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Perfil de fragilidad excluyendo el carbo+pacli estándar ± pembro / dostarlimab en avanzado/recurrente...

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IDRF-ENDOMETRIAL-FRAILTY-AGE
TipoSeñal de alerta
Situaciónreviewed 2026-04-27 | pending_clinical_signoff
EnfermedadesDIS-ENDOMETRIAL
FuentesSRC-ESMO-ENDOMETRIAL-2022 SRC-NCCN-UTERINE-2025

Origen de la bandera roja

DefiniciónFrailty profile precluding standard carbo+pacli ± pembro / dostarlimab in advanced/recurrent endometrial: ECOG ≥3, OR age ≥75 with ≥2 comorbidities, OR composite (age ≥70 + albumin <3.0 + Charlson ≥3), OR explicit "unfit for combination chemotherapy". Endometrial cancer median age at diagnosis is ~63 with rising incidence in elderly.
Dirección clínicadecreciente
Categoríaedad de fragilidad

Lógica de activación

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "ecog",
      "threshold": 3
    },
    {
      "finding": "fit_for_combination_chemo",
      "value": false
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 75
        },
        {
          "comparator": ">=",
          "finding": "comorbidity_count",
          "threshold": 2
        }
      ]
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 70
        },
        {
          "comparator": "<",
          "finding": "albumin_g_dl",
          "threshold": 3.0
        },
        {
          "comparator": ">=",
          "finding": "charlson_score",
          "threshold": 3
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notas

Frail elderly options: single-agent carboplatin (well tolerated, ORR 20-30%), weekly paclitaxel, or hormonal therapy (megestrol acetate / medroxyprogesterone) for ER/PR+ low-grade tumors. Pembrolizumab / dostarlimab monotherapy for dMMR/MSI-H is well tolerated even in frail patients (RUBY/NRG-GY018 included elderly subgroup with preserved benefit). Cardiac assessment baseline mandatory before doxorubicin (especially in carcinosarcoma backbone). Geriatric assessment (G8 / CGA) prior to regimen selection.

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