Rapid radiographic progression on first-line gem-cis-durvalumab, new symptomatic biliary...

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

ID	`RF-CHOLANGIOCARCINOMA-TRANSFORMATION-PROGRESSION`
Type	Red flag
Status	reviewed 2026-04-26 \| pending_clinical_signoff
Diseases	`DIS-CHOLANGIOCARCINOMA`
Sources	`SRC-NCCN-HCC-2025` `SRC-ONCOKB`

Red Flag Origin

Definition	Rapid radiographic progression on first-line gem-cis-durvalumab, new symptomatic biliary obstruction with cholangitis, or new peritoneal carcinomatosis — emergency-tier flag requiring biliary drainage, re-biopsy with comprehensive genomic profiling, and second-line decision (FOLFOX vs targeted therapy if actionable mutation).
Clinical direction	hold
Category	transformation-progression

Trigger Logic

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

Notes

ABC-06 trial established FOLFOX as 2L standard (mOS 6.2 vs 5.3 mo active symptom control); however biliary drainage (ERCP / PTBD) is prerequisite — chemotherapy on uncontrolled cholangitis is associated with rapid sepsis. Re-biopsy at progression yields actionable mutation in ~30% (FGFR2, IDH1, HER2, BRAF) per MSKCC and Mayo cohorts — changes 2L choice from FOLFOX to targeted therapy. Peritoneal carcinomatosis indicates poor prognosis (mOS <6 mo); palliative intent and early hospice consultation appropriate.

Used By

No reverse references found in the YAML corpus.