-tier hit)']

TP53 — 1 compound(s)

Drug	Score	Phase	Rationale
EPRENETAPOPT	48.0	Phase 3	['Phase 3', '3 driver-gene PubMed papers', 'targets 1 of your genes (likely_driver: TP53) [canonical for lgg_astrocytoma: TP53]']

TRPM8 — 1 compound(s)

Drug	Score	Phase	Rationale
MENTHOL	49.0	FDA approved	['FDA-approved', '4 tumor-type PubMed papers', 'targets 1 of your genes (likely_driver: TRPM8)']

TRPV4 — 2 compound(s)

Drug	Score	Phase	Rationale
BUTAMBEN	41.0	FDA approved	['FDA-approved', 'targets 1 of your genes (vus_uncertain: TRPV4)']
BUTAMBEN PICRATE	41.0	FDA approved	['FDA-approved', 'targets 1 of your genes (vus_uncertain: TRPV4)']

TUBA1A — 8 compound(s)

Drug	Score	Phase	Rationale
VINCRISTINE	68.5	FDA approved	['FDA-approved', '613 tumor-type PubMed papers', '34 driver-gene PubMed papers', '65 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']
PACLITAXEL	58.5	FDA approved	['FDA-approved', '327 tumor-type PubMed papers', '7 driver-gene PubMed papers', '22 clinical trials', '⚠ P-gp substrate (reduced CNS exposure)', 'targets 4 of your genes (low-signal — no driver-tier hit)']
DOCETAXEL	51.5	FDA approved	['FDA-approved', '73 tumor-type PubMed papers', '2 driver-gene PubMed papers', '5 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']
VINCRISTINE SULFATE	51.5	FDA approved	['FDA-approved', '7 tumor-type PubMed papers', '65 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']
VINBLASTINE	50.5	FDA approved	['FDA-approved', '86 tumor-type PubMed papers', '1 driver-gene PubMed papers', '13 clinical trials', '⚠ P-gp substrate (reduced CNS exposure)', 'targets 4 of your genes (low-signal — no driver-tier hit)']
COLCHICINE	48.5	FDA approved	['FDA-approved', '52 tumor-type PubMed papers', '1 driver-gene PubMed papers', '⚠ P-gp substrate (reduced CNS exposure)', 'targets 4 of your genes (low-signal — no driver-tier hit)']
VINORELBINE	47.5	FDA approved	['FDA-approved', '30 tumor-type PubMed papers', '6 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']
CABAZITAXEL	41.5	FDA approved	['FDA-approved', '8 tumor-type PubMed papers', '3 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']

TUBA1B — 8 compound(s)

Drug	Score	Phase	Rationale
VINCRISTINE	68.5	FDA approved	['FDA-approved', '613 tumor-type PubMed papers', '34 driver-gene PubMed papers', '65 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']
PACLITAXEL	58.5	FDA approved	['FDA-approved', '327 tumor-type PubMed papers', '7 driver-gene PubMed papers', '22 clinical trials', '⚠ P-gp substrate (reduced CNS exposure)', 'targets 4 of your genes (low-signal — no driver-tier hit)']
DOCETAXEL	51.5	FDA approved	['FDA-approved', '73 tumor-type PubMed papers', '2 driver-gene PubMed papers', '5 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']
VINCRISTINE SULFATE	51.5	FDA approved	['FDA-approved', '7 tumor-type PubMed papers', '65 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']
VINBLASTINE	50.5	FDA approved	['FDA-approved', '86 tumor-type PubMed papers', '1 driver-gene PubMed papers', '13 clinical trials', '⚠ P-gp substrate (reduced CNS exposure)', 'targets 4 of your genes (low-signal — no driver-tier hit)']
COLCHICINE	48.5	FDA approved	['FDA-approved', '52 tumor-type PubMed papers', '1 driver-gene PubMed papers', '⚠ P-gp substrate (reduced CNS exposure)', 'targets 4 of your genes (low-signal — no driver-tier hit)']
VINORELBINE	47.5	FDA approved	['FDA-approved', '30 tumor-type PubMed papers', '6 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']
CABAZITAXEL	41.5	FDA approved	['FDA-approved', '8 tumor-type PubMed papers', '3 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']

TUBB4A — 8 compound(s)

Drug	Score	Phase	Rationale
VINCRISTINE	68.5	FDA approved	['FDA-approved', '613 tumor-type PubMed papers', '34 driver-gene PubMed papers', '65 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']
PACLITAXEL	58.5	FDA approved	['FDA-approved', '327 tumor-type PubMed papers', '7 driver-gene PubMed papers', '22 clinical trials', '⚠ P-gp substrate (reduced CNS exposure)', 'targets 4 of your genes (low-signal — no driver-tier hit)']
DOCETAXEL	51.5	FDA approved	['FDA-approved', '73 tumor-type PubMed papers', '2 driver-gene PubMed papers', '5 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']
VINCRISTINE SULFATE	51.5	FDA approved	['FDA-approved', '7 tumor-type PubMed papers', '65 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']
VINBLASTINE	50.5	FDA approved	['FDA-approved', '86 tumor-type PubMed papers', '1 driver-gene PubMed papers', '13 clinical trials', '⚠ P-gp substrate (reduced CNS exposure)', 'targets 4 of your genes (low-signal — no driver-tier hit)']
COLCHICINE	48.5	FDA approved	['FDA-approved', '52 tumor-type PubMed papers', '1 driver-gene PubMed papers', '⚠ P-gp substrate (reduced CNS exposure)', 'targets 4 of your genes (low-signal — no driver-tier hit)']
VINORELBINE	47.5	FDA approved	['FDA-approved', '30 tumor-type PubMed papers', '6 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']
CABAZITAXEL	41.5	FDA approved	['FDA-approved', '8 tumor-type PubMed papers', '3 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']

TUBB6 — 8 compound(s)

Drug	Score	Phase	Rationale
VINCRISTINE	68.5	FDA approved	['FDA-approved', '613 tumor-type PubMed papers', '34 driver-gene PubMed papers', '65 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']
PACLITAXEL	58.5	FDA approved	['FDA-approved', '327 tumor-type PubMed papers', '7 driver-gene PubMed papers', '22 clinical trials', '⚠ P-gp substrate (reduced CNS exposure)', 'targets 4 of your genes (low-signal — no driver-tier hit)']
DOCETAXEL	51.5	FDA approved	['FDA-approved', '73 tumor-type PubMed papers', '2 driver-gene PubMed papers', '5 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']
VINCRISTINE SULFATE	51.5	FDA approved	['FDA-approved', '7 tumor-type PubMed papers', '65 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']
VINBLASTINE	50.5	FDA approved	['FDA-approved', '86 tumor-type PubMed papers', '1 driver-gene PubMed papers', '13 clinical trials', '⚠ P-gp substrate (reduced CNS exposure)', 'targets 4 of your genes (low-signal — no driver-tier hit)']
COLCHICINE	48.5	FDA approved	['FDA-approved', '52 tumor-type PubMed papers', '1 driver-gene PubMed papers', '⚠ P-gp substrate (reduced CNS exposure)', 'targets 4 of your genes (low-signal — no driver-tier hit)']
VINORELBINE	47.5	FDA approved	['FDA-approved', '30 tumor-type PubMed papers', '6 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']
CABAZITAXEL	41.5	FDA approved	['FDA-approved', '8 tumor-type PubMed papers', '3 clinical trials', 'targets 4 of your genes (low-signal — no driver-tier hit)']

TYK2 — 5 compound(s)

Drug	Score	Phase	Rationale
RUXOLITINIB	58.0	FDA approved	['FDA-approved', '12 tumor-type PubMed papers', '11 driver-gene PubMed papers', '3 clinical trials']
TOFACITINIB	45.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', '1 driver-gene PubMed papers', '1 clinical trials']
TOFACITINIB CITRATE	42.0	FDA approved	['FDA-approved', '1 clinical trials']
DEUCRAVACITINIB	42.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers']
UPADACITINIB	42.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers']

VKORC1 — 6 compound(s)

Drug	Score	Phase	Rationale
WARFARIN	59.0	FDA approved	['FDA-approved', '10 tumor-type PubMed papers', '2 driver-gene PubMed papers', 'targets 1 of your genes (pathogenic: VKORC1)']
ACENOCOUMAROL	52.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', 'targets 1 of your genes (pathogenic: VKORC1)']
WARFARIN SODIUM	52.0	FDA approved	['FDA-approved', '1 tumor-type PubMed papers', 'targets 1 of your genes (pathogenic: VKORC1)']
PHENPROCOUMON	50.0	FDA approved	['FDA-approved', 'targets 1 of your genes (pathogenic: VKORC1)']
PHENINDIONE	50.0	FDA approved	['FDA-approved', 'targets 1 of your genes (pathogenic: VKORC1)']
DICUMAROL	50.0	FDA approved	['FDA-approved', 'targets 1 of your genes (pathogenic: VKORC1)']

8. Immune / neoantigen angle

Plain English: your T-cells see foreign things through HLA molecules — your genetic "display cabinet." A tumor mutation becomes a neoantigen only if the mutant protein fragment (9-10 amino acids) fits tightly into your specific HLA display. We predicted every possible mutant peptide and ranked them by binding strength, surface presentation, RNA-level expression (the tumor must make the protein), and clonality (the mutation must be in most tumor cells).

