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MSI-alto / dMMR O TMB-alto (≥10 mut/Mb) recurrente, persistente, o paratiroides metastásicos...

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IDRF-PARATHYROID-CARCINOMA-MSI-TMB-HIGH-ACTIONABILITY
TipoSeñal de alerta
Situaciónreviewed 2026-07-11 | pending_clinical_signoff
EnfermedadesDIS-PARATHYROID-CARCINOMA
FuentesSRC-NCCN-NET-2025 SRC-NCCN-THYROID-2025

Origen de la bandera roja

DefiniciónMSI-alto / dMMR O TMB-alto (≥10 mut/Mb) carcinoma paratiroideo recurrente, persistente o metastásico — abre la indicación pembrolizumab tejido-agnóstico y anula la pista de soporte de cinacalcet-solo por defecto con una opción sistémica impulsada por biomarcadores.
Dirección clínicaintensificar
Categoríahigh-risk-biology
Algoritmo de cambiosALGO-PARATHYROID-CARCINOMA-1L

Lógica de activación

{
  "any_of": [
    {
      "finding": "BIO-MSI-STATUS",
      "value": "MSI-H"
    },
    {
      "finding": "msi_status",
      "value": "MSI-H"
    },
    {
      "finding": "BIO-DMMR-IHC",
      "value": "dMMR"
    },
    {
      "finding": "dmmr_status",
      "value": "deficient"
    },
    {
      "finding": "BIO-TMB-HIGH",
      "value": "positive"
    },
    {
      "finding": "tmb_status",
      "value": "TMB-H"
    }
  ],
  "type": "biomarker"
}

Notas

Parathyroid carcinoma has no standard cytotoxic regimen with consistent activity; this RF exists to surface the one biomarker- gated systemic option (pembrolizumab, tissue-agnostic MSI-H/dMMR + TMB-high FDA approvals) for the rare recurrent/metastatic case where it applies. No parathyroid-carcinoma-specific prevalence data exists for MSI-H/dMMR or TMB-H given disease rarity — trigger and rationale are extrapolated from general solid-tumor basket-trial eligibility, matching the pattern already used by RF-CRC-MSI-H-ACTIONABILITY and RF-CHOLANGIOCARCINOMA-HIGH-RISK-BIOLOGY for the same biomarkers. STUB — requires clinical co-lead signoff.

Utilizado por

Algoritmos

Enfermedad

Indicación