Germline or somatic BRCA1/2 mutation, PIK3CA mutation, ESR1 mutation, HER2-amplification,...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-BREAST-HIGH-RISK-BIOLOGY`
Type	Red flag
Status	pending_clinical_signoff
Diseases	`DIS-BREAST`
Sources	`SRC-ESMO-BREAST-METASTATIC-2024` `SRC-NCCN-BREAST-2025`

Red Flag Origin

Definition	Germline or somatic BRCA1/2 mutation, PIK3CA mutation, ESR1 mutation, HER2-amplification, or PD-L1 positivity — each opens distinct biomarker-driven indications.
Clinical direction	intensify
Category	high-risk-biology

Trigger Logic

{
  "any_of": [
    {
      "finding": "BIO-BRCA-GERMLINE",
      "value": "positive"
    },
    {
      "finding": "BIO-PIK3CA-MUTATION",
      "value": "positive"
    },
    {
      "finding": "BIO-HER2-SOLID",
      "value": "positive"
    },
    {
      "finding": "BIO-PDL1-EXPRESSION",
      "value": "positive"
    },
    {
      "finding": "esr1_mutation",
      "value": true
    }
  ],
  "type": "biomarker"
}

Notes

Biomarker-driven branching is the dominant breast-cancer pattern. Each positive biomarker opens distinct targeted-therapy options: BRCA → olaparib/talazoparib; PIK3CA → alpelisib; HER2-amp → HER2- targeted agents; PD-L1 → pembrolizumab + chemo; ESR1 → elacestrant. The Algorithm decision_tree resolves these per disease state.

Used By

Algorithms

ALGO-BREAST-1L - ALGO-BREAST-1L