Idade ≥75 com ECOG ≥2 ou ≥2 Comorbidades — methotrexate / adjuvante citotóxico de vinorelbina...

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ID	`RF-IMT-FRAILTY-AGE`
Tipo	Sinal de alerta
Estado	reviewed 2026-04-27 \| pending_clinical_signoff
Doenças	`DIS-IMT`
Fontes	`SRC-NCCN-SARCOMA`

Origem da bandeira vermelha

Definição	Age ≥75 with ECOG ≥2 or ≥2 comorbidities — methotrexate / vinorelbine cytotoxic adjuvant and TKI-class agents (crizotinib, lorlatinib) more toxic in elderly (mucositis, fatigue, hyperlipidemia, edema); consider monotherapy with reduced-dose TKI, watchful waiting if asymptomatic (IMT is intermediate-behavior), or best supportive care.
Direcção clínica	de escalonamento
Categoria	Idade de fragilidade

Lógica de Desencadeamento

{
  "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"
}

Notas

IMT spans pediatric to elderly; older patients more often have abdominal / retroperitoneal location and asymptomatic incidental diagnosis — watchful waiting reasonable for fusion-negative slow- growing disease. Lorlatinib in elderly: hyperlipidemia (statin coverage required), cognitive effects + neuropathy more frequent. Crizotinib: edema, fatigue, GI more pronounced. Geriatric assessment (G8 score) recommended ≥70 before initiating TKI. Methotrexate / vinorelbine cytotoxic adjuvant rarely tolerated in this group — TKI monotherapy preferred when fusion-positive.

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