Your HLA type

Class I (MHC-I): HLA-A*03:01 HLA-A*26:01 HLA-B*15:01 HLA-B*35:01 HLA-C*03:04 HLA-C*04:01
Class II (MHC-II): HLA-DPA1*01:03-DPB1*02:01 HLA-DQA1*01:03-DQB1*03:02 HLA-DQA1*01:03-DQB1*06:01 HLA-DRB1*04:01 HLA-DRB1*15:02

HLA-II typing notes:

DRB1*04:274 is a rare allele; fallback to DRB1*04:01 (same P-group, NetMHCIIpan-supported)
DPB1*677:01 is suspicious (likely typing artifact); fallback to DPB1*02:01 (most common)

HLA region copy status (depth proxy): HLA-A: depth gain (2.02×)HLA-B: depth gain (1.84×)HLA-C: depth gain (1.78×)

Caveat — not true HLA-LOH. LOHHLA was not run (reportability: insufficient_inputs; reasons: tumor_bam=missing, normal_bam=missing). The values above come from a tumor/normal read-depth proxy across the HLA region — useful as a CNV hint but not allele-specific. Do NOT down-weight peptides on this basis without a LOHHLA-confirmed call.

2,104 strong point-mutation binders (<500 nM or presentation score ≥ 0.5) across 213,102 scored point-mutation peptides (of 264,183 total candidates incl. 463 splicing)

Top-50 source breakdown: point_mutation: 50 · splicing-derived candidates are partitioned into a dedicated annex below.

Gene	Mutation	Peptide	HLA	Affinity (nM)	Pres.	Proc.	TPM	VAF	CCF	PRIME	TCR-fit	Self-fit	Signals	Composite
IDH1 driver	R132C	KPIIIGCHAY	HLA-B*35:01	56	0.91	0.54	37.1	22.1%	1.00	0.07	—	—	RNA supportedclonal	259.57
FGD4	M813V	YVYGAPQDV	HLA-C*03:04	58	0.63	0.05	48.1	16.2%	1.00	0.02	1.00	—	RNA supportedclonal2-caller consensus	240.39
TIMM44	N256H	VVFHRFFEM	HLA-C*03:04	144	0.72	0.41	9.9	37.8%	1.00	0.10	0.50	—	RNA supportedclonal2-caller consensus	226.94
ATRX driver	G1712D	LVDPDPDFV	HLA-C*04:01	115	0.68	0.29	99.2	52.2%	1.00	0.12	0.00	—	RNA supportedclonal2-caller consensus	225.63
FGD4	M813V	KQDPLVLYV	HLA-C*04:01	99	0.95	0.89	48.1	16.2%	1.00	0.14	—	—	RNA supportedclonal2-caller consensus	224.78
FGD4	M813V	KQDPLVLYVY	HLA-B*15:01	99	0.94	0.80	48.1	16.2%	1.00	0.10	—	—	RNA supportedclonal2-caller consensus	220.24
FGD4	M813V	KQDPLVLYV	HLA-C*03:04	361	0.85	0.89	48.1	16.2%	1.00	0.04	—	—	RNA supportedclonal2-caller consensus	213.85
AHNAK	K1319N	HFNAPKISM	HLA-C*04:01	66	0.92	0.61	73.9	30.1%	1.00	0.10	—	—	RNA supportedclonal2-caller consensus	210.96
FGD4	M813V	DPLVLYVY	HLA-B*35:01	147	0.88	0.71	48.1	16.2%	1.00	0.18	—	1.00	RNA supportedclonal2-caller consensus	210.46
ATRX driver	G1712D	ALVDPDPDF	HLA-B*15:01	140	0.54	0.18	99.2	52.2%	1.00	0.03	0.01	—	RNA supportedclonal2-caller consensus	202.12
AHNAK	K1319N	KMPEMHFNAPK	HLA-A*03:01	96	0.84	0.49	73.9	30.1%	1.00	0.03	—	—	RNA supportedclonal2-caller consensus	198.22
TP53 driver	Q144fs	RPAPASAPW	HLA-B*35:01	109	0.78	0.42	20.1	56.4%	1.00	—	1.00	—	RNA supportedclonal2-caller consensus	193.97
AKAP13	V2133I	MSSSIVRRL	HLA-C*03:04	61	0.97	0.89	41.4	30.2%	1.00	0.03	—	—	RNA supportedclonal	188.84
FGD4	M813V	KQDPLVLYV	HLA-B*15:01	1429	0.60	0.89	48.1	16.2%	1.00	0.04	—	—	RNA supportedclonal2-caller consensus	186.73
TP53 driver	Q144fs	IPHPRPAPA	HLA-B*35:01	126	0.74	0.40	20.1	56.4%	1.00	—	1.00	—	RNA supportedclonal2-caller consensus	184.32
TIMM44	N256H	VVFHRFFEM	HLA-A*26:01	626	0.38	0.41	9.9	37.8%	1.00	0.05	0.50	—	RNA supportedclonal2-caller consensus	181.26
ATRX driver	G1712D	LVDPDPDFV	HLA-C*03:04	524	0.32	0.29	99.2	52.2%	1.00	0.02	0.00	—	RNA supportedclonal2-caller consensus	176.22
TP53 driver	Q144fs	HPRPAPASAPW	HLA-B*35:01	96	0.73	0.31	20.1	56.4%	1.00	—	1.00	—	RNA supportedclonal2-caller consensus	175.40
AKAP13	V2133I	KMSSSIVRR	HLA-A*03:01	36	0.89	0.34	41.4	30.2%	1.00	0.10	—	—	RNA supportedclonal	165.02
TIMM44	N256H	VVFHRFFEM	HLA-B*15:01	1177	0.25	0.41	9.9	37.8%	1.00	0.04	0.50	—	RNA supportedclonal2-caller consensus	163.71
NLGN1	V363F	LQKKPYKELF	HLA-B*15:01	252	0.63	0.45	64.4	14.9%	0.93	0.03	—	—	RNA supportedclonal2-caller consensus	161.95
TIMM44	N256H	VVFHRFFEMK	HLA-A*03:01	161	0.56	0.24	9.9	37.8%	1.00	0.06	—	—	RNA supportedclonal2-caller consensus	158.10
TIMM44	N256H	KENNVVFHRF	HLA-B*15:01	894	0.44	0.58	9.9	37.8%	1.00	0.03	—	—	RNA supportedclonal2-caller consensus	158.05
PCBP1	I29T	EVGSITGKK	HLA-A*03:01	434	0.68	0.66	123.3	18.1%	1.00	0.02	—	—	RNA supportedclonal	155.83
IDH1 driver	R132C	KPIIIGCHAY	HLA-B*15:01	4058	0.14	0.54	37.1	22.1%	1.00	0.03	—	—	RNA supportedclonal	155.13
FGD4	M813V	IPKQDPLVLYVY	HLA-B*35:01	1360	0.61	0.89	48.1	16.2%	1.00	—	1.00	—	RNA supportedclonal2-caller consensus	147.42
TIMM44	N256H	KENNVVFHR	HLA-A*03:01	2193	0.31	0.66	9.9	37.8%	1.00	0.08	—	—	RNA supportedclonal2-caller consensus	146.35
TIMM44	N256H	VVFHRFFEM	HLA-B*35:01	3277	0.11	0.41	9.9	37.8%	1.00	0.04	0.50	—	RNA supportedclonal2-caller consensus	144.97
PCBP1	I29T	KEVGSITGK	HLA-A*03:01	572	0.56	0.59	123.3	18.1%	1.00	0.04	—	—	RNA supportedclonal	143.25
NLGN1	V363F	LFDQDIQPA	HLA-C*04:01	89	0.56	0.07	64.4	14.9%	0.93	0.02	—	—	RNA supportedclonal2-caller consensus	142.14
FGD4	M813V	KQDPLVLYVY	HLA-B*35:01	6332	0.21	0.80	48.1	16.2%	1.00	0.03	—	—	RNA supportedclonal2-caller consensus	141.54
AHNAK	K1319N	HFNAPKISM	HLA-B*35:01	2138	0.27	0.61	73.9	30.1%	1.00	0.02	—	—	RNA supportedclonal2-caller consensus	141.44
IDH1 driver	R132C	KPIIIGCHAY	HLA-A*26:01	19835	0.03	0.54	37.1	22.1%	1.00	0.02	—	—	RNA supportedclonal	141.12
TIMM44	N256H	VVFHRFFEM	HLA-A*03:01	4851	0.08	0.41	9.9	37.8%	1.00	0.04	0.50	—	RNA supportedclonal2-caller consensus	140.69
FGD4	M813V	KQDPLVLYV	HLA-A*03:01	13799	0.14	0.89	48.1	16.2%	1.00	0.09	—	—	RNA supportedclonal2-caller consensus	137.29
AHNAK	K1319N	HFNAPKISM	HLA-B*15:01	2758	0.23	0.61	73.9	30.1%	1.00	0.02	—	—	RNA supportedclonal2-caller consensus	136.44
FGD4	M813V	KQDPLVLYVY	HLA-A*03:01	9163	0.16	0.80	48.1	16.2%	1.00	0.03	—	—	RNA supportedclonal2-caller consensus	135.79
TIMM44	N256H	VVFHRFFEM	HLA-C*04:01	10205	0.04	0.41	9.9	37.8%	1.00	0.04	0.50	—	RNA supportedclonal2-caller consensus	135.57
FGD4	M813V	KQDPLVLYVY	HLA-C*04:01	11081	0.13	0.80	48.1	16.2%	1.00	0.03	—	—	RNA supportedclonal2-caller consensus	133.33
ATRX driver	G1712D	LVDPDPDFV	HLA-B*35:01	13987	0.02	0.29	99.2	52.2%	1.00	0.02	0.00	—	RNA supportedclonal2-caller consensus	133.32
ATRX driver	G1712D	ALVDPDPDF	HLA-B*35:01	4956	0.04	0.18	99.2	52.2%	1.00	0.03	0.01	—	RNA supportedclonal2-caller consensus	130.94
ATRX driver	G1712D	ALVDPDPDF	HLA-A*26:01	22912	0.01	0.18	99.2	52.2%	1.00	0.02	0.01	—	RNA supportedclonal2-caller consensus	127.10
TP53 driver	Q144fs	HPRPAPASA	HLA-B*35:01	146	0.53	0.17	20.1	56.4%	1.00	—	1.00	—	RNA supportedclonal2-caller consensus	122.94
AHNAK	K1319N	HFNAPKISM	HLA-C*03:04	349	0.69	0.61	73.9	30.1%	1.00	0.01	—	—	RNA supportedclonal2-caller consensus	121.84
PCBP1	I29T	EVGSITGKK	HLA-A*26:01	2336	0.29	0.66	123.3	18.1%	1.00	0.08	—	—	RNA supportedclonal	120.97
TIMM44	N256H	KENNVVFHR	HLA-A*26:01	23537	0.04	0.66	9.9	37.8%	1.00	0.02	—	—	RNA supportedclonal2-caller consensus	117.90
TIMM44	N256H	KENNVVFHRF	HLA-A*26:01	18012	0.04	0.58	9.9	37.8%	1.00	0.04	—	—	RNA supportedclonal2-caller consensus	114.88
TIMM44	N256H	KENNVVFHRF	HLA-A*03:01	22031	0.03	0.58	9.9	37.8%	1.00	0.05	—	—	RNA supportedclonal2-caller consensus	114.12
AKAP13	V2133I	KMSSSIVRRL	HLA-A*03:01	770	0.29	0.35	41.4	30.2%	1.00	0.03	—	—	RNA supportedclonal	111.49
TP53 driver	Q144fs	IPHPRPAPA	HLA-C*03:04	646	0.37	0.40	20.1	56.4%	1.00	—	1.00	—	RNA supportedclonal2-caller consensus	106.02

