89.3 🩺 內科專科考前版

89.3.0.1 📌 䞀頁重點

  • 22E: NETTER-2 (177Lu-DOTATATE 1st line G2/G3), CAPTEM PNET, everolimus + sunitinib expansion, MSI-H pembro for rare NEC
  • Taiwan: 健保 octreotide LAR/lanreotide depot, everolimus, sunitinib, 177Lu-DOTATATE for NET神經內分泌瘀

89.3.0.2 🌟 Pearls (12)

  1. NETTER-2 (NEJM 2024): 177Lu-DOTATATE 1st line G2/G3 GEP-NET
  2. CAPTEM (capecitabine + temozolomide) PNET — high response esp. MGMT-deficient
  3. Everolimus for PNET, intestinal NET, pulmonary NET (RADIANT-3/4)
  4. Sunitinib for PNET (A6181111)
  5. 177Lu-DOTATATE PRRT standard 2nd line+
  6. SSA early (PROMID, CLARINET) delay progression
  7. Telotristat for refractory carcinoid diarrhea
  8. Carcinoid crisis prophylaxis with octreotide before procedures/anesthesia
  9. MGMT methylation predicts CAPTEM response
  10. Hereditary syndromes: MEN1, VHL, NF1, TSC
  11. Liver-directed therapies: TACE, Y-90, RFA, debulking surgery
  12. DOTATATE PET-CT > octreotide scan

89.3.0.3 📍 Taiwan

  • 健保 octreotide LAR / lanreotide depot for functional + advanced NET
  • 健保 everolimus for advanced PNET / intestinal NET / pulmonary NET
  • 健保 sunitinib for advanced PNET
  • 健保 177Lu-DOTATATE (PRRT) for SSTR+ NET
  • 健保 capecitabine + temozolomide (CAPTEM) PNET 條件
  • DOTATATE PET 挞普及健保條件
  • MEN1 / VHL / NF1 panel testing 條件

89.3.0.4 🎓 內專重點

  1. WHO grading + Ki-67
  2. Carcinoid syndrome biomarkers
  3. PNET 5 functional + NF-PNET
  4. MEN1 cascade
  5. SSA early + sequential
  6. PRRT NETTER-1/2
  7. CAPTEM MGMT
  8. Liver-directed therapies
  9. NEC platinum + etoposide
  10. 22E: tumor agnostic immunotherapy MSI-H rare

⚠ AI 草皿。