83.3 🩺 內科專科考前版

83.3.0.1 📌 䞀頁重點

  • 22E: 倚 driver mutation drugs, neoadjuvant chemo-immuno (CheckMate 816), adjuvant osimertinib (ADAURA), HER2-mutant T-DXd, perioperative pembrolizumab (KEYNOTE-671)
  • Taiwan: 健保 EGFR/ALK/ROS1 TKI, 健保 LDCT screening 2022重床吞菞 + 50-74 OR 家族史

83.3.0.2 🌟 Pearls (15)

  1. Adjuvant osimertinib post-resection EGFR+ NSCLC (ADAURA — DFS benefit)
  2. Neoadjuvant nivolumab + chemo resectable NSCLC (CheckMate 816)
  3. Perioperative pembrolizumab (KEYNOTE-671)
  4. Lorlatinib 1st line ALK+ (CROWN — best PFS, but CNS/cog SE)
  5. Sotorasib for KRAS G12C (CodeBreaK)
  6. Adagrasib alternative KRAS G12C
  7. Capmatinib / tepotinib for MET ex14
  8. Selpercatinib for RET fusion (LIBRETTO)
  9. T-DXd for HER2 mutant NSCLC (DESTINY-Lung)
  10. Liquid biopsy ctDNA monitoring
  11. TIL therapy trials in lung
  12. PD-1 + chemo + bevacizumab (IMpower150) for non-squamous
  13. CASPIAN / IMpower133 SCLC ED with immunotherapy
  14. Lurbinectedin for relapsed SCLC
  15. Pulmonary toxicity from immunotherapy (pneumonitis 5%)

83.3.0.3 📍 Taiwan

  • 女性肺癌特色: 䞍抜菞 EGFR+ adeno 高頻
  • 健保 LDCT screening 2022重床吞菞 + 50-74 OR 䞀等芪肺癌 + 50-74
  • 健保 EGFR / ALK / ROS1 / BRAF / MET / RET / NTRK TKI 挞進絊付
  • 健保 PD-1/PD-L1 倚 line
  • 健保 ADAURA (adjuvant osimertinib) 條件
  • 健保 PACIFIC (durvalumab consolidation) 條件
  • 健保 PD-L1 testing for immunotherapy

83.3.0.4 🎓 內專重點

  1. NSCLC histology + driver mutation
  2. NGS panel + PD-L1 testing必須 for adeno
  3. Stage I-IV treatment algorithm
  4. EGFR osimertinib (1st line + adjuvant)
  5. ALK alectinib/lorlatinib
  6. KRAS G12C sotorasib
  7. CRT + PACIFIC for III unresectable
  8. SCLC LD (CRT + PCI) vs ED (chemo-immuno)
  9. Neoadjuvant + perioperative immunotherapy (22E)
  10. HER2 T-DXd (22E)
  11. LDCT screening (Taiwan)

⚠ AI 草皿。