Active or latent infection requiring resolution / prophylaxis before initiating cisplatin...

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

ID	`RF-HNSCC-INFECTION-SCREENING`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-HNSCC`
Sources	`SRC-ESMO-HNSCC-2020` `SRC-NCCN-HNSCC-2025`

Red Flag Origin

Definition	Active or latent infection requiring resolution / prophylaxis before initiating cisplatin-based chemoradiation, cetuximab + RT, or pembrolizumab in HNSCC: HBsAg-positive (HBV reactivation on cytotoxic chemotherapy + checkpoint inhibitors), anti-HBc-positive (occult HBV on cetuximab — anti-EGFR class), HIV-positive (ART coordination, often comorbid in HPV-related HNSCC), or active TB.
Clinical direction	hold
Category	infection-screening

Trigger Logic

{
  "any_of": [
    {
      "finding": "hbsag",
      "value": "positive"
    },
    {
      "finding": "anti_hbc_total",
      "value": "positive"
    },
    {
      "finding": "hiv_status",
      "value": "positive"
    },
    {
      "finding": "active_tb",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

Cetuximab — anti-EGFR mAb — has documented HBV reactivation reports (less than rituximab but non-zero); FDA label notes warning. Standard HBsAg + anti-HBc + anti-HBs serology pre-treatment; entecavir / tenofovir for HBsAg+. HIV-related HNSCC (oropharyngeal, cervical squamous) is increasingly recognized; ART coordination critical before cisplatin (renal interactions with tenofovir DF) — switch to TAF or coordinate with infectious disease. Active TB: complete anti-TB before head-and-neck RT given mucositis + neutropenia overlap.

Used By

Indications

IND-HNSCC-RM-1L-EXTREME - IND-HNSCC-RM-1L-EXTREME
IND-HNSCC-RM-1L-PEMBRO-CHEMO - IND-HNSCC-RM-1L-PEMBRO-CHEMO
IND-HNSCC-RM-1L-PEMBRO-MONO-CPS-HIGH - IND-HNSCC-RM-1L-PEMBRO-MONO-CPS-HIGH
IND-HNSCC-RM-2L-NIVOLUMAB - IND-HNSCC-RM-2L-NIVOLUMAB
IND-HNSCC-RM-2L-PEMBROLIZUMAB - IND-HNSCC-RM-2L-PEMBROLIZUMAB