Age ≥75 with ECOG ≥2 or ≥2 comorbidities — vandetanib / cabozantinib multikinase inhibito...

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

ID	`RF-MTC-FRAILTY-AGE`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-MTC`
Sources	`SRC-ATA-THYROID-2015` `SRC-NCCN-THYROID-2025`

Red Flag Origin

Definition	Age ≥75 with ECOG ≥2 or ≥2 comorbidities — vandetanib / cabozantinib multikinase inhibitors poorly tolerated (severe diarrhea, hand-foot, hypertension, fatigue); selpercatinib / pralsetinib better-tolerated alternatives but still require dose adjustment; for asymptomatic indolent MTC, watchful waiting with calcitonin / CEA monitoring is appropriate.
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

MTC is often indolent — watchful waiting with calcitonin doubling time monitoring is appropriate for slow-progressing asymptomatic disease in elderly (ATA recommendation). Cabozantinib (EXAM trial) and vandetanib (ZETA) have meaningful diarrhea + hypertension burden; dose reductions to 60 mg / 200 mg respectively common in elderly. Selpercatinib LIBRETTO-531 demonstrated superior tolerability vs vandetanib — preferred 1L when RET-mutant. Geriatric assessment (G8) ≥70 recommended before TKI initiation. ¹⁷⁷Lu-DOTATATE PRRT is generally well-tolerated in elderly with SSTR+ disease and limited acute toxicity profile.

Used By

No reverse references found in the YAML corpus.