Frailty profile precluding intensified 1L systemic in HCC: ECOG ≥3, OR (age ≥75 + Child-P...

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

ID	`RF-HCC-FRAILTY-AGE`
Type	Red flag
Status	reviewed 2026-04-26 \| pending_clinical_signoff
Diseases	`DIS-HCC`
Sources	`SRC-AASLD-HCC-2023` `SRC-NCCN-HCC-2025`

Red Flag Origin

Definition	Frailty profile precluding intensified 1L systemic in HCC: ECOG ≥3, OR (age ≥75 + Child-Pugh B7 + sarcopenia), OR composite (Karnofsky <70 + active hepatic encephalopathy + albumin <2.8). Triggers BSC discussion + palliative-care referral; sorafenib reduced-dose (200 mg BID) acceptable for selected CP-A frail patients.
Clinical direction	de-escalate
Category	frailty-age
Shifts algorithm	ALGO-HCC-SYSTEMIC-1L

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "ecog",
      "threshold": 3
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 75
        },
        {
          "finding": "child_pugh_class",
          "value": "B"
        },
        {
          "finding": "sarcopenia_present",
          "value": true
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notes

IMbrave150 + HIMALAYA both required ECOG ≤1 — frail elderly excluded from pivotal trials. Real-world: sorafenib 200 mg BID start with cautious escalation; lenvatinib body-weight-based dosing (8 mg if ≤60 kg). Best supportive care + palliative referral when life expectancy <3 months.

Used By

Algorithms

ALGO-HCC-SYSTEMIC-1L - ALGO-HCC-SYSTEMIC-1L

Indications

IND-HCC-SYSTEMIC-2L-CABOZANTINIB - IND-HCC-SYSTEMIC-2L-CABOZANTINIB
IND-HCC-SYSTEMIC-2L-RAMUCIRUMAB - IND-HCC-SYSTEMIC-2L-RAMUCIRUMAB
IND-HCC-SYSTEMIC-2L-REGORAFENIB - IND-HCC-SYSTEMIC-2L-REGORAFENIB