Treatment-defining biomarkers in esophageal/EGJ cancer: HER2+ (adeno only — TOGA-style ga...

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

ID	`RF-ESOPH-HIGH-RISK-BIOLOGY`
Type	Red flag
Status	reviewed 2026-04-26 \| pending_clinical_signoff
Diseases	`DIS-ESOPHAGEAL`
Sources	`SRC-ESMO-ESOPHAGEAL-2024` `SRC-NCCN-ESOPHAGEAL-2025`

Red Flag Origin

Definition	Treatment-defining biomarkers in esophageal/EGJ cancer: HER2+ (adeno only — TOGA-style gastric criteria) → trastuzumab+chemo metastatic; PD-L1 CPS ≥10 (KEYNOTE-590 squamous) OR CPS ≥1 (CheckMate-648 adeno+squamous) → ICI+chemo 1L; MSI-H → pembro mono.
Clinical direction	intensify
Category	high-risk-biology

Trigger Logic

{
  "any_of": [
    {
      "all_of": [
        {
          "finding": "histology",
          "value": "adeno"
        },
        {
          "finding": "her2_status",
          "value": "positive"
        }
      ]
    },
    {
      "all_of": [
        {
          "finding": "histology",
          "value": "squamous"
        },
        {
          "comparator": ">=",
          "finding": "pdl1_cps",
          "threshold": 10
        }
      ]
    },
    {
      "all_of": [
        {
          "finding": "histology",
          "value": "adeno"
        },
        {
          "comparator": ">=",
          "finding": "pdl1_cps",
          "threshold": 1
        }
      ]
    },
    {
      "finding": "msi_status",
      "value": "MSI-H"
    }
  ],
  "type": "biomarker"
}

Notes

Squamous CPS-cutoff vs adeno differs (KEYNOTE-590 used ≥10 for enrichment). Real-world: chemo+ICI is becoming default 1L for both histologies regardless of CPS in many centers. T-DXd 2L+ for HER2+ adeno (DESTINY-Gastric01 included GEJ subgroup).

Used By

No reverse references found in the YAML corpus.