Best neoantigen per mutation (for vaccine design)

One peptide per distinct mutation — what you'd include in a personalized vaccine, dedup'd so you don't get multiple peptides from the same source. Showing the top 50 of 572 unique mutations; the full ranking is in neoantigens_v5_all.json.

Gene	Mutation	Peptide	HLA	Affinity (nM)	Pres.	Proc.	TPM	VAF	CCF	PRIME	TCR-fit	Self-fit	Signals	Composite
IDH1 driver	R132C	KPIIIGCHAY	HLA-B*35:01	56	0.91	0.54	37.1	22.1%	1.00	0.07	—	—	RNA supportedclonal	259.57
FGD4	M813V	YVYGAPQDV	HLA-C*03:04	58	0.63	0.05	48.1	16.2%	1.00	0.02	1.00	—	RNA supportedclonal2-caller consensus	240.39
TIMM44	N256H	VVFHRFFEM	HLA-C*03:04	144	0.72	0.41	9.9	37.8%	1.00	0.10	0.50	—	RNA supportedclonal2-caller consensus	226.94
ATRX driver	G1712D	LVDPDPDFV	HLA-C*04:01	115	0.68	0.29	99.2	52.2%	1.00	0.12	0.00	—	RNA supportedclonal2-caller consensus	225.63
AHNAK	K1319N	HFNAPKISM	HLA-C*04:01	66	0.92	0.61	73.9	30.1%	1.00	0.10	—	—	RNA supportedclonal2-caller consensus	210.96
TP53 driver	Q144fs	RPAPASAPW	HLA-B*35:01	109	0.78	0.42	20.1	56.4%	1.00	—	1.00	—	RNA supportedclonal2-caller consensus	193.97
AKAP13	V2133I	MSSSIVRRL	HLA-C*03:04	61	0.97	0.89	41.4	30.2%	1.00	0.03	—	—	RNA supportedclonal	188.84
NLGN1	V363F	LQKKPYKELF	HLA-B*15:01	252	0.63	0.45	64.4	14.9%	0.93	0.03	—	—	RNA supportedclonal2-caller consensus	161.95
PCBP1	I29T	EVGSITGKK	HLA-A*03:01	434	0.68	0.66	123.3	18.1%	1.00	0.02	—	—	RNA supportedclonal	155.83
CABIN1	D76G	AVSSGGEKEGLK	HLA-A*03:01	108	0.48	0.04	50.5	23.5%	1.00	—	—	—	RNA supportedclonal2-caller consensus	52.63
FMNL1 driver	V648A	MPLLNWAAL	HLA-B*35:01	57	0.77	0.23	11.3	27.5%	1.00	—	—	—	no RNA evidenceclonal2-caller consensus	39.76
HEPACAM2 driver	G164R	GAVEYVRNM	HLA-C*03:04	57	0.91	0.54	0.3	34.9%	1.00	—	—	—	no RNA evidenceclonal2-caller consensus	25.45
HTR1E	D269N	RIPPFNNDL	HLA-C*03:04	86	0.92	0.70	1.7	28.5%	1.00	—	0.01	—	no RNA evidenceclonal2-caller consensus	24.41
NPC1 driver	D508N	YANYHTHFL	HLA-C*03:04	27	0.98	0.83	39.3	0%	0.00	—	—	—	no RNA evidencesubclonal	17.01
SMARCA1	I722S	RMDSEQSLY	HLA-B*15:01	95	0.96	0.90	87.6	0%	0.00	—	1.00	—	no RNA evidencesubclonal	16.93
NPC1 driver	S954L	YFDWVKPQL	HLA-C*04:01	26	0.98	0.80	39.3	0%	0.00	—	—	—	no RNA evidencesubclonal	16.88
HMOX2	R137W	KYVEWIHYI	HLA-C*04:01	207	0.93	0.96	27.1	0%	0.00	—	1.00	—	no RNA evidencesubclonal	16.83
TTN	S12667L	VVLEKKVPL	HLA-C*03:04	70	0.69	0.17	5.0	16.6%	1.00	—	0.01	—	no RNA evidenceclonal	16.75
NVL driver	R49L	RVYSIDYGLR	HLA-A*03:01	81	0.82	0.40	14.3	0%	0.00	—	1.00	—	no RNA evidencesubclonal	16.66
CCDC178	R472W	KTNESIWKK	HLA-A*03:01	31	0.97	0.69	20.2	0%	0.00	—	1.00	—	no RNA evidencesubclonal	16.17
TCF20	Q186H	VQQLRQHLY	HLA-B*15:01	43	0.94	0.60	26.3	0%	0.00	—	1.00	—	no RNA evidencesubclonal	15.40
CHD8	H1117R	RIIPHDFHL	HLA-C*03:04	75	0.91	0.63	35.6	0%	0.00	—	1.00	—	no RNA evidencesubclonal	15.15
ERBB3 driver	R916L	EPYAGLLLA	HLA-B*35:01	582	0.63	0.67	21.8	0%	0.00	—	1.00	—	no RNA evidencesubclonal	14.92
FLRT2	E189fs	SYPTWPSRI	HLA-C*04:01	189	0.85	0.72	32.7	0%	0.00	—	0.99	—	no RNA evidencesubclonal	14.74
PLCG2 driver	D1144N	FSNPNFLAH	HLA-B*35:01	184	0.90	0.83	8.5	0%	0.00	—	—	—	no RNA evidencesubclonal	14.67
GRID2	R692H	AVYEHVHMK	HLA-A*03:01	24	0.99	0.94	37.0	0%	0.00	—	0.50	—	no RNA evidencesubclonal	14.65
CDC42BPB	R496C	KLNEEIECL	HLA-C*03:04	197	0.84	0.70	71.7	0%	0.00	—	1.00	—	no RNA evidencesubclonal	14.55
SEC31A	A906V	NVYPNTPYI	HLA-C*03:04	81	0.88	0.55	61.0	0%	0.00	—	1.00	—	no RNA evidencesubclonal	14.36
POLR1B	R72H	AFKDEHISF	HLA-C*04:01	97	0.87	0.57	21.0	0%	0.00	—	1.00	—	no RNA evidencesubclonal	14.31
HOOK3	A51T	VLQKIDPTY	HLA-B*15:01	43	0.91	0.45	72.0	0%	0.00	—	1.00	—	no RNA evidencesubclonal	14.29
ZBTB47	G258R	RPSPATVVL	HLA-B*35:01	76	0.96	0.90	71.6	0%	0.00	—	0.50	—	no RNA evidencesubclonal	14.21
MICALL2	S631I	GSFAGIVHI	HLA-C*03:04	145	0.91	0.80	13.9	0%	0.00	—	0.67	—	no RNA evidencesubclonal	14.12
SMPD1	P181S	STVPKPPPK	HLA-A*03:01	26	0.92	0.37	15.9	0%	0.00	—	1.00	—	no RNA evidencesubclonal	14.10
ENPP5	T175M	KIIEWFMSK	HLA-A*03:01	23	0.98	0.80	8.1	0%	0.00	—	0.67	—	no RNA evidencesubclonal	13.56
LRRC8D	K730fs	EPAAFAYHW	HLA-B*35:01	475	0.73	0.74	33.6	0%	0.00	—	1.00	—	no RNA evidencesubclonal	13.14
CPSF1	D801N	LPNWRLVFL	HLA-B*35:01	139	0.91	0.77	110.9	0%	0.00	—	0.50	—	no RNA evidencesubclonal	13.11
FAM171A1	F57Y	VADALIEIY	HLA-B*35:01	61	0.93	0.65	45.7	0%	0.00	—	0.50	—	no RNA evidencesubclonal	12.93
COG6	R521H	ALFEFTDRH	HLA-A*03:01	192	0.77	0.56	51.7	0%	0.00	—	0.99	—	no RNA evidencesubclonal	12.88
PEG3	R50W	HQRFWNLIY	HLA-B*15:01	37	0.95	0.58	59.4	0%	0.00	—	0.51	—	no RNA evidencesubclonal	12.85
SIL1	R92W	VPAGSHVWL	HLA-B*35:01	235	0.75	0.59	11.4	0%	0.00	—	1.00	—	no RNA evidencesubclonal	12.82
ADCY5	R228W	FPSDKLEWL	HLA-B*35:01	88	0.88	0.57	23.6	0%	0.00	—	0.67	—	no RNA evidencesubclonal	12.81
BEST3	S66A	RYFEKLAIY	HLA-B*15:01	388	0.71	0.67	115.7	0%	0.00	—	0.99	—	no RNA evidencesubclonal	12.52
RAPH1	R353C	IFMECIEKY	HLA-B*15:01	352	0.81	0.80	83.7	0%	0.00	—	0.50	—	no RNA evidencesubclonal	12.09
ATG2A	Y973F	SQFCGQPGLGY	HLA-B*15:01	36	0.91	0.41	14.5	0%	0.00	—	0.50	—	no RNA evidencesubclonal	11.76
CDH13	K366T	SPKFTKTEF	HLA-B*35:01	54	0.98	0.94	18.9	0%	0.00	—	—	—	no RNA evidencesubclonal	11.60
LARGE1	R515H	AEAQQFLHY	HLA-B*15:01	109	0.96	0.93	26.6	0%	0.00	—	—	—	no RNA evidencesubclonal	11.39
TBC1D13	S248R	FATDPNREW	HLA-B*35:01	93	0.96	0.91	23.4	0%	0.00	—	0.00	—	no RNA evidencesubclonal	11.37
B4GALT2	A36T	YFDVYTQHL	HLA-C*04:01	25	0.98	0.83	39.8	0%	0.00	—	0.00	—	no RNA evidencesubclonal	11.33
PLXNA3	A91T	TPVDNINKL	HLA-B*35:01	69	0.96	0.87	21.2	0%	0.00	—	—	—	no RNA evidencesubclonal	11.28
MLKL	N212T	LLRETEVSTLY	HLA-B*15:01	104	0.90	0.69	4.7	0%	0.00	—	0.99	—	no RNA evidencesubclonal	11.24

