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Frailty profile precluding standard FOLFOX+nivo / FLOT in gastric cancer: ECOG ≥3, OR (ag...

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

IDRF-GASTRIC-FRAILTY-AGE
TypeRed flag
Statusreviewed 2026-04-26 | pending_clinical_signoff
DiseasesDIS-GASTRIC
SourcesSRC-ESMO-GASTRIC-2024 SRC-NCCN-GASTRIC-2025

Red Flag Origin

DefinitionFrailty profile precluding standard FOLFOX+nivo / FLOT in gastric cancer: ECOG ≥3, OR (age ≥75 + Charlson ≥3), OR composite (age ≥70 + albumin <3.0 + ≥10% weight loss + sarcopenia — common in gastric cancer). Triggers regimen de-escalation (5-FU / capecitabine monotherapy, omit ICI/biologic).
Clinical directionde-escalate
Categoryfrailty-age

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "ecog",
      "threshold": 3
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 70
        },
        {
          "comparator": "<",
          "finding": "albumin_g_dl",
          "threshold": 3.0
        },
        {
          "comparator": ">=",
          "finding": "weight_loss_pct_3mo",
          "threshold": 10
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notes

Pre-treatment nutrition optimization (PEG/J-tube, parenteral nutrition bridge) often required. Nivolumab-containing regimens have lower symptomatic toxicity than FLOT for elderly — ATTRACTION-4 included ECOG 0-1 only; real-world frail elderly: capecitabine + nivolumab is reasonable de-escalation.

Used By

Indications