slide1
Download
Skip this Video
Download Presentation
婦癌考試解答

Loading in 2 Seconds...

play fullscreen
1 / 22

婦癌考試解答 - PowerPoint PPT Presentation


  • 76 Views
  • Uploaded on

婦癌考試解答. Date: Sep. 11, 2006. 1. 針對上皮性卵巢癌,術後第一線化學治療(不管期別),請寫出五種混合式 化學治療處方( combined chemotherapy), 包括藥品,劑量,頻率,及療程. cyclophosphamide ( 750 mg/m 2 )+ cisplatin( 75 mg/m 2 ) (or carboplatin) q3w x 6 courses

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' 婦癌考試解答' - philippa-demi


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

婦癌考試解答

Date: Sep. 11, 2006

1 combined chemotherapy
1. 針對上皮性卵巢癌,術後第一線化學治療(不管期別),請寫出五種混合式化學治療處方(combined chemotherapy),包括藥品,劑量,頻率,及療程
  • cyclophosphamide (750 mg/m2 )+ cisplatin( 75 mg/m2 ) (or carboplatin) q3w x 6 courses
  • cyclophosphamide (500 mg/m2 )+ adriamycin (50mg/m2 )+ cisplatin(50mg/m2 ) q3w x 6 courses
  • carboplatin ((AUC) of 5-7.5) + paclitaxel (175 mg/ m2 3-hr infusion) q3w x 6 courses
  • paclitaxel (175 mg/m2 as a 3-hour infusion )+ cisplatin(75 mg/m2 ) q3w x 6 courses
  • docetaxel ( 60-75 mg/ m2 1-hr infusion)+ carboplatin( AUC of 5 to 6 ) q3w x 6 courses
  • paclitaxel (135 mg/ m2 , IV for 24-h infusion day 1) + cisplatin (100 mg/ m2 IP, day 2)+ paclitaxel (60 mg/m2 IP, day 8 (max BSA 2.0 m2)) q3w x 6 courses
2 single active agent
2. 針對下列婦癌疾病,最有效單一的化學藥物(single active agent)為何?
  • Uterine cerivcal cancer, SCC: Cisplatin
  • Choriocarcinoma: MTX
  • Uterine leiomyosarcoma: Doxorubicin
  • Uterine MMMT: Ifosfamide
slide4
3.請問下列化療藥物各屬於何種類藥物?
  • Etoposide: Topoisomerase II inhibitor
  • Epirubicin: Antitumor antibiotics
  • Vincristin: Vinca alkaloid
  • Cyclophosphamide: Alkylating agent
  • Methotrexate: Antimetabolics
4 cisplatin and palcitaxel pre medication
4. Cisplatin and palcitaxel 使用前應注意事項及其pre-medication
  • Cisplatin
    • Hematologic toxicity
    • Nephrotoxicity
      • CCr < 50 ml/min, contraindication to Cisplatin  carboplatin
      • Prehydration and posthydration, Diuretic(Lasix)
    • GI toxicity (for emesis)
      • Metoclopramide ( primperan )
      • Navoban (5H3 serotonin antagonist)
    • Neurotoxicity
      • Peripheral neuropathy  Vit. B (Hi-Bilox)
4 cisplatin and palcitaxel pre medication1
4. Cisplatin and palcitaxel 使用前應注意事項及其pre-medication
  • Paclitaxel
    • Paclitaxel  Cisplatin, Cisplatin  Paclitaxol
    • GI toxicity (for emesis)
      • prochloperazine (Novamin)
    • Hypersensitivity reaction
      • Corticosteroids (Decadron )
      • H1 blocker (Benamine)
      • H2 blocker (Tagamet)
      • Dipjenhydramine (Allermin)
    • Cardiotoxicity (arrhythmia, bradycardia): EKG monitor
    • Neurotoxicity
      • Peripheral neuropathy  Vit. B (Hi-Bilox)
5 ifosphamide chemoprotectant ifosphamide
5. ifosphamide 是屬於何種類化學藥物?有哪兩種比較特殊的毒性? 有何種化療保護劑(chemoprotectant),應如何使用? 有那類婦癌疾病會應用到ifosphamide來治療(請至少寫出兩種)
  • Alkylating agent
  • Toxicity
    • Hemorrhagic cystitis
    • Ifosfamide syndrome
  • Mesna
    • Dose: 60-120 % of ifosphamide total dosage
    • 3-day: 400 mg/m2 IV, 15-min, 4-hr, 8-hr, for 3 days
    • 24-hr:
      • Halfof total mesna dose: divide 6doses Q4H
      • Remaining half dose: divide 2 doses Q6H
  • cervical cancer, ovarian cancer, and uterine sarcoma
6 adriamycin bleomycine dose limiting side effect
6.請問Adriamycin 和 Bleomycine各屬於何種類藥物? 兩者都有致命的毒性(dose-limiting side effect) 其致命毒性為何?又其累積劑量多少就會致命?
  • Both are antitumor antibiotics
    • Adriamycin: inhibits RNA synthesis
    • Bleomycin: prevent DNA repair
  • Toxicity
    • Adriamycin: cadiomyopathy
    • Bleomycin: interstitial pneumonitis, pulmonary fibrosis
  • Cumulative dose
    • Adrimycin: 500-550 mg/ m2
    • Bleomycin: 150 mg/ m2 (顏師傅) or 400 mg/ m2 (other team)
slide9

