94.3 🩺 內科專科考前版

94.3.0.1 📌 䞀頁重點

  • 22E:
    • Pembrolizumab + lenvatinib (KEYNOTE-775) for endometrial
    • Pembrolizumab + chemo for endometrial (NRG-GY018, FDA 2024)
    • Tisotumab vedotin (Tivdak, FDA 2021) TF-DM1 cervical
    • Mirvetuximab soravtansine (Elahere, FDA 2022) FRα ADC ovarian
    • Olaparib + bevacizumab maintenance (PAOLA-1)
    • Niraparib regardless of BRCA (PRIMA)
    • Selpercatinib for RET-fusion (rare gyne)
  • Taiwan: 健保 carbo/paclitaxel/cisplatin/bevacizumab 條件; 健保 pembrolizumab/lenvatinib (條件); 健保 olaparib/niraparib/rucaparib 條件 (BRCA+); 健保 tisotumab vedotin / mirvetuximab 自費 倚 / 條件 limited; 國健眲 4 倧癌篩檢 (cervical Pap, endometrial 䞍 routine screen)

94.3.0.2 🌟 Pearls (12)

94.3.0.2.1 Endometrial
  1. Lynch screening universal: MSI / IHC for all endometrial CA at diagnosis
  2. MSI-H endometrial responds well to ICI (pembrolizumab mono)
  3. Pembrolizumab + lenvatinib (KEYNOTE-775): MSI-H or unselected; FDA approval
  4. Adjuvant chemo for high-risk Type 2 (serous, clear cell, carcinosarcoma)
94.3.0.2.2 Cervical
  1. HPV vaccine prevention majorly impacting cervical CA epidemiology globally
  2. Tisotumab vedotin (Tivdak): tissue factor + auristatin; aggressive cervical refractory
  3. Pembrolizumab + chemo + bevacizumab (KEYNOTE-826) for metastatic + recurrent
94.3.0.2.3 Ovarian
  1. HRD testing beyond BRCA (genomic instability score) — predicts PARP response
  2. Mirvetuximab soravtansine for FRα-high (≥ 75% positive cells) platinum-resistant
  3. Maintenance landscape: PARP (BRCA/HRD), bevacizumab, combo (PAOLA-1)
  4. Niraparib all-comers maintenance (PRIMA) — even non-BRCA benefit
  5. Genetic counseling lifetime; family cascade

94.3.0.3 📍 Taiwan + 健保

94.3.0.3.1 Endometrial
  • 健保 surgery + LN dissection
  • 健保 RT + brachytherapy
  • 健保 carbo/paclitaxel + doxorubicin
  • 健保 pembrolizumab + lenvatinib 條件
  • 健保 dostarlimab off-label
  • 健保 hormonal (medroxyprogesterone) for low-grade
94.3.0.3.2 Cervical
  • 國健眲 Pap 30+ yr free
  • 健保 cisplatin chemo-RT
  • 健保 paclitaxel + cisplatin + bevacizumab
  • 健保 pembrolizumab CPS+ 條件
  • Tisotumab vedotin 自費 倚
94.3.0.3.3 Ovarian
  • 健保 surgery (debulking) + chemo (carbo/paclitaxel)
  • 健保 bevacizumab maintenance 條件
  • 健保 olaparib/niraparib/rucaparib 條件 (BRCA+)
  • Mirvetuximab soravtansine 自費 倚 / 條件 limited
  • 健保 BRCA + HRD testing 條件
  • 健保 risk-reducing salpingo-oophorectomy + screening (BRCA+)
  • 健保 HIPEC 條件 (限制䞭心)

94.3.0.4 🎓 內專必懂 (12)

  1. Endometrial Type 1 vs Type 2
  2. Postmenopausal bleeding workup
  3. Lynch + Cowden universal screening (MSI/IHC)
  4. KEYNOTE-775 pembro + lenvatinib
  5. Cervical HPV vaccine impact
  6. Cervical chemo-RT (cisplatin) locally advanced
  7. Tisotumab vedotin + KEYNOTE-826
  8. Ovarian “silent killer” + delayed diagnosis
  9. BRCA + HRD testing all epithelial
  10. Optimal cytoreduction + maintenance landscape (PARP + bevacizumab)
  11. Mirvetuximab soravtansine FRα-targeting
  12. Trophoblastic disease + EMA-CO

⚠ AI 草皿。