Endometrial carcinoma 2L candidate with adequate organ function and controllable comorbid...

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

ID	`RF-ENDOMETRIAL-FIT-FOR-LENVATINIB-COMBO`
Type	Red flag
Status	reviewed 2026-04-30 \| pending_clinical_signoff
Diseases	`DIS-ENDOMETRIAL`
Sources	`SRC-ESMO-ENDOMETRIAL-2022` `SRC-NCCN-UTERINE-2025`

Red Flag Origin

Definition	Endometrial carcinoma 2L candidate with adequate organ function and controllable comorbidities to tolerate pembrolizumab + lenvatinib combination per KEYNOTE-775 (Makker NEJM 2022). Captures the prereq bundle: BP controllable on antihypertensives, no recent major surgery (<3 weeks), no active GI bleeding, no severe cardiac dysfunction (LVEF >=45%), and no uncontrolled proteinuria (UP/C <1.0 g/g) — these are the dose-modifying triggers for lenvatinib that, if uncontrolled at baseline, gate combination eligibility per FDA label.
Clinical direction	intensify
Category	fitness-eligibility
Shifts algorithm	ALGO-ENDOMETRIAL-2L

Trigger Logic

{
  "all_of": [
    {
      "any_of": [
        {
          "finding": "uncontrolled_hypertension",
          "value": false
        },
        {
          "comparator": "<",
          "finding": "blood_pressure_systolic_mmhg",
          "threshold": 150
        }
      ]
    },
    {
      "any_of": [
        {
          "finding": "recent_surgery_within_3_weeks",
          "value": false
        },
        {
          "comparator": ">=",
          "finding": "weeks_since_last_surgery",
          "threshold": 3
        }
      ]
    },
    {
      "any_of": [
        {
          "finding": "active_gi_bleed",
          "value": false
        },
        {
          "finding": "gi_bleed_history_recent",
          "value": false
        }
      ]
    },
    {
      "any_of": [
        {
          "comparator": ">=",
          "finding": "lvef_percent",
          "threshold": 45
        },
        {
          "finding": "severe_cardiac_dysfunction",
          "value": false
        }
      ]
    },
    {
      "any_of": [
        {
          "finding": "proteinuria_uncontrolled",
          "value": false
        },
        {
          "comparator": "<",
          "finding": "up_c_ratio_g_per_g",
          "threshold": 1.0
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notes

Aggregates the "Adequate organ function" + "lenvatinib toxicity tolerance required" gates from ALGO-ENDOMETRIAL-2L step 2. Each trigger axis defaults to "false" (i.e., NOT contraindicated) when finding absent — so patients without explicit contraindication documentation pass the gate. This is permissive-by-default which matches clinical practice (assume eligible unless documented ineligible). MDT brief should still surface lenvatinib-specific prerequisites for verbal confirmation. Patients flagged ineligible fall back to single-agent options (doxorubicin, paclitaxel re-challenge) outside current KB scope.

Used By

Algorithms

ALGO-ENDOMETRIAL-2L - ALGO-ENDOMETRIAL-2L