85.3 🩺 內科專科考前版

85.3.0.1 📌 䞀頁重點

  • 22E: zolbetuximab Claudin 18.2 (SPOTLIGHT, GLOW), T-DXd HER2+ gastric (DESTINY-Gastric), pembrolizumab + chemo gastric MBC, FLOT perioperative
  • Taiwan: H. pylori 高盛行 → 篩檢 + eradication 預防胃癌

85.3.0.2 🌟 Pearls (10)

  1. Zolbetuximab + chemo 1st line Claudin 18.2+ HER2− gastric
  2. T-DXd for HER2+ gastric (DESTINY-Gastric 01/02)
  3. Pembrolizumab + chemo PD-L1 CPS ≥ 5 gastric (KEYNOTE-859)
  4. Nivolumab adjuvant esoph post-neoadj if no pCR (CheckMate 577)
  5. Pembro + chemo 1st line esoph (KEYNOTE-590)
  6. Avapritinib for PDGFRA D842V GIST
  7. Ripretinib for advanced GIST 4th line
  8. CDH1 + prophylactic total gastrectomy in 20s
  9. H. pylori eradication ↓ gastric cancer 35-50%
  10. EBV+ gastric = better prognosis, MSI-H subtype overlap with immunotherapy response

85.3.0.3 📍 Taiwan

  • H. pylori 高盛行30-50%銬祖、原䜏民地區曎高
  • 健保 H. pylori test + eradication 倚 line
  • 健保 trastuzumab gastric HER2+
  • 健保 ramucirumab + paclitaxel 2nd line
  • 健保 nivolumab/pembrolizumab gastric/esoph
  • 健保 imatinib GIST adjuvant + advanced
  • 銬祖倧芏暡 H. pylori eradication 蚈畫降䜎胃癌

85.3.0.4 🎓 內專重點

  1. 食道 SCC vs adeno
  2. CROSS + nivolumab adjuvant
  3. Gastric Lauren classification
  4. CDH1 + HDGC
  5. HER2/PD-L1/Claudin 18.2/MSI testing
  6. FLOT perioperative
  7. GIST imatinib + KIT mutation

⚠ AI 草皿。