Radiologically confirmed active brain metastases (parenchymal, enhancing on MRI gadoliniu...

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

ID	`RF-CNS-METASTASES-ACTIVE`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-EANO-GBM-2024` `SRC-NCCN-CNS-2025`

Red Flag Origin

Definition	Radiologically confirmed active brain metastases (parenchymal, enhancing on MRI gadolinium). Triggers parallel CNS-directed therapy (stereotactic radiosurgery for ≤4 lesions, whole-brain RT for diffuse, craniotomy for symptomatic single lesion ≥3 cm) and selection of systemic therapy with CNS-penetrant activity (osimertinib, alectinib, lorlatinib, tucatinib, T-DXd, pembrolizumab, dabrafenib + trametinib).
Clinical direction	intensify
Category	oncologic-emergency

Trigger Logic

{
  "any_of": [
    {
      "finding": "active_brain_metastases",
      "value": true
    },
    {
      "comparator": ">=",
      "finding": "brain_metastases_count",
      "threshold": 1
    }
  ],
  "type": "imaging_finding"
}

Notes

ASCO/SNO/ASTRO 2022 guideline for brain metastases. SRS preferred for ≤4 lesions per QUARTZ + AAPM; WBRT reserved for diffuse (>10 lesions) or leptomeningeal involvement. Systemic CNS-penetrant choices by tumor: NSCLC EGFR — osimertinib (FLAURA CNS), brigatinib post-crizotinib (ALTA-1L); NSCLC ALK — alectinib (ALEX CNS), lorlatinib (CROWN); NSCLC ROS1 — entrectinib, repotrectinib; HER2+ breast — tucatinib + trastuzumab + capecitabine (HER2CLIMB), T-DXd (DESTINY-Breast03 CNS subgroup); melanoma — pembrolizumab + ipilimumab (CheckMate-204) or dab+tram if BRAF; SCLC — atezo + chemo, lurbinectedin. Steroids (dexamethasone 4-8 mg/d) for vasogenic edema; taper as soon as feasible — high-dose steroids attenuate ICI efficacy.

Used By

No reverse references found in the YAML corpus.