7. Topotecan 和 Irinotecan (CPT-11) 同屬於 Camptothecin analogue,其作用是 topoisomerase inhibitor,請分別指出何者是Top I inhibitor?何者是Top II inhibitor ? 這兩種藥物各有其應注意的毒性為何?

  • Both are Topoisomerase I inhibitor
  • Toxicity
    • Topotecan: myelosuppression
    • Irinotecan: myelosuppression (neutropenia), diarrhea
8 hormone therapy
8. 請問婦癌哪些腫瘤會使用hormone therapy來治療? 常用有哪些藥物?請至少寫出三種。
  • Megace: breast cancer, endometrial cancer, endometrial stromal sarcoma
  • Progesterone: endometrial cancer
  • Tamoxifene: breast cancer, ovarian cancer
  • GnRH agonist: postmenopausal breast cancer
  • Aromatase inhibitor: breast cancer
10 ccr nc no change 75 50 25 omit
10. 婦癌有些化學藥物有腎毒性,有時常依據CCr來減量調整(請填滿下列表格- NC: no change, 75% 劑量,50% 劑量, 25% 劑量,Omit)
11 sgot bilirubin nc no change 75 50 25 omit

Bilirubin

<1.5

1.5-3.0

3.1-5.0

5.0

SGOT

<60

60-180

>180

Adriamycin

100%

50%

25%

omit

Daunorbicin

100%

75%

50%

omit

Vinblastine

Vincristine

VP-16

100%

50%

omit

omit

Cyclophos-phamide

Methotrexate

100%

100%

75%

omit

5-FU

100%

100%

100%

omit

11. 當婦癌化療病患有肝功能異常時,尤其是SGOT及Bilirubin,有些 藥物需要減量(請填滿下列表格- NC: no change, 75% 劑量, 50% 劑量,25% 劑量,Omit)
12 tumor lysis syndrome
12. 婦癌有兩種疾病對化學治療的反應非常有效,甚至可達治癒的可能 性,但我們應小心可能發生tumor lysis syndrome,請問為哪兩 種婦癌腫瘤?
  • Choriocarcinoma& Ovarian germ cell tumor
  • Clinic manifestations:
    • Tetany, malaise
    • Uremia, hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia occurring within 24-48 hrs after chemotherapy
    • Prolonged QT interval
  • Prophylaxis:
    • Hydration, urinary alkalization
    • Allopurinol at least 12 hrs or preferentially 24 hrs before C/T
  • Treatment:
    • I.V. hydration to maintain urine output ,if possible of 100ml/hr
    • Urinary alkalization to maintain urinary pH at 7 or above
    • Allopurinol 600mg q.d. initially
    • Hemodialysis is indicated if hyperkalemia (>6mEq/L), hyperphosphatemia (>10mg/dl), hyperuricemia, acidosis, volume overload, symptomatic hypocalcemia, or a serum creatine level above 10 mg
13 mtd based chemotherapy metronomic chemotherapy
13. 治癌的化學治療,是用 MTD-based chemotherapy 的觀念,目前有種新觀念,稱為 metronomic chemotherapy 應用。請您簡單敘述這兩種化學治療的觀念有何不同?
13 mtd based chemotherapy metronomic chemotherapy1
13. 治癌的化學治療,是用 MTD-based chemotherapy 的觀念,目前有種新觀念,稱為 metronomic chemotherapy 應用。請您簡單敘述這兩種化學治療的觀念有何不同?
  • Metronomic Chemotherapy
    • Frequency: frequent, even daily
    • Doses: significantly below the MTD, with no prolonged drug-free breaks
    • Mechanism:
      • suppress VEGF anti-angiogenesis tumor progression
      • prevention of cancer cell mutation
    • Advantages:
      • reduce acute toxicity
      • convenience when using oral drugs
      • feasible as adjuvant chemotherapy for early stage disease
      • can be integrated with targeted therapies for prolonged periods
slide17

