Active or latent infection requiring resolution / prophylaxis before initiating cisplatin...

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

ID	`RF-THYROID-ANAPLASTIC-INFECTION-SCREENING`
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	Active or latent infection requiring resolution / prophylaxis before initiating cisplatin / paclitaxel / doxorubicin chemoradiation, dabrafenib + trametinib, larotrectinib / entrectinib, or selpercatinib for ATC: HBsAg-positive (HBV reactivation on cytotoxic + targeted), anti-HBc-positive (occult HBV), HIV-positive (ART coordination, CYP3A4 interactions with TKIs), or active TB. Disease tempo limits ability to fully resolve infection — pragmatic prophylaxis approach required.
Clinical direction	hold
Category	infection-screening

Trigger Logic

{
  "any_of": [
    {
      "finding": "hbsag",
      "value": "positive"
    },
    {
      "finding": "anti_hbc_total",
      "value": "positive"
    },
    {
      "finding": "hiv_status",
      "value": "positive"
    },
    {
      "finding": "active_tb",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

ATC has median OS 3-6 months untreated and ~14 months on best targeted therapy — the timeline for infection workup must be days, not weeks. HBsAg+: start entecavir / tenofovir prophylaxis immediately rather than waiting for hepatology consult. HIV+: start ATC therapy concurrently with ART optimization (delay would be fatal); BRAFi/MEKi/TKI are CYP3A4 substrates — avoid ritonavir- boosted PIs. Active TB: pragmatic — start anti-TB and ATC therapy together with monitoring, given disease tempo. The "hold" direction here is pragmatic prophylaxis-coordinated start, not delayed treatment.

Used By

Indications

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