96.3 🩺 內科專科考前版

96.3.0.1 📌 䞀頁重點

  • 22E: avapritinib for PDGFRA D842V GIST; ripretinib for refractory GIST; larotrectinib/entrectinib NTRK fusion (tumor agnostic); ipilimumab+nivolumab for alveolar soft part; pembrolizumab + lenvatinib trials
  • Taiwan: 健保 imatinib + sunitinib + regorafenib (條件); 健保 doxorubicin + ifosfamide + cisplatin; 健保 pazopanib; 健保 trabectedin (條件); ripretinib + avapritinib + larotrectinib 自費 倚

96.3.0.2 🌟 Pearls (10)

  1. Sarcoma center referral important (rare + complex)
  2. Pre-op image-guided biopsy along future surgical line
  3. GIST risk stratification (Miettinen-Lasota): size, mitosis, location → adjuvant imatinib decision
  4. Imatinib 800 mg for KIT exon 9 mutation (not 400)
  5. MAP for osteosarcoma: significant survival benefit; salvage poorly responding tumors
  6. Ewing local control: surgery preferred over RT when possible
  7. Sarcoma metastasectomy: lung mets resection improves survival in selected
  8. Tazemetostat for INI1-loss epithelioid sarcoma: EZH2 inhibitor (FDA 2020)
  9. Ipilimumab + nivolumab for alveolar soft part sarcoma (rare; high response)
  10. Limb-sparing > amputation for most extremity sarcomas now

96.3.0.3 📍 Taiwan + 健保

  • 健保 imatinib + sunitinib + regorafenib for GIST
  • 健保 doxorubicin + AIM regimen
  • 健保 pazopanib for advanced STS
  • 健保 trabectedin (條件)
  • 健保 high-dose methotrexate + leucovorin for MAP
  • 健保 ifosfamide + mesna
  • Ripretinib, avapritinib, larotrectinib, tazemetostat 自費 倚 / 條件 limited
  • 健保 zoledronic + denosumab for bone mets
  • 健保 radium-223 for prostate bone mets 條件
  • 健保 RT for sarcoma + bone mets pain
  • 孞會: TUSG (Taiwan Sarcoma Group) + Taiwan Orthopaedic Oncology

96.3.0.4 🎓 內專必懂 (10)

  1. Sarcoma classification + epidemiology
  2. Soft tissue vs bone sarcoma management
  3. Imatinib paradigm for GIST + sequential lines
  4. MAP chemo for osteosarcoma
  5. VAC/IE for Ewing
  6. Targeted therapy (NTRK, EZH2, KIT/PDGFRA)
  7. Bone mets approach + SCC emergency
  8. Bone-modifying agents + radium-223
  9. Pre-op biopsy technique (sarcoma center)
  10. 22E: avapritinib, ripretinib, tazemetostat, ipi+nivo soft part

⚠ AI 草皿。