522 additional mutations below composite score 11.24 omitted (see cache file).

Splicing-derived neoantigens (exploratory annex — not part of the SLP vaccine ordering unit)

Treat these as candidates for follow-up, not vaccine-ready targets. MHCflurry scores here look strong (presentation ≥ 0.94 on the top rows), but several validation steps are missing before any of these should replace a point-mutation candidate in the SLP table above:

Junction reads are not translation evidence. High uniq_reads confirms the junction is spliced; it does not confirm the predicted peptide is made. Frameshift junctions often trigger NMD and the mRNA is degraded before translation.
No normal-tissue atlas filter. "Novel" here means "not in GENCODE", which is not the same as "absent from GTEx / recount3 normal tissue." A cryptic junction present at low levels in brain or liver produces off-target T-cell attack.
Clonality is unmeasured, not subclonal. Splicing events lack VAF/CCF; the "subclonal" pill elsewhere is a display fallback when clonal is None.
Gene identity not always resolved. Rows are keyed by genomic coordinates of the junction; the parent transcript / gene and its essentiality are not annotated here.

Junction	Strand/Frame	Peptide	HLA	Pres.	Proc.	Reads	v5 score
3:12836224-12839348	./?	AADVQQILL	HLA-C*04:01	0.98	0.86	4,086	101.94
1:225501071-225507950	./?	YLQTKIHTL	HLA-C*03:04	0.97	0.85	1,810	101.40
1:182385888-182386255	./?	LPRAPGSIL	HLA-B*35:01	0.94	0.83	2,260	99.74
7:139620564-139626600	./?	SPQHTRQIM	HLA-B*35:01	0.91	0.73	2,889	97.06
11:10800836-10800961	./?	HLWDRHLSL	HLA-C*03:04	0.94	0.66	2,288	97.05
14:103520312-103520468	./?	ASAPASPRL	HLA-C*03:04	0.93	0.58	1,647	95.70
14:21019977-21020495	./?	SPQANRPHL	HLA-B*35:01	0.80	0.93	2,369	94.84
17:7651631-7653373	./?	AAPGPAGPL	HLA-C*03:04	0.92	0.37	1,986	91.72
19:3980710-3980840	./?	RTTRLPWALK	HLA-A*03:01	0.89	0.42	2,462	91.31
7:26197733-26200571	./?	RLSPRWREK	HLA-A*03:01	0.86	0.26	1,693	87.50
17:44913824-44914027	./?	TTWLPIDRK	HLA-A*03:01	0.78	0.35	4,880	85.59
14:61726819-61727452	./?	KVCNMEGIAL	HLA-C*03:04	0.74	0.51	1,803	85.58
1:110020852-110021673	./?	ITDTNGPYY	HLA-B*35:01	0.68	0.60	2,448	84.24
7:121968131-121972540	./?	ITLGKQWKL	HLA-C*03:04	0.66	0.58	3,745	83.40
5:181237720-181238098	./?	RPQHQDLGF	HLA-B*35:01	0.93	0.86	2,051	83.22

448 additional splicing candidates omitted (see splicing_neoantigens_strong.json).

Vaccine-candidate ordering list (short + long + optimized)

Plain English: this is what a vaccine designer would actually order. Modern personalized cancer vaccines (Ott et al. 2017 Nature; Keskin et al. 2019 Nature; BioNTech mRNA-4157) pair each mutation's short class-I epitope (8-12mer, CD8 killer response) with a long class-II peptide (13-25mer, CD4 helper response + cross-presentation to CD8). We add a third column: an optimized heteroclitic variant with anchor-position substitutions (P2 / P_Ω) designed to bind HLA more tightly while leaving the TCR-contact face untouched — the same trick used in the melanoma gp100 V→L heteroclitic and the NY-ESO-1 vaccines (Borbulevych 2007). The DAI pill is Łuksza 2017's differential agretopicity (WT/MT affinity ratio); the TCEM / anchor / flanking pill is Capietto 2020's position class; the TCR-fit pill is Łuksza 2017's partition-function R-score — BLOSUM62 similarity of the short peptide to the IEDB positive T-cell-epitope catalogue, so higher = closer to a known immunogen = more likely a TCR that can recognise it already exists. Blank pill = no IEDB neighbour (doesn't mean non-immunogenic, just unobserved). The ⚠ mimicry pill fires when the same short peptide also looks like a normal human protein (R_SELF against the Swiss-Prot proteome ≥ 0.5 with TCR-fit ≥ 0.5) — that's the molecular-mimicry profile for post-vaccine autoimmunity (Segal & Shoenfeld 2018), so the composite score's TCR-fit boost is capped by max(0, TCR-fit − Self-fit) to down-rank those candidates automatically. An self-like pill (amber) means R_SELF ≥ 0.5 without a high TCR-fit — less urgent but still worth flagging.

