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

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

ID	`RF-CHOLANGIOCARCINOMA-INFECTION-SCREENING`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-CHOLANGIOCARCINOMA`
Sources	`SRC-ESMO-BTC-2023` `SRC-NCCN-HEPATOBILIARY`

Red Flag Origin

Definition	Active or latent infection requiring resolution / prophylaxis before initiating gemcitabine + cisplatin + durvalumab or FGFR2/IDH1-targeted therapy: HBsAg-positive (HBV reactivation risk on chemoimmunotherapy + durvalumab), anti-HBc-positive (occult HBV), HIV-positive (ART coordination required), or active TB. Cholangitis from biliary obstruction is also addressed in transformation-progression flag.
Clinical direction	hold
Category	infection-screening

Trigger Logic

{
  "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"
}

Notes

HBsAg+: entecavir / tenofovir prophylaxis before durvalumab + gem-cis (immune-checkpoint inhibitors carry HBV reactivation signal even in HBsAg-negative / anti-HBc-positive patients). HIV+ biliary cancer manageable with TOPAZ-1 regimen but requires ART coordination — avoid ritonavir-boosted PIs with TKIs (CYP3A4 interactions with FGFR / IDH inhibitors). Active TB: anti-TB completion preferred before chemoimmunotherapy. This flag operationalizes the hold via parallel supportive-care workup rather than indication switch.

Used By

No reverse references found in the YAML corpus.