Baseline organ dysfunction precluding standard cisplatin / paclitaxel / doxorubicin chemo...

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

ID	`RF-THYROID-ANAPLASTIC-ORGAN-DYSFUNCTION`
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	Baseline organ dysfunction precluding standard cisplatin / paclitaxel / doxorubicin chemoradiation or affecting BRAF-MEK-inhibitor dosing in ATC: CrCl <30 mL/min (cisplatin contraindicated), LVEF <50% (doxorubicin contraindicated; trametinib cardiac monitoring), bilirubin >3× ULN (BRAFi/MEKi hepatic clearance), QTc >480 ms (dabrafenib QT signal), or compromised airway from tumor (tracheostomy or stent required before systemic therapy initiation).
Clinical direction	de-escalate
Category	organ-dysfunction

Trigger Logic

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "creatinine_clearance_ml_min",
      "threshold": 30
    },
    {
      "comparator": "<",
      "finding": "lvef_percent",
      "threshold": 50
    },
    {
      "comparator": ">=",
      "finding": "bilirubin_ratio_to_uln",
      "threshold": 3
    },
    {
      "comparator": ">",
      "finding": "qtc_ms",
      "threshold": 480
    },
    {
      "finding": "compromised_airway",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

ATC patients commonly present with rapid neck mass + airway compromise — emergency airway management (tracheostomy / endotracheal stent) is the gating step before any systemic therapy. Cisplatin-paclitaxel weekly with concurrent IMRT is the cytotoxic standard in BRAF-wild- type ATC; CrCl <30 forces switch to carboplatin or omit platinum. Dabrafenib + trametinib better tolerated than cytotoxic in BRAF-mutant ATC — preferred for organ-dysfunction scenarios. LVEF <50% is gating for doxorubicin-containing regimens (DHA-BCG historical). Trametinib carries LVEF decline risk (~5% Gr3+) — baseline ECHO + serial. Critical severity reflects the disease's narrow therapeutic window.

Used By

Indications

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