High-risk biological features in SCLC: extensive-stage at presentation (ES-SCLC, ~70% of...

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

ID	`RF-SCLC-HIGH-RISK-BIOLOGY`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-SCLC`
Sources	`SRC-ESMO-SCLC-2021` `SRC-NCCN-SCLC-2025`

Red Flag Origin

Definition	High-risk biological features in SCLC: extensive-stage at presentation (ES-SCLC, ~70% of cases), brain metastases at baseline, bulky liver metastases (LDH >2× ULN), or molecular subtype-Y / inflamed (SCLC-I) emerging as ICI-responsive subgroup vs SCLC-A/N/P (less ICI-responsive in IMpower133 / CASPIAN biomarker analyses).
Clinical direction	intensify
Category	high-risk-biology

Trigger Logic

{
  "any_of": [
    {
      "finding": "sclc_extensive_stage",
      "value": true
    },
    {
      "finding": "brain_metastases",
      "value": true
    },
    {
      "comparator": ">=",
      "finding": "ldh_ratio_to_uln",
      "threshold": 2
    },
    {
      "finding": "sclc_molecular_subtype",
      "value": "SCLC-I"
    },
    {
      "finding": "liver_metastases_bulky",
      "value": true
    }
  ],
  "type": "composite"
}

Notes

ES-SCLC at presentation routes to platinum-etoposide + atezolizumab (IMpower133) or platinum-etoposide + durvalumab (CASPIAN) as 1L standard. Brain metastases: prophylactic cranial irradiation (PCI) controversial in ES-SCLC (Takahashi 2017 vs Slotman 2007); for baseline brain mets, stereotactic radiosurgery or whole-brain RT before/concurrent with chemo+ICI. Bulky liver disease (LDH >2× ULN): associated with worse OS but standard regimen still appropriate. SCLC molecular subtypes (Rudin 2019 — SCLC-A/N/P/Y or -I): SCLC-I (inflamed) shows greatest ICI benefit in retrospective biomarker analyses; not yet routine clinical testing but emerging.

Used By

No reverse references found in the YAML corpus.