Age ≥75 with ECOG ≥2 or ≥2 comorbidities — methotrexate / vinorelbine cytotoxic adjuvant...

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

ID	`RF-IMT-FRAILTY-AGE`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-IMT`
Sources	`SRC-NCCN-SARCOMA` `SRC-ONCOKB`

Red Flag Origin

Definition	Age ≥75 with ECOG ≥2 or ≥2 comorbidities — methotrexate / vinorelbine cytotoxic adjuvant and TKI-class agents (crizotinib, lorlatinib) more toxic in elderly (mucositis, fatigue, hyperlipidemia, edema); consider monotherapy with reduced-dose TKI, watchful waiting if asymptomatic (IMT is intermediate-behavior), or best supportive care.
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

IMT spans pediatric to elderly; older patients more often have abdominal / retroperitoneal location and asymptomatic incidental diagnosis — watchful waiting reasonable for fusion-negative slow- growing disease. Lorlatinib in elderly: hyperlipidemia (statin coverage required), cognitive effects + neuropathy more frequent. Crizotinib: edema, fatigue, GI more pronounced. Geriatric assessment (G8 score) recommended ≥70 before initiating TKI. Methotrexate / vinorelbine cytotoxic adjuvant rarely tolerated in this group — TKI monotherapy preferred when fusion-positive.

Used By

No reverse references found in the YAML corpus.