91.3 🩺 內科專科考前版

91.3.0.1 📌 䞀頁重點

  • 22E:
    • EV-302 (enfortumab vedotin + pembrolizumab) FDA 2023 — paradigm shift 1st line metastatic
    • Nadofaragene firadenovec (Adstiladrin, FDA 2022) for BCG-unresponsive
    • Erdafitinib for FGFR-altered
    • Disitamab vedotin for HER2+
    • Sacituzumab govitecan for TROP2-expressing refractory
    • Adjuvant nivolumab (CheckMate 274) post-cystectomy
  • Taiwan: 健保 BCG, MMC, gemcitabine, cisplatin, avelumab maintenance (條件); 健保 cystectomy + neobladder + ileal conduit; 健保 atezolizumab/pembrolizumab/nivolumab/erdafitinib (條件); enfortumab vedotin + nadofaragene 自費 倚

91.3.0.2 🌟 Pearls (10)

  1. EV-302 changed metastatic urothelial 1st line
  2. Cisplatin-ineligibility criteria: ECOG ≥ 2, eGFR < 60, peripheral neuropathy ≥ 2, hearing loss ≥ 2, NYHA III HF
  3. Carboplatin alternative less effective; consider IO-based
  4. BCG induction → maintenance: SWOG protocol better than induction alone
  5. Trimodal therapy (TMT) alternative to cystectomy: maximal TURBT + chemo-RT
  6. Bladder-preserving in selected: complete TURBT + good function + no hydronephrosis
  7. FGFR3 frequent in low-grade NMIBC: prognostic + therapeutic (erdafitinib)
  8. Lynch syndrome surveillance: urothelial cytology + cystoscopy
  9. Neoadjuvant pembrolizumab + chemo trials emerging (PURE-01)
  10. EV warning: peripheral neuropathy, hyperglycemia, skin reactions, ocular SE

91.3.0.3 📍 Taiwan + 健保

  • 健保 BCG, MMC, gemcitabine å…š
  • 健保 cisplatin DDMVAC + GC å…š
  • 健保 atezolizumab, pembrolizumab, nivolumab 條件 (post-platinum or specific lines)
  • 健保 avelumab 條件 (maintenance post-platinum)
  • 健保 erdafitinib 條件 (FGFR+; expanding)
  • 健保 cystectomy + neobladder + ileal conduit å…š
  • Enfortumab vedotin + nadofaragene + sacituzumab + disitamab 自費 倚 / 條件 limited

91.3.0.4 🎓 內專必懂 (10)

  1. Histology + risk factors comprehensive
  2. NMIBC ladder (TURBT + BCG → IO/gene therapy → cystectomy)
  3. MIBC standard (neoadj cisplatin + cystectomy + adjuvant nivolumab)
  4. Trimodal bladder-preserving alternative
  5. EV-302 1st line metastatic (22E)
  6. JAVELIN Bladder 100 maintenance
  7. FGFR-altered + erdafitinib
  8. Cisplatin eligibility criteria
  9. ADC era (EV, sacituzumab, disitamab)
  10. Lynch + urothelial surveillance

⚠ AI 草皿。