14. 最近兩年來,美國GOG, phaseII的研究首度證實混合式化學治療 對Disseminated uterine cervical cancer or endometrial adenocarcinoma 有效,請寫出其藥物、劑量、頻率、療程及 應注意事項。

  • GOG#179

CP: Cisplatin 50mg/m2 every 3 wks

CPT: Cisplatin 50mg/m2 (D1)

Topotecan 0.75mg/m2 (D1-3) every 3 wks

  • CPT (146 cases) CT (147 cases)

Median OS 9.4m 6.5m p:0.017

Median PFS 4.6m 2.9m p:0.014

Response Rate 27% 13%

  • First randomized phase III trial: a survival advantage for combined chemotherapy over cisplatin alone in advanced cervix cancer

( J Clin Oncol 2005; 23: 4626-4633 )

slide18

14. 最近兩年來,美國GOG, phaseII的研究首度證實混合式化學治療 對Disseminated uterine cervical cancer or endometrial adenocarcinoma 有效,請寫出其藥物、劑量、頻率、療程及 應注意事項。

  • GOG#177

TAP + G-CSF regimen:

Day 1 : Doxorubicin 45mg/m2

Cisplatin 50mg/m2

Day 2 : Paclitaxel 160mg/m2 ( 3hrs )

Day 3 & 12 : G-CSF 5μg/kg

every 3 weeks for 7 courses

  • TAP significantly improves RR, PFS, and OS

increased risk of peripheral neuropathy

15 ovarian germ cell tumor bep regimen
15. 對 ovarian germ cell tumor 的化學治療,目前最常用的是BEP regimen。依台灣多家醫學中心經驗,使用歐美建議的劑量曾發生 致死病例。因此台灣婦癌專家修正其劑量。 請寫出其藥物、劑量、及頻率。
  • Recommended dose
    • Bleomycin 20U/m2 (max 30U) iv weekly x 9-12
    • Etoposide 100mg/m2 iv (D1-5) q3w x 3-4
    • Cisplatin 20mg/m2 iv (D1-5) q3w x 3-4
  • Modified dose (q3w x6)
    • Course 1-3:
      • Bleomycin 15mg/m2 iv x 3 days
      • Etoposide 100mg/m2 iv x 3 days
      • Cisplatin 20mg/m2 iv x 3 days
    • Course 4:
      • Bleomycin 15mg/m2 iv x 1 day
      • Etoposide 100mg/m2 iv x 3 days
      • Cisplatin 20mg/m2 iv x 3 days
    • Course 5 and 6:
      • Etoposide 100mg/m2 iv x 3 days
      • Cisplatin 20mg/m2 iv x 3 days
1 6 febrie neuropenia
16. 對於發生Febrie neuropenia的病人,請簡述處理原則。
  • Supplementary historical information
    • Major comorbid illness
    • Time since last chemotherapy administration
    • History of prior documented infections
    • Recent antibiotics therapy
    • Exposure: others at home with similar symptoms,

pets, travel, recent blood product administration

1 6 febrie neuropenia1
16. 對於發生Febrie neuropenia的病人,請簡述處理原則。
  • Careful physical examination
    • Skin
    • Lung and sinus
    • Alimentary canal
      • month, pharynx, esophagus, bowel, rectum
    • Perivaginal/perianal
    • Intravascular access devices
  • Laboratory/Radiology assessment
    • CBC/DC, BUN/Cr, LFT, electrolytes
    • CXR, urinalysis, pulse oximetry
1 6 febrie neuropenia2
16. 對於發生Febrie neuropenia的病人,請簡述處理原則。
  • Primary culture
    • Blood culture x 2 sets
    • Urine culture
    • Site-specific culture
      • Diarrhea
        • Clostridium difficile assay, enteric pathogen screen
      • Skin: aspiration or biopsy of skin lesion
      • Vascular access cutaneous site if inflammation
        • routine/fungal/mycobacteria
    • Viral culture:
      • throat or nasopharynx for respiratory virus symptoms
  • Medication
    • Broad spectrum antibiotics
    • Culture-specific antibiotics
ad