婦癌考試解答
This presentation is the property of its rightful owner.
Sponsored Links
1 / 22

婦癌考試解答 PowerPoint PPT Presentation


  • 58 Views
  • Uploaded on
  • Presentation posted in: General

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

Download Presentation

婦癌考試解答

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


6732687

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


6732687

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)


6732687

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


9 ctc grading

9. 請指出化療後血液毒性(CTC)的Grading


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


6732687

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 )


6732687

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


  • Login