97.3 🩺 內科專科考前版

97.3.0.1 📌 䞀頁重點

  • 22E: comprehensive genomic profiling (CGP/NGS) standard for CUP; tumor agnostic FDA approvals expanding (pembrolizumab MSI-H/TMB-H, larotrectinib NTRK, dabrafenib BRAF V600E, selpercatinib RET, T-DXd HER2); CUPISCO trial molecular-guided
  • Taiwan: 健保 conventional CT + tumor markers; 健保 IHC; 健保 NGS panel (條件 expanding); 健保 pembrolizumab MSI-H 條件; larotrectinib + dabrafenib 自費 倚

97.3.0.2 🌟 Pearls (8)

  1. Comprehensive workup before labeling CUP: history + imaging + IHC + molecular
  2. CUPISCO trial 2024: molecular-guided > empirical chemo (better PFS)
  3. PRoFiLE-CUP: similar paradigm
  4. Liquid biopsy ctDNA for CUP source identification (research)
  5. Methylation-based classification (TissueOM, EpiSwitch) — research/emerging
  6. NextGen sequencing actionable mutation rate ~ 30% in CUP
  7. Empiric chemo (carbo + paclitaxel) historically; declining role with targeted
  8. Survival improvement with molecular-guided in CUPISCO ~ 4 mo benefit

97.3.0.3 📍 Taiwan + 健保

  • 健保 IHC panel
  • 健保 NGS panel 條件 (advanced cancer)
  • 健保 pembrolizumab MSI-H 條件
  • 健保 carboplatin + paclitaxel 充分
  • 健保 cisplatin + etoposide for poorly diff
  • Larotrectinib, entrectinib, dabrafenib + trametinib, selpercatinib, T-DXd 自費 倚 / 條件 limited

97.3.0.4 🎓 內專必懂 (8)

  1. CUP definition + epidemiology
  2. Comprehensive workup algorithm
  3. IHC patterns + molecular profiling
  4. Favorable subsets identification
  5. Tumor agnostic FDA-approved drugs
  6. CUPISCO + PRoFiLE-CUP molecular-guided trials
  7. Pembrolizumab MSI-H/TMB-H tumor agnostic
  8. CGP NGS workflow + interpretation

⚠ AI 草皿。