Symptomatic CNS metastases OR rapid visceral progression on current therapy — emergency-t...

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

ID	`RF-BREAST-TRANSFORMATION-PROGRESSION`
Type	Red flag
Status	pending_clinical_signoff
Diseases	`DIS-BREAST`
Sources	`SRC-ESMO-BREAST-METASTATIC-2024` `SRC-NCCN-BREAST-2025`

Red Flag Origin

Definition	Symptomatic CNS metastases OR rapid visceral progression on current therapy — emergency-tier flag requiring brain imaging, urgent multidisciplinary consult, and treatment intensification.
Clinical direction	hold
Category	transformation-progression

Trigger Logic

{
  "any_of": [
    {
      "finding": "symptomatic_cns_metastases",
      "value": true
    },
    {
      "finding": "rapid_visceral_progression",
      "value": true
    }
  ],
  "type": "composite_clinical"
}

Notes

CNS-active HER2+ options: tucatinib + capecitabine + trastuzumab (HER2CLIMB; intracranial response rate ~50%); T-DXd (DESTINY-Breast03 brain-met subgroup). For visceral crisis (rapid LFT/PFT decline): may need emergent chemotherapy backbone over endocrine therapy even in HR+ disease.

Used By

Indications

IND-BREAST-HER2-POS-MAINT-TRAST - IND-BREAST-HER2-POS-MAINT-TRAST
IND-BREAST-HR-POS-3L-POST-CDK46I-POST-AKT - IND-BREAST-HR-POS-3L-POST-CDK46I-POST-AKT
IND-BREAST-HR-POS-MAINT-CDK46I - IND-BREAST-HR-POS-MAINT-CDK46I
IND-BREAST-TNBC-3L-POST-SACI-POST-T-DXD - IND-BREAST-TNBC-3L-POST-SACI-POST-T-DXD