Age ≥75 with ECOG ≥2 or ≥2 comorbidities — lenvatinib full-dose (24 mg) poorly tolerated;...

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

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

Red Flag Origin

Definition	Age ≥75 with ECOG ≥2 or ≥2 comorbidities — lenvatinib full-dose (24 mg) poorly tolerated; consider lenvatinib 14 mg starting dose (Brose et al subgroup), selective RET / NTRK inhibitor monotherapy if fusion+, or watchful waiting if asymptomatic indolent metastatic disease (most PTC indolent — frail elderly often die with rather than from disease).
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

PTC is the most indolent thyroid malignancy; for elderly with metastatic but asymptomatic disease, watchful waiting with serial thyroglobulin + imaging is appropriate (especially if doubling time >12 mo). Lenvatinib starting at 14 mg (vs 24 mg standard) tested in Study 211 — PFS comparable, lower hypertension / fatigue / proteinuria burden in elderly. Selpercatinib / pralsetinib (RET+) and larotrectinib / entrectinib (NTRK+) better tolerated than multikinase — preferred in frail elderly when biomarker-positive. Geriatric assessment (G8) ≥70 recommended before TKI initiation. Most PTC patients in this category will benefit more from symptom-focused care + low-dose TKI than full-dose induction.

Used By

No reverse references found in the YAML corpus.