Frailty profile precluding standard carbo+pacli ± pembro / dostarlimab in advanced/recurr...

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

ID	`RF-ENDOMETRIAL-FRAILTY-AGE`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-ENDOMETRIAL`
Sources	`SRC-ESMO-ENDOMETRIAL-2022` `SRC-NCCN-UTERINE-2025`

Red Flag Origin

Definition	Frailty profile precluding standard carbo+pacli ± pembro / dostarlimab in advanced/recurrent endometrial: ECOG ≥3, OR age ≥75 with ≥2 comorbidities, OR composite (age ≥70 + albumin <3.0 + Charlson ≥3), OR explicit "unfit for combination chemotherapy". Endometrial cancer median age at diagnosis is ~63 with rising incidence in elderly.
Clinical direction	de-escalate
Category	frailty-age

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "ecog",
      "threshold": 3
    },
    {
      "finding": "fit_for_combination_chemo",
      "value": false
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 75
        },
        {
          "comparator": ">=",
          "finding": "comorbidity_count",
          "threshold": 2
        }
      ]
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 70
        },
        {
          "comparator": "<",
          "finding": "albumin_g_dl",
          "threshold": 3.0
        },
        {
          "comparator": ">=",
          "finding": "charlson_score",
          "threshold": 3
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notes

Frail elderly options: single-agent carboplatin (well tolerated, ORR 20-30%), weekly paclitaxel, or hormonal therapy (megestrol acetate / medroxyprogesterone) for ER/PR+ low-grade tumors. Pembrolizumab / dostarlimab monotherapy for dMMR/MSI-H is well tolerated even in frail patients (RUBY/NRG-GY018 included elderly subgroup with preserved benefit). Cardiac assessment baseline mandatory before doxorubicin (especially in carcinosarcoma backbone). Geriatric assessment (G8 / CGA) prior to regimen selection.

Used By

Indications

IND-ENDOMETRIAL-2L-DOSTARLIMAB-DMMR - IND-ENDOMETRIAL-2L-DOSTARLIMAB-DMMR
IND-ENDOMETRIAL-2L-PEMBRO-LENVA-PMMR - IND-ENDOMETRIAL-2L-PEMBRO-LENVA-PMMR