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Active or latent infection requiring resolution / prophylaxis before initiating cisplatin...

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IDRF-HNSCC-INFECTION-SCREENING
TipoSeñal de alerta
Situaciónreviewed 2026-04-27 | pending_clinical_signoff
EnfermedadesDIS-HNSCC
FuentesSRC-ESMO-HNSCC-2020 SRC-NCCN-HNSCC-2025

Origen de la bandera roja

DefiniciónActive or latent infection requiring resolution / prophylaxis before initiating cisplatin-based chemoradiation, cetuximab + RT, or pembrolizumab in HNSCC: HBsAg-positive (HBV reactivation on cytotoxic chemotherapy + checkpoint inhibitors), anti-HBc-positive (occult HBV on cetuximab — anti-EGFR class), HIV-positive (ART coordination, often comorbid in HPV-related HNSCC), or active TB.
Dirección clínicaAtención
Categoríadetección de infecciones

Lógica de activación

{
  "any_of": [
    {
      "finding": "hbsag",
      "value": "positive"
    },
    {
      "finding": "anti_hbc_total",
      "value": "positive"
    },
    {
      "finding": "hiv_status",
      "value": "positive"
    },
    {
      "finding": "active_tb",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notas

Cetuximab — anti-EGFR mAb — has documented HBV reactivation reports (less than rituximab but non-zero); FDA label notes warning. Standard HBsAg + anti-HBc + anti-HBs serology pre-treatment; entecavir / tenofovir for HBsAg+. HIV-related HNSCC (oropharyngeal, cervical squamous) is increasingly recognized; ART coordination critical before cisplatin (renal interactions with tenofovir DF) — switch to TAF or coordinate with infectious disease. Active TB: complete anti-TB before head-and-neck RT given mucositis + neutropenia overlap.

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