Age ≥75 with ECOG ≥2 or ≥2 comorbidities — cisplatin-paclitaxel CRT poorly tolerated and...

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

ID	`RF-THYROID-ANAPLASTIC-FRAILTY-AGE`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-THYROID-ANAPLASTIC`
Sources	`SRC-ATA-THYROID-2015` `SRC-NCCN-THYROID-2025`

Red Flag Origin

Definition	Age ≥75 with ECOG ≥2 or ≥2 comorbidities — cisplatin-paclitaxel CRT poorly tolerated and curative-intent surgical resection often not feasible; for BRAF-mutant ATC, dabrafenib + trametinib monotherapy (without RT or surgery) is reasonable; for BRAF-wild-type frail patients, palliative-intent care + tracheostomy for airway management is often the appropriate path. ATC frailty assessment must integrate with palliative-care planning given short median OS.
Clinical direction	de-escalate
Category	frailty-age

Trigger Logic

{
  "all_of": [
    {
      "comparator": ">=",
      "finding": "age_years",
      "threshold": 75
    },
    {
      "any_of": [
        {
          "comparator": ">=",
          "finding": "ecog_status",
          "threshold": 2
        },
        {
          "comparator": ">=",
          "finding": "comorbidity_count",
          "threshold": 2
        }
      ]
    }
  ],
  "type": "composite_clinical"
}

Notes

ATC predominantly affects elderly (median age ~70); aggressive CRT is rarely tolerated in ≥75 with comorbidity. For BRAF-mut ATC in elderly: dabrafenib + trametinib monotherapy retains ~60% ORR with much lower toxicity than CRT — palliative-intent treatment may approach disease-modifying benefit. For BRAF-wt elderly: tracheostomy + symptom control + hospice often appropriate; selected fit elderly may benefit from pembrolizumab monotherapy (better tolerated than cytotoxic). Goals-of-care discussion within first MDT meeting is ATA-recommended given disease tempo. Severity critical because of high stakes; priority 50 because BRAF status overrides this in conflict (RF-THYROID-ANAPLASTIC-HIGH-RISK-BIOLOGY priority 30).

Used By

Indications

IND-ATC-BRAF-V600E-DAB-TRAM - IND-ATC-BRAF-V600E-DAB-TRAM