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

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IDRF-THYROID-ANAPLASTIC-INFECTION-SCREENING
TipoSeñal de alerta
Situaciónreviewed 2026-04-27 | pending_clinical_signoff
EnfermedadesDIS-THYROID-ANAPLASTIC
FuentesSRC-ATA-THYROID-2015 SRC-NCCN-THYROID-2025

Origen de la bandera roja

DefiniciónActive or latent infection requiring resolution / prophylaxis before initiating cisplatin / paclitaxel / doxorubicin chemoradiation, dabrafenib + trametinib, larotrectinib / entrectinib, or selpercatinib for ATC: HBsAg-positive (HBV reactivation on cytotoxic + targeted), anti-HBc-positive (occult HBV), HIV-positive (ART coordination, CYP3A4 interactions with TKIs), or active TB. Disease tempo limits ability to fully resolve infection — pragmatic prophylaxis approach required.
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

ATC has median OS 3-6 months untreated and ~14 months on best targeted therapy — the timeline for infection workup must be days, not weeks. HBsAg+: start entecavir / tenofovir prophylaxis immediately rather than waiting for hepatology consult. HIV+: start ATC therapy concurrently with ART optimization (delay would be fatal); BRAFi/MEKi/TKI are CYP3A4 substrates — avoid ritonavir- boosted PIs. Active TB: pragmatic — start anti-TB and ATC therapy together with monitoring, given disease tempo. The "hold" direction here is pragmatic prophylaxis-coordinated start, not delayed treatment.

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