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Rapid progression in CRC: relapse within ≤6 months of completing adjuvant chemo (oxalipla...

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

IDRF-CRC-TRANSFORMATION-PROGRESSION
TypeRed flag
Statusreviewed 2026-04-26 | pending_clinical_signoff
DiseasesDIS-CRC
SourcesSRC-ESMO-COLON-2024 SRC-NCCN-COLON-2025

Red Flag Origin

DefinitionRapid progression in CRC: relapse within ≤6 months of completing adjuvant chemo (oxaliplatin-resistant phenotype), new peritoneal carcinomatosis with ascites + obstruction, OR rapid LDH/CEA doubling (>50% rise over 4-8 weeks). Alters 2L+ regimen choice + may contraindicate oxaliplatin re-introduction.
Clinical directionintensify
Categorytransformation-progression

Trigger Logic

{
  "any_of": [
    {
      "finding": "relapse_within_6mo_adjuvant",
      "value": true
    },
    {
      "finding": "new_peritoneal_carcinomatosis_with_obstruction",
      "value": true
    },
    {
      "finding": "cea_doubling_4_8wk",
      "value": true
    },
    {
      "finding": "ldh_doubling_4_8wk",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

Oxaliplatin-resistance defined by relapse <6 mo post-adjuvant; this group benefits from FOLFIRI ± biologic 2L instead of FOLFOX re-trial. Peritoneal-only progression: HIPEC (PRODIGE-7 negative for benefit; case-by-case at expert centers). CEA-rise without imaging confirmation is NOT progression — always restage by CT/MRI before switching.

Used By

Algorithms

Indications