18 mutation-level vaccine candidates. Pairing: 492 nested (ideal SLP), 0 overlapping only, 0 synthesized, 0 short-only.
Flanking optimization: 10 improved anchors, 8 already canonical; 14 TCEM-mutation (best immunogenicity), 3 anchor-mutation (weakest per Capietto). Showing top 25 by class-I composite score.

Mutation	Short (class I)	Long (class II)	Optimized (flanking)	SLP registration	Signals	DNA / RNA VAF	Score
IDH1 R132C	KPIIIGCHAY HLA-B*35:01 · 56 nM	GWVKPIIIGCHAY 13mer · HLA-DRB1*04:01	native anchors already canonical — no optimization needed	nested (SLP-ready)	clonalRNA+defining driverTCEMDAI 1.3×	22.1% RNA —	344.2
ATRX G1712D	LVDPDPDFV HLA-C*04:01 · 115 nM	FNKALVDPDPDFV 13mer · HLA-DRB1*04:01	LYDPDPDFL anchor: P2 V→Y, P9 V→L · needs MHCflurry re-score	nested (SLP-ready)	clonalRNA+canonical driver (primary)TCEMDAI 0.7×	52.2% RNA —	293.3
TIMM44 N256H	VVFHRFFEM HLA-C*03:04 · 144 nM	KENNVVFHRFFEM 13mer · HLA-DRB1*04:01	VVFHRFFEL anchor: P9 M→L · needs MHCflurry re-score	nested (SLP-ready)	clonalRNA+TCEMDAI 0.6×TCR-fit 0.50	37.8% RNA —	255.3
AHNAK K1319N	HFNAPKISM HLA-C*04:01 · 66 nM	MPEMHFNAPKISM 13mer · HLA-DRB1*04:01	native anchors already canonical — no optimization needed	nested (SLP-ready)	clonalRNA+TCEMDAI 4.4×	30.1% RNA —	189.9
AKAP13 V2133I	KMSSSIVRR HLA-A*03:01 · 36 nM	FVKKKMSSSIVRR 13mer · HLA-DRB1*04:01	native anchors already canonical — no optimization needed	nested (SLP-ready)	clonalRNA+TCEMDAI 1.0×	30.2% RNA —	148.5
FGD4 M813V	YVYGAPQDV HLA-C*03:04 · 58 nM	PLVLYVYGAPQDV 13mer · HLA-DRB1*04:01	YVYGAPQDL anchor: P9 V→L · needs MHCflurry re-score	nested (SLP-ready)	clonalRNA+anchorDAI 3.1×TCR-fit 1.00	16.2% RNA —	147.2
TP53 Q144fs	APWPSTSSH HLA-B*35:01 · 90 nM	APASAPWPSTSSH 13mer · HLA-DRB1*04:01	APWPSTSSY anchor: P9 H→Y · needs MHCflurry re-score	nested (SLP-ready)	clonalRNA+canonical driver (primary)	56.4% RNA —	127.8
PCBP1 I29T	EVGSITGKK HLA-A*03:01 · 434 nM	MHGKEVGSITGKK 13mer · HLA-DRB1*04:01	native anchors already canonical — no optimization needed	nested (SLP-ready)	clonalRNA+TCEMDAI 0.9×	18.1% RNA —	71.1
NLGN1 V363F	LFDQDIQPA HLA-C*04:01 · 89 nM	PYKELFDQDIQPA 13mer · HLA-DRB1*04:01	LFDQDIQPL anchor: P9 A→L · needs MHCflurry re-score	nested (SLP-ready)	clonalRNA+anchorDAI 31.0×	14.9% RNA —	57.3
CABIN1 D76G	AVSSGGEKEGLK HLA-A*03:01 · 108 nM	EAVSSGGEKEGLK 13mer · HLA-DRB1*04:01	native anchors already canonical — no optimization needed	nested (SLP-ready)	clonalRNA+TCEMDAI 1.0×	23.5% RNA —	44.5
FMNL1 V648A	MPLLNWAAL HLA-B*35:01 · 57 nM	TKFRMPLLNWAAL 13mer · HLA-DRB1*04:01	native anchors already canonical — no optimization needed	nested (SLP-ready)	clonalcandidate driverTCEMDAI 0.8×	27.5% RNA —	39.8
HEPACAM2 G164R	GAVEYVRNM HLA-C*03:04 · 57 nM	HPPSGAVEYVRNM 13mer · HLA-DRB1*04:01	GAVEYVRNL anchor: P9 M→L · needs MHCflurry re-score	nested (SLP-ready)	clonalcandidate driverTCEMDAI 1.5×	34.9% RNA —	25.4
HTR1E D269N	RIPPFNNDL HLA-C*03:04 · 86 nM	HASIRIPPFNNDL 13mer · HLA-DRB1*04:01	RAPPFNNDL anchor: P2 I→A · needs MHCflurry re-score	nested (SLP-ready)	clonalTCEMDAI 1.4×	28.5% RNA —	22.1
TTN S12667L	KVPLTPPKK HLA-A*03:01 · 56 nM	VLEKKVPLTPPKK 13mer · HLA-DRB1*04:01	native anchors already canonical — no optimization needed	nested (SLP-ready)	clonalTCEMDAI 0.8×	16.6% RNA —	6.4
CDKN2A G45S	YSRRPIQVM HLA-C*03:04 · 65 nM	APNSYSRRPIQVM 13mer · HLA-DRB1*04:01	YSRRPIQVL anchor: P9 M→L · needs MHCflurry re-score	nested (SLP-ready)	canonical driver (primary)anchorDAI 1.9×	— RNA —	4.5
CLCA2 C429W	LGNWLPTVL HLA-C*03:04 · 78 nM	DDKLLGNWLPTVL 13mer · HLA-DRB1*04:01	LANWLPTVL anchor: P2 G→A · needs MHCflurry re-score	nested (SLP-ready)	clonalTCEMDAI 1.5×	13.2% RNA —	3.6
TTL V181M	GQVHMIQKY HLA-B*15:01 · 34 nM	IDNQGQVHMIQKY 13mer · HLA-DRB1*04:01	native anchors already canonical — no optimization needed	nested (SLP-ready)	clonalTCEMDAI 1.0×	6.7% RNA —	3.3
EIF2A A234V	LWNKKATVV HLA-C*04:01 · 282 nM	KVTMLWNKKATVV 13mer · HLA-DRB1*04:01	LYNKKATVL anchor: P2 W→Y, P9 V→L · needs MHCflurry re-score	nested (SLP-ready)	clonalTCEMDAI 1.5×	8.2% RNA —	1.0

Full ordering list: cache/vaccine_candidates.json. References: Ott 2017, Keskin 2019, Sahin 2017 (SLP design); Łuksza 2017 (DAI); Capietto 2020 (position filter); Borbulevych 2007 (heteroclitic mechanism); Lindeboom 2016 (NMD rules).

12. Data quality & limits

Plain English: every number in this report has error bars. Low coverage means we might have missed some mutations; low purity means we might have missed subclonal ones; caller disagreement means some calls are low-confidence. This section shows what every major pipeline step actually produced on your data, flags anomalies inline with ⚠, and ends with an explicit list of what this report does not cover.

Sequencing QC (raw alignment)

Mapped reads	359,934,891 / 360,168,707
Mapping rate	99.94%
Duplicate rate	35.6% (insert-size overlap: insert 161bp < 2× read 136bp; some duplicates are R1/R2 overlap artifacts, not PCR)
Mean coverage	unavailable — coverage parser received total bases, not mean coverage
% bases ≥ 30×	—
HQ aligned Q20 bases	44,365,351,876
Mean read length	136 bp
Consensus rate (Mutect2 ∩ MuSE)	31.6% ⚠ low multi-caller agreement
Tumor purity confidence	purity_ploidy_aware

Per-stage output audit

Every major pipeline step with its key outputs and any inline ⚠ anomalies. If a stage isn't listed, it didn't run or produced no cache for this patient.

Somatic variant calling

Somatic variants annotated (VEP)	649
MuSE Tier2/3 rescued (research_only pool)	33
Genes with ≥1 somatic variant	618

Merged Mutect2 PASS + MuSE Tier1. Relaxed-threshold rescue (FilterMutectCalls tuned down) feeds `somatic.pass_relaxed.vcf.gz`. MuSE Tier2/3 rescue flagged `research_only_tier` and consumed on next neoantigen spawn.

