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

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

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

Red Flag Origin

Definition	Active or latent infection requiring resolution / prophylaxis before initiating crizotinib / lorlatinib / entrectinib or methotrexate / vinorelbine cytotoxic adjuvant in IMT: HBsAg-positive (HBV reactivation on TKI / cytotoxic), anti-HBc-positive (occult HBV), HIV-positive (ART coordination, CYP3A4 interactions with TKIs), 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

ALK / ROS1 / NTRK inhibitors (crizotinib, lorlatinib, alectinib, entrectinib, larotrectinib) are CYP3A4 substrates — coordinate with HIV ART regimens to avoid CYP3A4 inhibitors (ritonavir-boosted PIs) which raise TKI levels and toxicity. HBsAg+: entecavir / tenofovir prophylaxis for duration of TKI (often years in IMT). HIV+: PCP prophylaxis if on cytotoxic methotrexate / vinorelbine. Active TB: complete anti-TB before TKI initiation; rifampin (CYP3A4 inducer) lowers TKI levels — prefer rifabutin if anti-TB needed concurrently.

Used By

No reverse references found in the YAML corpus.