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婦癌考試解答

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

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婦癌考試解答

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  1. 婦癌考試解答 Date: Sep. 11, 2006

  2. 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

  3. 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

  4. 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

  5. 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)

  6. 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)

  7. 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

  8. 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)

  9. 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

  10. 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

  11. 9. 請指出化療後血液毒性(CTC)的Grading

  12. 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）

  13. 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）

  14. 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

  15. 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？

  16. 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

  17. 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 )

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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

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