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Disfunção dos órgãos basais excluindo imatinib padrão / sunitinib / regorafenib / av...

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IDRF-GIST-ORGAN-DYSFUNCTION
TipoSinal de alerta
Estadoreviewed 2026-04-27 | pending_clinical_signoff
DoençasDIS-GIST
FontesSRC-ESMO-SARCOMA-2024 SRC-NCCN-GIST-2025

Origem da bandeira vermelha

DefiniçãoBaseline organ dysfunction precluding standard imatinib / sunitinib / regorafenib / avapritinib in GIST: LVEF <50% (sunitinib + regorafenib cardiotoxicity, hypertension), CrCl <30 mL/min (TKI-class dose adjustment, especially regorafenib), bilirubin >3× ULN (imatinib / avapritinib hepatic clearance — dose-limiting toxicity), or uncontrolled hypertension (sunitinib / regorafenib contraindicated).
Direcção clínicade escalonamento
Categoriadisfunção de órgãos

Lógica de Desencadeamento

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

Notas

Imatinib well-tolerated in mild-moderate hepatic impairment; severe hepatic dysfunction (Child-Pugh C) requires dose reduction. Sunitinib (2L) — significant cardiac signal: LVEF decline, hypertension, hand-foot syndrome — require baseline ECHO + serial monitoring, hold if LVEF drops >15% or below 50%. Regorafenib (3L) — hepatotoxicity (FDA boxed warning), severe hand-foot, hypertension — contraindicated if Child-Pugh C. Avapritinib carries CNS bleeding signal; QTc monitoring not required but cognitive effects observed at 300 mg. Uncontrolled hypertension is gating for sunitinib/regorafenib — optimize before initiation.

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