Cache: stage1_all_mutations.json, muse_rescued_variants.json

VEP annotation

Total VEP-annotated rows	649
HIGH impact (frameshift / stop / splice)	82
MODERATE impact (missense)	567
Top consequences	missense_variant: 565, stop_gained: 48, splice_donor_variant: 15, splice_acceptor_variant: 12

Cache: somatic.vep.txt

Variant pathogenicity classification

Tumor type resolved	lgg_astrocytoma
Canonical driver reference set size	44 genes
Pathogenic (ClinVar)	11
Likely driver	29
VUS / uncertain	451
Likely passenger	150
Canonical patient drivers (literature-backed for tumor type)	4: ATRX, CDKN2A, IDH1, TP53
Algorithmic candidates (predictor-only)	25: ARHGEF10L, AXIN1, BCL6, CASZ1, CUX1, CYP2C8, DOT1L, ERBB3, FAT3, FMNL1, HEPACAM2, HLA-B, KDM3B, KDR, NBEA, NVL, RNF213, SPEN, STK11, SUSD2, TBX3, TPR, TRPM8, USP9X, WNK2
Canonical drivers with no signal (wild-type in every source)	28 — defining: IDH2; primary: ARID1A, ARID2, BCOR, CHD4, CIC, DNMT3A, EGFR, FUBP1, MAX, MTOR, NF1, NIPBL, NRAS, PDGFRA, PIK3CA, PLCG1, PTEN, PTPN11, SETD2, SMARCA4; secondary: CDKN2C, CHRDL1, ELF4, MED12, MYH11, RUNX1T1; NKX2-1

Canonical vs algorithmic split comes from merging IntOGen per-cancer-type + hand-curated override. COSMIC CGC layer not yet staged (see `scripts/fetch_cosmic_cgc.py`).

Cache: variant_pathogenicity.json

Copy-number variants

Total CNV gain events	0
Total CNV loss events	0
CNV events on canonical-driver genes	0
Segment-level view
Glioma-relevant loci	1q (chr1:122–249 Mb): log2CR +0.05 neutral (4 segs) — arm-level gain in CIMP-low GBM-like progression 1p (chr1:0–122 Mb): log2CR +0.01 neutral (4 segs) — loss → oligodendroglioma if paired with 19q chr7 (chr7:0–159 Mb): log2CR +0.14 subtle gain (7 segs) — whole-chromosome gain = GBM signature 9p21 (CDKN2A/B) (chr9:20–26 Mb): log2CR -0.17 subtle loss (1 seg) — hom-del → WHO grade 4 reclassification chr10 (chr10:0–136 Mb): log2CR +0.08 neutral (6 segs) — whole-chromosome loss = GBM signature (PTEN region) 12q13-q15 (chr12:56–69 Mb): log2CR +0.10 subtle gain (1 seg) — amp → CDK4/MDM2 amplification 19q (chr19:27–59 Mb): log2CR -0.18 subtle loss (2 segs) — loss → oligodendroglioma if paired with 1p 4q12 (chr4:53–56 Mb): log2CR +0.13 subtle gain (1 seg) — amp → PDGFRA amplification 7p11 (chr7:55–56 Mb): log2CR +0.06 neutral (2 segs) — amp → EGFR amplification 17p13 (TP53 region) (chr17:6–9 Mb): log2CR -0.09 neutral (1 seg) — loss → TP53 LOH
Focal / high-magnitude segments (\|log2CR\| ≥ 0.5)	`chr22:10,630,001-10,700,000` log2CR -1.84 (hom-del, 70 kb) `chr17:37,930,001-38,210,000` log2CR -1.43 (hom-del, 280 kb) `chr9:61,320,001-61,540,000` log2CR -1.42 (hom-del, 220 kb) `chr5:70,210,001-71,370,000` log2CR -0.91 (loss, 1.2 Mb) `chr15:32,240,001-32,540,000` log2CR -0.86 (loss, 300 kb) `chr6:113,640,001-113,920,000` log2CR +0.76 (gain, 280 kb) `chr1:12,720,001-13,450,000` log2CR -0.69 (loss, 730 kb) `chrX:125,670,001-128,990,000` log2CR -0.63 (loss, 3.3 Mb) `chr16:70,830,001-71,230,000` log2CR -0.60 (loss, 400 kb)
Total usable segments called	117 (after dropping centromere-like artifacts: \|log2CR\| < −3 or sub-50-kb with \|log2CR\| > 2)

Gene rollups (top) only surface CNVs with |log2CR| ≥ 0.5. Segment-level view (bottom) reports every glioma driver locus regardless of magnitude, since low tumor purity compresses log2CR toward zero — a true arm-level loss can show up at |log2CR| ≈ 0.15 in a 30%-purity sample. Published IDH-mutant-glioma context: 1p/19q codeletion ⇒ oligodendroglioma; chr7 gain + chr10 loss ⇒ GBM-like; 9p21 hom-del ⇒ WHO grade 4; 12q amp ⇒ CDK4/MDM2 amplification.

Cache: stage1_all_mutations.json (gene rollups) + tumor.called.seg (segments)

Structural variants & fusions

SV events on curated cancer genes	0
Arriba RNA fusions (total, pre-dedup)	9

High-confidence in-frame fusions involving known oncogenes are clinically actionable. Low-confidence fusions commonly represent artifact.

Cache: fusions.tsv, sv_annotation.json

HLA typing + copy-number/QC proxy

Class I alleles (germline DNA typing)	6 / 6 (A, B, C × 2 each)
Class II alleles (arcasHLA from RNA)	13
LOHHLA gate	blocked (tumor_bam=missing, normal_bam=missing) — LOH is QC context only ⚠ Do NOT use this to drop or down-weight peptides. Decision-supportive HLA-LOH needs allele-specific LOHHLA-grade evidence.
HLA-A depth/QC status	AMPLIFIED (tumor/normal ratio 2.02)
HLA-B depth/QC status	AMPLIFIED (tumor/normal ratio 1.84)
HLA-C depth/QC status	AMPLIFIED (tumor/normal ratio 1.78)

Class I HLA uses germline DNA (T1K + OptiType consensus) for clinical-grade typing. Class II uses tumor-RNA arcasHLA. Decision-supportive LOHHLA was NOT available for this case (see gate reasons above) — the per-locus values below are a bulk tumor/normal depth ratio across the HLA region, i.e. a copy-number proxy, not true allele-specific LOH. Do not use them to drop or down-weight peptides.

Cache: hla_class_i.json, class_ii_with_arcashla.json, hla_loh.json, hla_loh_gate.json

Neoantigen prediction

Total candidate peptides	264,183
Point-mutation peptides	263,720
Splicing-derived peptides (exploratory)	463
Class I (8-13mer)	213,565
Class II (13-25mer)	50,618
Frameshift-tail peptides	3,872
Point-mutation MHCflurry-scored	213,102
Point-mutation awaiting scoring (next Modal spawn)	50,618 ⚠ frameshift peptides queued
Strong point-mutation binders (<500 nM or presentation ≥0.5)	2,104
Strong splicing-derived epitopes (exploratory)	463
NMD-flagged (full_nmd)	0
Partial-NMD (kept with 50% penalty)	0
Vaccine candidates (short + long SLP pairs)	18
— canonical drivers (literature-backed)	4
— algorithmic candidates (predictor-only)	2
— passengers	12
Clonality mix (clonal / major-subclonal / minor-subclonal)	10 / 5 / 3
Heteroclitic-optimized (§7c)	10 / 18
Capietto position breakdown (TCEM / anchor / flanking)	14 / 3 / 0
HLA-LOH filter: dropped / partial-LOH flagged	0 / 0

SLP design pairs class I short (CD8) + class II long (CD4) per mutation. Heteroclitic variants substitute P2/PΩ anchors per HLA-specific preferences (45+ alleles supported).

Cache: neoantigens_v5_all.json, vaccine_candidates.json

Splicing neoantigens (exploratory)

Strong splicing neoepitopes

463

Novel junctions detected by the RNA aligner. Scored by MHCflurry but NOT yet validated against a normal-tissue splice atlas, NMD prediction, or protein-level evidence — do not treat as drop-in vaccine candidates. See the dedicated annex in the neoantigen section for per-row caveats.

Cache: splicing_neoantigens_strong.json

Compound scoring (stage 6)

Compounds scored (total, all phases)	751
Shown (top 200)	200
FDA-approved in top 200	187
With direct-target hit on a patient gene	200
⭐ Currently prescribed to patient	1
⚠ Penalized for patient-specific resistance mutation	0 (CIViC catalog: run scripts/fetch_civic_resistance.py to populate)
Top-ranked compound	VORASIDENIB (score 99)

Scoring: phase + tumor-type PubMed/trials/CIViC + tumor-type-canonical direct-target bonus + patient-medication ⭐ bonus, minus NegBioDB negative-evidence penalty. Drug-gene attribution filtered on ChEMBL/DGIdb action_type (no `INTERACTS` catch-all).

