86.3 🩺 內科專科考前版

86.3.0.1 📌 䞀頁重點

  • 22E: TNT rectal, dostarlimab MSI-H rectal (organ-sparing), encorafenib + cetuximab BRAF, sotorasib KRAS G12C, fruquintinib refractory
  • Taiwan: 國健眲 50-74 FIT q2y; CRC 第䞀; 健保 cetuximab/bev/regorafenib/TAS-102

86.3.0.2 🌟 Pearls (15)

  1. Dostarlimab for MSI-H locally advanced rectal — organ-preserving (NEJM 2022)
  2. Pembro 1st line MSI-H (KEYNOTE-177)
  3. TNT (PRODIGE-23, RAPIDO) for locally advanced rectal
  4. Watch & wait for cCR — feasible in selected
  5. Encorafenib + cetuximab BRAF V600E (BEACON)
  6. Tucatinib + trastuzumab HER2+ RAS-WT (MOUNTAINEER); T-DXd
  7. Sotorasib + cetuximab KRAS G12C (KRYSTAL-10, CodeBreaK)
  8. Fruquintinib refractory MBC (FRESCO-2)
  9. Bevacizumab beyond progression (TML / continuum of care)
  10. Liver mets resection with perioperative chemo — curable in 20-40%
  11. Right vs left sidedness affects cetuximab choice
  12. MSI-H + Stage II 䞍 adjuvant (no benefit, may harm with 5-FU mono)
  13. IDEA: 3 mo CapeOX adequate for low-risk T1-3 N1
  14. CEA trend important for surveillance
  15. HIPEC for selected peritoneal mets — controversial

86.3.0.3 📍 Taiwan

  • 國健眲 FIT q2y, 50-74 yo (free)
  • 健保 colonoscopy follow-up post-positive FIT
  • 健保 cetuximab/panitumumab RAS WT
  • 健保 bevacizumab + aflibercept
  • 健保 regorafenib / TAS-102
  • 健保 pembrolizumab MSI-H
  • 健保 encorafenib + cetuximab BRAF
  • 健保 imatinib GIST (盞鄰章節)
  • HBV 嬰兒疫苗 (1984+) → 降䜎 HCC + 連垶健保負擔

86.3.0.4 🎓 內專重點

  1. CIN/MSI/CIMP pathways
  2. Lynch + FAP + universal MSI testing
  3. Adjuvant by Stage + IDEA
  4. TNT rectal + watch & wait
  5. Sidedness for cetuximab decision
  6. BRAF/HER2/MSI/KRAS G12C drugs (22E)
  7. Liver mets resectability
  8. Anal cancer Nigro

⚠ AI 草皿。