84.2 📚 國考版醫垫國考 / PGY OSCE

84.2.0.1 📌 Cram Sheet

84.2.0.1.1 🔥 高 yield 15
  1. Risk: BRCA, age, reproductive, dense breast, alcohol, obesity post-meno
  2. 4 subtypes: Luminal A/B, HER2+, TNBC
  3. BRCA1 → TNBC common; BRCA2 → ER+ + male breast + pancreatic
  4. DCIS = Stage 0; LCIS = marker (not cancer)
  5. USPSTF 2024: mammography 40-74 q2y
  6. High-risk MRI + mammo annual from 25-30
  7. Triple assessment: clinical + imaging + biopsy
  8. BCT + RT = mastectomy survival (NSABP B-06)
  9. Z0011: spare ALND if BCT + SLNB 1-2+
  10. Tamoxifen pre-meno / AI post-meno
  11. Tamoxifen toxicities: endometrial Ca + DVT
  12. CDK4/6 + endocrine for ER+ MBC 1st line
  13. THP (taxane + trastuzumab + pertuzumab) for HER2+ MBC 1st
  14. T-DXd for HER2+ 2nd line + HER2-low
  15. Pembrolizumab + chemo for TNBC PD-L1 CPS ≥ 10
84.2.0.1.2 🔢 必背
項目 æ•žå­—
Lifetime risk Taiwan 1/13
BRCA1 breast 60-70%
BRCA1 ovarian 40-50%
BRCA2 breast 40-60%
Trastuzumab adjuvant 1 yr
Tamoxifen / AI 5-10 yr
HER2 IHC+ 3+ or 2+ + FISH amp
CPS PD-L1 threshold TNBC ≥ 10
Oncotype DX RS (TAILORx) < 26 spare chemo

84.2.0.2 ⭐ 高 yield

84.2.0.2.1 Adjuvant Quick by Subtype
Subtype Adjuvant
ER+/HER2−/N0 low risk (Oncotype < 26) Endocrine alone
ER+/HER2−/N0 high risk Chemo + endocrine
ER+/HER2+ Chemo + trastuzumab + endocrine
HER2+/ER- Chemo + trastuzumab (± pertuzumab)
TNBC Chemo (AC-T) ± pembrolizumab (KEYNOTE-522)
84.2.0.2.2 Metastatic Quick
Subtype 1st line MBC
ER+/HER2− CDK4/6 + AI/fulvestrant
HER2+ THP (taxane + trast + pert)
TNBC PD-L1+ Pembrolizumab + chemo
TNBC BRCA+ PARP (olaparib)
84.2.0.2.3 Trial Names
  • NSABP B-06: BCT + RT = mastectomy
  • TAILORx: Oncotype DX
  • PALOMA, MONALEESA, MONARCH: CDK4/6 inhibitors
  • CLEOPATRA: pertuzumab + trast + docetaxel
  • KATHERINE: T-DM1 adjuvant if no pCR
  • DESTINY-Breast 03/04: T-DXd
  • KEYNOTE-522: pembro + chemo TNBC neoadj
  • KEYNOTE-355: pembro + chemo TNBC MBC
  • OlympiA: olaparib adjuvant BRCA
  • SOFT/TEXT: ovarian suppression + AI pre-meno
  • Z0011: SLNB+ no ALND
  • ADAURA: (NSCLC, not breast — careful!)
84.2.0.2.4 High-Risk Mutations
  • BRCA1, BRCA2 (panel)
  • TP53 (Li-Fraumeni)
  • PALB2 (moderate)
  • CHEK2 1100delC (moderate)
  • PTEN (Cowden)
  • CDH1 (lobular + diffuse gastric)
  • STK11 (Peutz-Jeghers)

84.2.0.3 🎯 自我檢枬

  1. 4 subtypes? → Luminal A/B, HER2+, TNBC
  2. BRCA1 vs BRCA2? → BRCA1 TNBC/ovarian; BRCA2 ER+/male/pancreatic
  3. DCIS vs LCIS? → DCIS = Stage 0; LCIS = marker
  4. USPSTF mammo 2024? → 40-74 q2y
  5. Tamoxifen toxicity? → Endometrial Ca + DVT
  6. AI toxicity? → Arthralgia, osteoporosis
  7. Z0011 criteria? → BCT + SLNB 1-2+ → no ALND
  8. Oncotype DX RS spare chemo? → < 26 (TAILORx)
  9. CDK4/6 ER+ 1st line? → + AI/fulvestrant
  10. HER2+ MBC 1st? → THP (taxane+trast+pert)
  11. T-DXd 適應症? → HER2+ 2nd line + HER2-low
  12. TNBC PD-L1+ MBC? → Pembro + chemo
  13. PARP for? → BRCA mutant
  14. KATHERINE trial? → T-DM1 adjuvant if no pCR HER2+
  15. KEYNOTE-522? → Pembro + chemo TNBC neoadj

⚠ AI 草皿。