Platinum-resistant disease: progression-free interval (PFI) ≤6 months from completion of...

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

ID	`RF-PRIOR-PLATINUM-RESISTANT`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-AURELIA-PUJADE-LAURAINE-2014` `SRC-NCCN-OVARIAN-2025`

Red Flag Origin

Definition	Platinum-resistant disease: progression-free interval (PFI) ≤6 months from completion of last platinum-containing regimen. Standard taxonomy in ovarian (PROC), urothelial, NSCLC, head-and-neck. Triggers non-platinum next line — single-agent chemotherapy (PLD, topotecan, weekly paclitaxel for ovarian; docetaxel, ADC for urothelial), targeted therapy, or trial.
Clinical direction	de-escalate
Category	prior-therapy-class

Trigger Logic

{
  "any_of": [
    {
      "all_of": [
        {
          "finding": "prior_platinum_received",
          "value": true
        },
        {
          "comparator": "<=",
          "finding": "platinum_free_interval_months",
          "threshold": 6
        }
      ]
    },
    {
      "finding": "platinum_resistant",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

Ovarian PROC: AURELIA established weekly paclitaxel ± bevacizumab, PLD ± bev, topotecan ± bev as standard; mirvetuximab for FRα-high (MIRASOL); olaparib if BRCA + PARPi-naive. Platinum-refractory (progression on platinum or PFI <1 mo) is even more aggressive — bev combinations preferred. Urothelial post-platinum PD: enfortumab vedotin + pembrolizumab (EV-302) is now 1L standard but for those who progressed on prior platinum without IO, EV mono or EV+pembro (KEYNOTE-A39); sacituzumab govitecan (TROPHY-U-01); erdafitinib if FGFR2/3 alteration. NSCLC: docetaxel ± ramucirumab, ICI rechallenge rare. PFI cutoff 6 months is convention — some trials use 3 or 12.

Used By

Algorithms

ALGO-ENDOMETRIAL-2L - ALGO-ENDOMETRIAL-2L