Cache: stage6_ranked.json

Clinical trials

Total trials surfaced	155
Phase 2/3	75
Currently recruiting	124
Matched via tumor type	54

Cache: clinical_trials.json

Stage caveats (free-text heads-ups)

Stage	Caveat
subtype	Marker-gene classifier is a point estimate. Confidence can be misleading when tumor types are biologically similar (e.g., LUAD vs LUSC). Clinical context should override.
mgmt	Bulk RNA TPM is expression context only. Bisulfite sequencing, methylation-specific PCR, pyrosequencing, or methylation-array testing is required for an MGMT promoter methylation call.

What this report does not cover

Epigenomics beyond MGMT — full methylation profiling needs a separate bisulfite assay.
Proteomics — we predict protein consequences from DNA; we don't directly measure protein levels.
Microbiome / metabolome — outside the scope of tumor + germline sequencing.
Response to specific drugs you've already tried — we don't have your treatment history, just your sequencing.
Imaging findings — radiographic evidence isn't in this pipeline.

Drug	Failed trials	Binding negatives	Score penalty
PEMBROLIZUMAB	10	0	−6.0
PALBOCICLIB	6	1	−4.0
SORAFENIB	5	1	−3.0
CEDIRANIB	3	1	−2.0
PERAMPANEL	3	0	−1.0
CABOZANTINIB	3	1	−1.0
PAZOPANIB	3	1	−1.0
RIBOCICLIB	4	1	−1.0
ABEMACICLIB	2	1	−1.0
NINTEDANIB	1	1	−1.0

Supplement	Direction score	Mechanism note
L-glutamine	-50	IDH-mutant tumors are glutamine-dependent. Do not supplement.
nicotinamide riboside	-40	NAD+ precursor
NADH	-40
NMN	-40
niacinamide B3	-40	Restores NAD+ in tumor cells — reverses IDH-mutant metabolic vulnerability.
methionine	-20	Methionine restriction has anticancer rationale.
methylfolate 5MTHF	-20	Methyl donor
methylcobalamin B12	-20	Methyl-B12 for methionine synthase
melatonin	-15	High-dose melatonin (20mg) studied in glioma. Dual role: antioxidant concern vs. anti-proliferative benefit.
selenium	-15	Selenium feeds glutathione peroxidase — restores tumor redox defense.

NCT / status	Title & intervention	Matched findings	Sites
NCT07077616 EARLY_PHASE1 RECRUITING	Clinical Study for the Safety and Therapeutic Efficacy of the AI-QMMM Designed TamavaqTM Personalised Vaccine in Patients With Newly Diagnosed Glioma. Intervention: Biological: personalized vaccine Based on genetic and transcriptional sequencing information, personalized peptide vaccines would be designed and produced;	TP53_-/X IDH1_R/C ATRX_G/D HLA-B_A/T	1
NCT06794736 N/A RECRUITING	STRatifying Adult DIffuse Lower-grade Gliomas Based on Their VARIed Metabolic Profiles (STRADIVARI Project) Intervention:	IDH1_R/C ATRX_G/D CDKN2A_G/S	4
NCT07417761 PHASE2 RECRUITING	Tuvusertib in Astrocytoma With ATRX Mutation Intervention: Tuvusertib	IDH1_R/C ATRX_G/D CDKN2A_G/S	10
NCT07242963 N/A RECRUITING	Relapsed and Progressive Sonic Hedgehog Medulloblastoma With U1 Mutation Registry Study Intervention:	TP53_-/X tumor_type	2
NCT06363162 NA RECRUITING	Evaluate the Effectiveness and Safety of Raman IVD Analyzer in the Molecular Diagnosis of Gliomas During Surgery Intervention: Immunohistochemistry or genetic test	TP53_-/X ATRX_G/D	1
NCT07219199 NA NOT_YET_RECRUITING	Residual IDH1-Mutant Tumor Cell Quantification Study Intervention: UR-ddPCR	IDH1_R/C tumor_type	1
NCT06575452 NA NOT_YET_RECRUITING	Using the Epitranscriptome to Diagnose and Treat Gliomas Intervention: Blood, urine and tumoral tissue samples, Tumoral tissue samples	IDH1_R/C ATRX_G/D	2
NCT03896568 PHASE1 RECRUITING	MSC-DNX-2401 in Treating Patients With Recurrent High-Grade Glioma Intervention: Oncolytic Adenovirus Ad5-DNX-2401, Therapeutic Conventional Surgery	IDH1_R/C tumor_type	1
NCT05564390 PHASE2 RECRUITING	MYELOMATCH: A Screening Study to Assign People With Myeloid Cancer to a Treatment Study or Standard of Care Treatment Within myeloMATCH (MyeloMATCH Screening Trial) Intervention: Allogeneic Hematopoietic Stem Cell Transplantation, Azacitidine, Best Practice	IDH1_R/C IRAK4_R/*	347
NCT05303519 PHASE3 RECRUITING	SIGMA (Safusidenib in IDH1 Mutant Glioma Maintenance) Intervention: safusidenib, Placebo	IDH1_R/C tumor_type	45
NCT07486713 PHASE4 RECRUITING	Olutasidenib DDI Study in Patients With IDH1 Mutation Positive Malignancies Intervention: Olutasidenib, CYP1A2, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP3A4, and OATP1B1 Probe Substrates	CYP2C8_P/S IDH1_R/C	2
NCT07017816 EARLY_PHASE1 NOT_YET_RECRUITING	A Phase 0/1 Study of cDNA for TP53, Checkpoint Inhibition and Radiation in Children With Recurrent, Progressive or Refractory CNS Malignancies. Intervention: SGT-53, hypofractionated radiotherapy with immunotherapy, Nivolumab	TP53_-/X	1
NCT05432518 EARLY_PHASE1 RECRUITING	Pilot Trial for Treatment of Recurrent Glioblastoma Intervention: Afatinib, Dasatinib, Palbociclib	TP53_-/X	1
NCT06381570 EARLY_PHASE1 RECRUITING	Pilot Study of Vinblastine and Tovorafenib in Pediatric Patients With Recurrent/Progressive RAF Altered Low Grade Gliomas Intervention: Tovorafenib, Vinblastine	tumor_type	1
NCT07268053 EARLY_PHASE1 RECRUITING	A Phase 0/1 Clinical Trial With an Expansion Phase of GSK5764227, a B7-H3-Targeted Antibody-Drug Conjugate (ADC), in Patients With Recurrent Grade 4 Glioma and Patients With Brain Intervention: Risvutatug rezetecan	tumor_type	1

Score	Supplement	Direction	Target overlap	Mechanism
+43	vitamin C IV pharmacologic	(+20)		50-100g IV — completely different pharmacology than oral.
+33	BHB betahydroxybutyrate	(+24)		Ketone body; HDAC inhibition; alternative fuel
+32	artemisinin artesunate	(+15)		Antimalarial with strong preclinical anticancer data. Case reports in glioma. IV preparations exist.
+29	butyrate sodium butyrate	(+16)		HDAC inhibitor
+28	curcumin	(+5)	AKT1 BRAF	Multi-target polyphenol: NF-κB inhibitor, STAT3 inhibitor, anti-angiogenic, HDAC modulation
+25	luteolin	(+5)	AKT1	Anti-angiogenic; EGFR inhibitor
+25	kaempferol	(+5)	AKT1	PI3K/AKT/mTOR inhibitor; pro-apoptotic
+25	vitamin C oral low dose	(+8)		Physiologic oral doses (<500mg) may support TET demethylation. High oral doses (>1g) become antioxidant — direction reverses.
+24	quercetin	(+5)	AKT1	PI3K/AKT inhibitor; weak CYP3A4 inhibitor
+23	apigenin	(+5)	AKT1	PI3K inhibitor; pro-apoptotic
+23	ursolic acid	(+5)	AKT1	STAT3/NF-κB inhibitor; anti-angiogenic; pro-apoptotic
+20	green tea catechins	(+5)		Broader catechin mix including EGCG, ECG, EGC; DNMT1 inhibitor (epigenetic)

