Rapid progression in PDAC: clinical decline + CA19-9 doubling within 4-8 weeks during 1L...

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

ID	`RF-PDAC-TRANSFORMATION-PROGRESSION`
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	Rapid progression in PDAC: clinical decline + CA19-9 doubling within 4-8 weeks during 1L systemic, OR new peritoneal carcinomatosis with malignant ascites, OR new liver metastases on first restaging. Triggers MDT for 2L switch + early palliative-care escalation.
Clinical direction	investigate
Category	transformation-progression

Trigger Logic

{
  "any_of": [
    {
      "finding": "ca19_9_doubling_4_8wk",
      "value": true
    },
    {
      "finding": "new_peritoneal_carcinomatosis_with_ascites",
      "value": true
    },
    {
      "finding": "new_liver_mets_on_restaging",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

CA19-9 must be interpreted with caution in Lewis-blood-group-negative patients (~5-7% non-secretors). Always re-image (CT) — CA19-9 fluctuations alone don't define progression.

Used By

No reverse references found in the YAML corpus.