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Active or latent infection requiring resolution / prophylaxis before initiating platinum-...

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IDRF-SCLC-INFECTION-SCREENING
TipoSinal de alerta
Estadoreviewed 2026-04-27 | pending_clinical_signoff
DoençasDIS-SCLC
FontesSRC-ESMO-SCLC-2021 SRC-NCCN-SCLC-2025

Origem da bandeira vermelha

DefiniçãoActive or latent infection requiring resolution / prophylaxis before initiating platinum-etoposide + ICI (atezolizumab / durvalumab) or topotecan in SCLC: HBsAg+ or anti-HBc+ (HBV reactivation on cytotoxic chemo and on ICI), HCV-RNA+, HIV+, active TB, or active uncontrolled infection. SCLC patients are usually heavy smokers with high COPD / TB-history burden — TB screening notably relevant.
Direcção clínicaaguentar
Categoriarastreamento de infecções

Lógica de Desencadeamento

{
  "any_of": [
    {
      "finding": "hbsag",
      "value": "positive"
    },
    {
      "finding": "anti_hbc_total",
      "value": "positive"
    },
    {
      "finding": "hcv_rna",
      "value": "positive"
    },
    {
      "finding": "hiv_status",
      "value": "positive"
    },
    {
      "finding": "active_tb",
      "value": true
    },
    {
      "finding": "latent_tb",
      "value": true
    },
    {
      "finding": "active_uncontrolled_infection",
      "value": true
    }
  ],
  "type": "composite"
}

Notas

HBsAg+ → entecavir or tenofovir from before first cycle through ≥6 months post-last-chemo / ICI. Latent TB common in SCLC population (heavy smoking + lower socioeconomic strata + Ukrainian endemic TB): IGRA / TST + chest imaging at workup; isoniazid prophylaxis 6-9 mo if positive, deferring start until at least 4 weeks of antiviral / anti-TB if active. HIV+ with stable ART can receive ICI safely. Active uncontrolled chest infection (frequent in SCLC presenting with post-obstructive pneumonia) — antibiotic course + drainage if needed before initiating cytotoxic chemo. Direction "hold" surfaces a workup-prerequisite annotation rather than switching indication.

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