Baseline organ dysfunction precluding standard cisplatin-based chemotherapy or affecting...

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ID	`RF-SALIVARY-ORGAN-DYSFUNCTION`
Tipo	Sinal de alerta
Estado	reviewed 2026-04-27 \| pending_clinical_signoff
Doenças	`DIS-SALIVARY`
Fontes	`SRC-ESMO-SALIVARY` `SRC-NCCN-HEAD-AND-NECK`

Origem da bandeira vermelha

Definição	Baseline organ dysfunction precluding standard cisplatin-based chemotherapy or affecting targeted therapy in advanced salivary gland carcinoma: CrCl <60 mL/min (cisplatin contraindicated, switch to carboplatin), LVEF <50% (trastuzumab contraindicated for HER2+ SDC, doxorubicin in adenoid-cystic chemo), bilirubin >3× ULN (taxane / TKI hepatic clearance), baseline ototoxicity (cisplatin contraindicated), or QTc >480 ms (entrectinib / tipifarnib QT signal).
Direcção clínica	de escalonamento
Categoria	disfunção de órgãos

Lógica de Desencadeamento

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "creatinine_clearance_ml_min",
      "threshold": 60
    },
    {
      "comparator": "<",
      "finding": "lvef_percent",
      "threshold": 50
    },
    {
      "comparator": ">=",
      "finding": "bilirubin_ratio_to_uln",
      "threshold": 3
    },
    {
      "finding": "baseline_ototoxicity",
      "value": true
    },
    {
      "comparator": ">",
      "finding": "qtc_ms",
      "threshold": 480
    }
  ],
  "type": "lab_value"
}

Notas

Cisplatin-based chemotherapy in salivary gland cancer has only modest activity (ORR ~30% in mucoepidermoid / adenoid cystic) — the organ- dysfunction flag pushes harder toward histology-specific targeted therapy when biomarker-positive. HER2+ SDC: trastuzumab + chemotherapy requires baseline LVEF ≥50% (analogous to breast cancer protocols). Larotrectinib / entrectinib for NTRK+ MASC well-tolerated; entrectinib has documented QT prolongation. Tipifarnib (HRAS+ SDC) carries cytopenias + QT prolongation. AR-targeted therapy (bicalutamide + LHRH) generally well-tolerated even with organ dysfunction — a viable de-escalation path for AR+ SDC.

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