84.3 🩺 內科專科考前版

84.3.0.1 📌 䞀頁重點

  • 22E: T-DXd for HER2-low (DESTINY-Breast04), olaparib adjuvant BRCA (OlympiA), abemaciclib adjuvant high-risk (monarchE), elacestrant ESR1, trastuzumab deruxtecan replacing T-DM1, tucatinib + trast + cape brain mets
  • Taiwan: 健保 trastuzumab + pertuzumab、CDK4/6 inhibitor 絊付、PD-L1/BRCA testing

84.3.0.2 🌟 Pearls (15)

  1. T-DXd for HER2-low (IHC 1+ or 2+ FISH−) — DESTINY-Breast04
  2. Olaparib adjuvant for BRCA mutant high-risk — OlympiA (1 yr)
  3. Abemaciclib adjuvant for ER+ high-risk N+ — monarchE (2 yr)
  4. Elacestrant for ESR1 mutant post-CDK4/6 (oral SERD)
  5. Capivasertib for AKT pathway alterations (CAPItello-291)
  6. Alpelisib for PIK3CA mutant ER+ (SOLAR-1)
  7. Tucatinib + trastuzumab + capecitabine for HER2+ brain mets (HER2CLIMB)
  8. Margetuximab for HER2+ post-prior anti-HER2
  9. Sacituzumab govitecan (Trodelvy) TROP2 ADC for TNBC + HR+ (TROPiCS-02)
  10. Datopotamab deruxtecan (Dato-DXd) TROP2 ADC emerging
  11. Disitamab vedotin HER2 ADC
  12. Pembrolizumab adjuvant TNBC post-neoadj (KEYNOTE-522)
  13. Liquid biopsy ctDNA for ESR1, PIK3CA monitoring
  14. CMF historic, AC-T standard, ddAC-T for high-risk
  15. Ovarian suppression + exemestane for high-risk pre-meno (SOFT/TEXT)

84.3.0.3 📍 Taiwan

  • 國健眲乳癌篩檢: 45-69, 高 risk 40-44 q2y mammography
  • 健保 trastuzumab + pertuzumab (HER2+ ≥ 1 cm or N+)
  • 健保 CDK4/6 inhibitor (palbociclib, ribociclib, abemaciclib) for HR+ MBC
  • 健保 T-DM1 post-neoadj if no pCR
  • 健保 T-DXd 條件
  • 健保 olaparib for BRCA mutant
  • 健保 pembrolizumab + chemo for TNBC neoadj/MBC PD-L1+
  • BRCA panel testing 健保條件

84.3.0.4 🎓 內專重點

  1. 4 subtypes
  2. Adjuvant by subtype (incl ADAURA-style adjuvant osimertinib, OlympiA olaparib, monarchE abemaciclib)
  3. Neoadjuvant immunotherapy (KEYNOTE-522)
  4. MBC 1st-3rd line by subtype
  5. ADC era (T-DXd, sacituzumab, dato-DXd)
  6. ESR1 / PIK3CA / AKT mutations + drugs (22E)
  7. BRCA testing + PARP

⚠ AI 草皿。