Age ≥75 with ECOG ≥2 or ≥2 comorbidities — high-dose imatinib 800 mg (KIT exon 9) and TKI...

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

ID	`RF-GIST-FRAILTY-AGE`
Type	Red flag
Status	reviewed 2026-04-26 \| pending_clinical_signoff
Diseases	`DIS-GIST`
Sources	`SRC-NCCN-MELANOMA-2025` `SRC-ONCOKB`

Red Flag Origin

Definition	Age ≥75 with ECOG ≥2 or ≥2 comorbidities — high-dose imatinib 800 mg (KIT exon 9) and TKI sequencing into sunitinib / regorafenib poorly tolerated; consider imatinib 400 mg, dose reductions, and earlier supportive-care emphasis.
Clinical direction	de-escalate
Category	frailty-age

Trigger Logic

{
  "all_of": [
    {
      "comparator": ">=",
      "finding": "age_years",
      "threshold": 75
    },
    {
      "any_of": [
        {
          "comparator": ">=",
          "finding": "ecog_status",
          "threshold": 2
        },
        {
          "comparator": ">=",
          "finding": "comorbidity_count",
          "threshold": 2
        }
      ]
    }
  ],
  "type": "composite_clinical"
}

Notes

Imatinib is generally well-tolerated in elderly but cumulative fluid retention, periorbital edema, and hepatotoxicity are more frequent. Sunitinib (2L) carries significant cardiotoxicity, hypertension, hand-foot syndrome — geriatric patients at higher risk; regorafenib (3L) similar concerns. Adjuvant imatinib durations (3 vs 6 yr) should be individualized in elderly: SSG-XXII / PERSIST-5 data on extended duration enrolled fewer patients ≥70. Source-gap caveat: NCCN GIST / ESMO Sarcoma not yet ingested — using NCCN-MELANOMA-2025 (adjacent KIT-pathway reference per disease YAML precedent) and SRC-ONCOKB.

Used By

No reverse references found in the YAML corpus.