90.3 🩺 內科專科考前版

90.3.0.1 📌 䞀頁重點

  • 22E:
    • Adjuvant pembrolizumab (KEYNOTE-564, FDA 2021) for high-risk clear cell post-nephrectomy
    • Belzutifan (Welireg, FDA 2021) for VHL-related RCC + pancreatic NET + hemangioblastoma
    • IO+TKI 1st line metastatic standard now
    • Tivozanib newer VEGFR TKI (FDA 2021)
  • Taiwan: 健保 sunitinib/pazopanib/cabozantinib/lenvatinib (條件); 健保 nivolumab/pembrolizumab/ipilimumab 條件; everolimus/temsirolimus; belzutifan + tivozanib 自費 倚 / 條件 limited

90.3.0.2 🌟 Pearls (10)

  1. Multifocal RCC in VHL: surveillance + selective resection / belzutifan
  2. HLRCC + FH mutation: aggressive Type 2 papillary; specific systemic care
  3. Renal medullary carcinoma: in sickle cell trait; aggressive; specific consideration
  4. IL-2 high-dose: small subset durable CR; selected centers; higher SE than IO
  5. Active surveillance for small renal mass: 30% never grow; monitor protocol
  6. Cytoreductive nephrectomy in mets: traditional; less common now in IO era; selective
  7. CARMENA + SURTIME trials: redefined cytoreductive role
  8. Cabozantinib post-IO: META post-IO efficacy
  9. TKI side effects: HTN, hand-foot, hypothyroidism (sunitinib), cardiac (sunitinib + pazopanib), ↓ lymph
  10. VHL surveillance: brain/spine MRI q3-5 yr, retinal annual, abdominal MRI q1-2 yr (RCC + pancreas), pheo screen annual

90.3.0.3 📍 Taiwan + 健保

  • 健保 RCC drugs (CTKI 充分; IO 條件)
  • 健保 nephrectomy (open + laparoscopic + robotic 條件)
  • 健保 ablation (RFA, cryo) 條件
  • 健保 RT 條件 (palliative bone)
  • Belzutifan, tivozanib 自費 倚
  • 健保 cytoreductive nephrectomy 條件
  • 孞會: TUA (urology) + Taiwan Oncology Society + endo (VHL)

90.3.0.4 🎓 內專必懂 (10)

  1. Histologic subtypes + genetics (VHL, MET, FH, FLCN, TSC, BAP1)
  2. Hereditary RCC syndromes + VHL surveillance
  3. Workup + staging
  4. Localized treatment (partial > radical, surveillance, ablation)
  5. Adjuvant pembrolizumab (KEYNOTE-564)
  6. Metastatic IO+TKI / IO+IO combinations (KEYNOTE-426, CheckMate 9ER, CLEAR, CheckMate 214)
  7. Belzutifan for VHL
  8. IMDC risk stratification
  9. Cytoreductive nephrectomy paradigm shift
  10. TKI side effect management

⚠ AI 草皿。