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Profil de fragilité excluant FOLFIRINOX dans le PDAC: ECOG ≥2, OU (âge ≥75 + Charlson ≥3), OU co...

Vue déterministe de l'entité source de la LJAM. L'autorité clinique demeure avec les ID de la source cités et l'état d'approbation de l ́examinateur.

IDRF-PDAC-FRAILTY-AGE
TypeSignal d’alerte
Étatreviewed 2026-04-26 | pending_clinical_signoff
MaladiesDIS-PDAC
SourcesSRC-ESMO-PANCREATIC-2024 SRC-NCCN-PANCREATIC-2025

Origine du drapeau rouge

DéfinitionFrailty profile precluding FOLFIRINOX in PDAC: ECOG ≥2, OR (age ≥75 + Charlson ≥3), OR composite (age ≥70 + albumin <3.0 + cachexia ≥10% weight loss). Triggers gem-nab-pac (better-tolerated alternative) OR gemcitabine monotherapy OR best supportive care.
Direction cliniquedésescalade
Catégorieâge de fragilité
Algorithme de décalageALGO-PDAC-METASTATIC-1L

Logique de déclenchement

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "ecog",
      "threshold": 2
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 75
        },
        {
          "comparator": ">=",
          "finding": "charlson_score",
          "threshold": 3
        }
      ]
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 70
        },
        {
          "comparator": "<",
          "finding": "albumin_g_dl",
          "threshold": 3.0
        },
        {
          "comparator": ">=",
          "finding": "weight_loss_pct_3mo",
          "threshold": 10
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notes

ACCORD-11 excluded ECOG ≥2; FOLFIRINOX in real-world frail patients has Grade 3-4 toxicity ~75% + early discontinuation. MPACT trial for gem-nab-pac was more permissive (KPS 70-100); better fit for the borderline-fit patient. Pure BSC for ECOG 4 or organ failure.

Utilisé par

Algorithmes

Indication

Signal d’alerte