Active or latent infection requiring resolution / prophylaxis before initiating platinum-...

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

ID	`RF-SCLC-INFECTION-SCREENING`
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	Active or latent infection requiring resolution / prophylaxis before initiating platinum-etoposide + ICI (atezolizumab / durvalumab) or topotecan in SCLC: HBsAg+ or anti-HBc+ (HBV reactivation on cytotoxic chemo and on ICI), HCV-RNA+, HIV+, active TB, or active uncontrolled infection. SCLC patients are usually heavy smokers with high COPD / TB-history burden — TB screening notably relevant.
Clinical direction	hold
Category	infection-screening

Trigger Logic

{
  "any_of": [
    {
      "finding": "hbsag",
      "value": "positive"
    },
    {
      "finding": "anti_hbc_total",
      "value": "positive"
    },
    {
      "finding": "hcv_rna",
      "value": "positive"
    },
    {
      "finding": "hiv_status",
      "value": "positive"
    },
    {
      "finding": "active_tb",
      "value": true
    },
    {
      "finding": "latent_tb",
      "value": true
    },
    {
      "finding": "active_uncontrolled_infection",
      "value": true
    }
  ],
  "type": "composite"
}

Notes

HBsAg+ → entecavir or tenofovir from before first cycle through ≥6 months post-last-chemo / ICI. Latent TB common in SCLC population (heavy smoking + lower socioeconomic strata + Ukrainian endemic TB): IGRA / TST + chest imaging at workup; isoniazid prophylaxis 6-9 mo if positive, deferring start until at least 4 weeks of antiviral / anti-TB if active. HIV+ with stable ART can receive ICI safely. Active uncontrolled chest infection (frequent in SCLC presenting with post-obstructive pneumonia) — antibiotic course + drainage if needed before initiating cytotoxic chemo. Direction "hold" surfaces a workup-prerequisite annotation rather than switching indication.

Used By

Indications

IND-SCLC-RR-LURBINECTEDIN - IND-SCLC-RR-LURBINECTEDIN
IND-SCLC-RR-TARLATAMAB - IND-SCLC-RR-TARLATAMAB
IND-SCLC-RR-TOPOTECAN - IND-SCLC-RR-TOPOTECAN