Gene	Diplotype	Phenotype	Activity score	Call source
ABCG2	Unknown/Unknown	No Result	—	MATCHER
CACNA1S	Unknown/Unknown	No Result	—	MATCHER
CFTR	Unknown/Unknown	No Result	—	MATCHER
CYP2B6	1/6	Intermediate Metabolizer	—	MATCHER
CYP2C19	2/17	Intermediate Metabolizer	—	MATCHER
CYP2C9	1/1	Normal Metabolizer	2.0	MATCHER
CYP2D6	Unknown/Unknown	No Result	No Result	NONE
CYP3A5	3/3	Poor Metabolizer	—	MATCHER
CYP4F2	1/1	—	—	MATCHER
DPYD	c.85T>C (*9A)/c.496A>G	Normal Metabolizer	2.0	MATCHER
G6PD	B (reference)/B (reference)	Normal	—	MATCHER
HLA-A	Unknown/Unknown	—	—	NONE
HLA-B	Unknown/Unknown	—	—	NONE
IFNL3	Unknown/Unknown	No Result	—	MATCHER
MT-RNR1	Unknown	No Result	—	NONE
NUDT15	Unknown/Unknown	No Result	—	MATCHER
RYR1	Unknown/Unknown	No Result	—	MATCHER
SLCO1B1	19/24	Indeterminate	—	MATCHER
TPMT	1/1	Normal Metabolizer	—	MATCHER
UGT1A1	1/1	Normal Metabolizer	—	MATCHER
VKORC1	Unknown/Unknown	—	—	MATCHER

Panel	Lane	Coverage / observability	Flagged findings
PGx CPIC sentinel sites	pgx	12 / 15 sites called (80.0%)	0
Expanded pharmacogenomics genes	pgx	13 / 65 genes observable (20.0%)	0
Hereditary cancer predisposition genes	hereditary_cancer	2 / 77 genes observable (2.6%)	1
ACMG secondary findings v3.3	acmg_secondary_findings	3 / 95 genes observable (3.2%)	1
Consumer-style genetics context	consumer_context	1 / 74 genes observable (1.4%)	0

Lane	Gene	Status	Change	ClinVar
hereditary_cancer	TP53	finding_present	C/R	uncertain_significance,likely_pathogenic
acmg_sf_v3_3	TP53	finding_present	C/R	uncertain_significance,likely_pathogenic

Gene	Marker	Genotype	Label
ABCB1	rs1045642+rs2032582+rs1128503	0/0+0/0+0/0	Normal
ACTN3	rs1815739	0/1	R/X het
ADH1B	rs1229984	1/1	Fast
APOE	rs429358+rs7412	0/0+0/0	ε3/ε3
COMT	rs4680	0/1	Val/Met
CYP1A2	rs762551	1/1	Inducible; activity depends on smoking/caffeine/inducers
FTO	rs9939609	0/0	Normal
GLP1R	rs6923761	0/0	Normal
LCT	rs4988235	1/1	Tolerant
MTHFR	rs1801131	1/1	A1298C hom
SOD2	rs4880	1/1	Val/Val
VDR	rs2228570	1/1	FokI hom

Term	What it means
BBB	Blood-Brain Barrier — the filter that keeps most drugs out of the brain. Matters only for brain tumors.
CCF	Cancer Cell Fraction — what percentage of tumor cells carry this mutation. 1.0 = clonal (in every cell).
CDKN2A	Tumor suppressor gene on 9p21. Its homozygous deletion is the key event driving IDH-mutant glioma progression from grade II to grade III/IV.
CIViC	Clinical Interpretation of Variants in Cancer — expert-curated gene-variant-drug evidence.
CNV	Copy Number Variant — regions of the genome that gained or lost copies.
COSMIC	Catalogue Of Somatic Mutations In Cancer — curated list of known cancer-driver mutation hotspots.
CYP	Cytochrome P450 — the liver enzymes that metabolize most drugs. Genetic variants change how fast you break down specific medications.
ChEMBL	An open database of ~2M bioactive molecules with assay data and clinical-phase annotations.
DepMap	A project that systematically knocked out every gene in hundreds of cancer cell lines. Tells us which genes a tumor needs vs. which genes normal cells also need.
FDA	U.S. Food and Drug Administration. An FDA-approved drug has full regulatory approval for some indication.
HLA	Human Leukocyte Antigen — the molecules on your cells that display protein fragments to T-cells. You inherit a specific set; neoantigens must bind them to be immunogenic.
IC50	Drug concentration that inhibits 50% of the target activity. Lower = more potent. For peptide-HLA binding: <50 nM = strong binder.
IDH	Isocitrate Dehydrogenase. Mutations (IDH1 R132H / IDH2 R172K) define a major subset of gliomas and predict vorasidenib response.
LOH	Loss of Heterozygosity — the tumor deleted one of your two HLA alleles, so neoantigens that would have bound it are no longer presented. A proper call requires LOHHLA (allele-specific tumor/normal BAF); a bulk read-depth ratio alone is only a CNV proxy.
MGMT	O-6-methylguanine-DNA methyltransferase. Promoter methylation is a direct lab biomarker; RNA expression here is context only.
MSI	Microsatellite Instability — a hypermutated state caused by mismatch-repair defects. Here it is a biomarker signal, not automatic treatment eligibility.
NCT	ClinicalTrials.gov identifier — every trial gets an NCT number.
NegBioDB	A curated database of negative biological evidence — failed clinical trials, drug-target binding assays that showed no effect, knockouts that didn't kill cells.
PGx	Pharmacogenomics — using your germline DNA to predict drug response and side-effect risk.
SV	Structural Variant — large rearrangement (deletion, duplication, inversion, translocation).
TCGA	The Cancer Genome Atlas — the reference dataset of ~11,000 sequenced tumors across 33 cancer types.
TMB	Tumor Mutational Burden — the number of coding mutations per megabase. Here it is WES context, not an assay-calibrated immunotherapy eligibility call.
TPM	Transcripts Per Million — RNA expression level, normalized so each sample sums to 1 million.
VAF	Variant Allele Frequency — the fraction of sequencing reads carrying the mutation.

Stage	Status	Elapsed
Stage 4 -- exome_cnv_purity (cnv_profile.json)	ok	1.0s
Stage 1B -- germline_completeness (CPIC core sites)	ok	1.3s
Stage 1C -- germline_panel_screen (PGx / ACMG / consumer lanes)	ok	1.8s
Stage 2 -- somatic_consensus (Mutect2 ∩ MuSE)	ok	0.0s
Stage 3 -- cosmic_annotation (tier-1 driver hotspots)	ok	0.4s
Stage 4 -- differential_expression (z-score / log2FC)	ok	0.2s
Stage 5 -- sv_annotation (CDKN2A/B, EGFR, …)	ok	0.0s
Report render -- health.reports.unified_report.main	ok	2.0s
Report render -- health.reports.unified_report_v2.main	ok	1.6s

1. What we did

2. Your tumor at a glance

Biomarkers

Immune checkpoints & phagocytosis signals (RNA expression)

Tumor microenvironment — cell composition

3. What drives your cancer

Canonical drivers for this tumor type (literature-backed)

Candidate drivers (algorithmic — pan-cancer signals only)

Germline findings (inherited)

RNA fusions

Structural variants (large rearrangements)

4. Dysregulated pathways

Canonical LGG-specific pathways

IDH / α-ketoglutarate metabolism

DNA methylation / G-CIMP / MGMT

Histone methylation / chromatin

ATRX / Alternative Lengthening of Telomeres (ALT)

p53 / cell cycle / CDKN2A

PI3K / AKT / mTOR

RAS / MAPK

Homologous recombination / DNA damage response

Universal oncogenic signaling pathways (pan-cancer)

Cell cycle (RB / CDKN2A)

Hippo (YAP / TAZ)

Notch

PI3K / AKT / mTOR

RTK / RAS / MAPK

TGF-β

p53 / ATM / MDM2

WNT / β-catenin

Myc (MYC / MAX)

Oxidative stress (NRF2 / KEAP1)

Statistically most-disrupted pathways (generic enrichment)

5. Standard of care

first line

second line

investigational / other

6. Targeted therapy

Drugs organized by your mutated gene

7. What NOT to pursue

Targets to deprioritize

Drugs with concerning negative evidence

Supplements to avoid / taper

8. Immune / neoantigen angle

Your HLA type

2,104 strong point-mutation binders (<500 nM or presentation score ≥ 0.5) across 213,102 scored point-mutation peptides (of 264,183 total candidates incl. 463 splicing)

Best neoantigen per mutation (for vaccine design)

Splicing-derived neoantigens (exploratory annex — not part of the SLP vaccine ordering unit)

Vaccine-candidate ordering list (short + long + optimized)

9. Clinical trials

10. Supplements

Helpful direction (consider — discuss with oncologist)

Mild concern

11. Drug safety (PGx)

CPIC guidelines — 9 / 21 genes called

DPWG guidelines — 8 / 15 genes called

Inherited genetics screen

Flagged inherited findings

Configured consumer-style SNP context

12. Data quality & limits

Sequencing QC (raw alignment)

Per-stage output audit

Somatic variant calling

VEP annotation

Variant pathogenicity classification

Copy-number variants

Structural variants & fusions

HLA typing + copy-number/QC proxy

Neoantigen prediction

Splicing neoantigens (exploratory)

Compound scoring (stage 6)

Clinical trials

Stage caveats (free-text heads-ups)

What this report does not cover

13. Glossary

14. How this was built