Infection-screening gate before mCRC systemic therapy: HBsAg+ / anti-HBc+ (HBV reactivati...

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

ID	`RF-CRC-INFECTION-SCREENING`
Type	Red flag
Status	reviewed 2026-04-26 \| pending_clinical_signoff
Diseases	`DIS-CRC`
Sources	`SRC-ESMO-COLON-2024` `SRC-NCCN-COLON-2025`

Red Flag Origin

Definition	Infection-screening gate before mCRC systemic therapy: HBsAg+ / anti-HBc+ (HBV reactivation on pembrolizumab + chemo with steroids), HIV+ (alters drug pharmacokinetics + ICI safety), or active TB. Routes to mandatory prophylaxis (entecavir/TDF for HBV) BEFORE initiating pembro / FOLFOX+ICI / cetuximab.
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

Pembrolizumab + bevacizumab carry HBV reactivation risk; entecavir prophylaxis from day -7 through ≥6 mo post-last-dose. HIV+ mCRC uses standard FOLFOX/pembro with ART optimization first; CD4 baseline documentation. Active TB: complete intensive phase before chemo.

Used By

No reverse references found in the YAML corpus.