Infection-screening gate before PDAC FOLFIRINOX / gem-nab-pac: HBsAg+ / anti-HBc+ (HBV re...

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

ID	`RF-PDAC-INFECTION-SCREENING`
Type	Red flag
Status	reviewed 2026-04-26 \| pending_clinical_signoff
Diseases	`DIS-PDAC`
Sources	`SRC-ESMO-PANCREATIC-2024` `SRC-NCCN-PANCREATIC-2025`

Red Flag Origin

Definition	Infection-screening gate before PDAC FOLFIRINOX / gem-nab-pac: HBsAg+ / anti-HBc+ (HBV reactivation on dexamethasone-containing regimens), HIV+, OR active cholangitis (post-stent infectious complication — common given biliary instrumentation in head-of-pancreas tumors).
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_cholangitis",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

Cholangitis typically post-stenting (~10-20% of plastic stents, lower for metallic). Treat with antibiotics + drainage adjustment; delay chemo until afebrile + bilirubin trending down.

Used By

Indications

IND-PDAC-METASTATIC-1L-NALIRIFOX - IND-PDAC-METASTATIC-1L-NALIRIFOX
IND-PDAC-METASTATIC-2L-NAL-IRI - IND-PDAC-METASTATIC-2L-NAL-IRI