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Age ≥75 with ECOG ≥2 or ≥2 comorbidities — gemcitabine + cisplatin + durvalumab triplet p...

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

IDRF-CHOLANGIOCARCINOMA-FRAILTY-AGE
TypeRed flag
Statusreviewed 2026-04-26 | pending_clinical_signoff
DiseasesDIS-CHOLANGIOCARCINOMA
SourcesSRC-NCCN-HCC-2025 SRC-ONCOKB

Red Flag Origin

DefinitionAge ≥75 with ECOG ≥2 or ≥2 comorbidities — gemcitabine + cisplatin + durvalumab triplet poorly tolerated; consider gemcitabine + cisplatin doublet, gemcitabine monotherapy, or best supportive care depending on biliary-tree dysfunction and performance status.
Clinical directionde-escalate
Categoryfrailty-age

Trigger Logic

{
  "all_of": [
    {
      "comparator": ">=",
      "finding": "age_years",
      "threshold": 75
    },
    {
      "any_of": [
        {
          "comparator": ">=",
          "finding": "ecog_status",
          "threshold": 2
        },
        {
          "comparator": ">=",
          "finding": "comorbidity_count",
          "threshold": 2
        }
      ]
    }
  ],
  "type": "composite_clinical"
}

Notes

TOPAZ-1 (gem-cis-durvalumab) and KEYNOTE-966 (gem-cis-pembrolizumab) enrolled mostly ECOG 0–1 fit patients; older / frail patients have higher rates of gem-cis-related thrombocytopenia, neutropenia, and decompensated cholestasis. Geriatric assessment (G8) recommended ≥70. In frail patients with adequate biliary drainage, gem-cis doublet (ABC-02 doublet) remains acceptable; gem monotherapy or capecitabine for very frail. Source gap: NCCN Hepatobiliary / ESMO Biliary Tract Cancer guideline not yet ingested as a separate Source entity — using SRC-NCCN-HCC-2025 (adjacent hepatobiliary reference per disease YAML precedent) and SRC-ONCOKB until biliary-specific Source is added.

Used By

Indications