{"id":7523,"date":"2023-08-17T06:25:43","date_gmt":"2023-08-17T06:25:43","guid":{"rendered":"http:\/\/d1s07skqdwll4z.cloudfront.net\/mrcc-tool\/3-management-of-mrcc\/3-3-treatment-criteria-for-initiation-of-checkpoint-inhibitors\/"},"modified":"2024-03-28T17:08:13","modified_gmt":"2024-03-28T17:08:13","slug":"3-3-treatment-criteria-for-initiation-of-checkpoint-inhibitors","status":"publish","type":"page","link":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/mrcc-tool\/3-management-of-mrcc\/3-3-treatment-criteria-for-initiation-of-checkpoint-inhibitors\/","title":{"rendered":"3.3 Treatment criteria for initiation of checkpoint inhibitors"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:-60px;--awb-background-color:var(--awb-color3);--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-search-element fusion-search-element-1 fusion-search-form-clean\" style=\"--awb-border-radius:7px;--awb-text-color:var(--awb-color8);--awb-border-color:var(--awb-color8);--awb-bg-color:var(--awb-color3);\">\t\t<form role=\"search\" class=\"searchform fusion-search-form  fusion-live-search fusion-search-form-clean\" method=\"get\" action=\"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/\">\n\t\t\t<div class=\"fusion-search-form-content\">\n\n\t\t\t\t\n\t\t\t\t<div class=\"fusion-search-field search-field\">\n\t\t\t\t\t<label><span class=\"screen-reader-text\">Search for:<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"search\" class=\"s fusion-live-search-input\" name=\"s\" id=\"fusion-live-search-input-0\" autocomplete=\"off\" placeholder=\"Search...\" required aria-required=\"true\" aria-label=\"Search...\"\/>\n\t\t\t\t\t\t\t\t\t\t\t<\/label>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"fusion-search-button search-button\">\n\t\t\t\t\t<input type=\"submit\" class=\"fusion-search-submit searchsubmit\" aria-label=\"Search\" value=\"&#xf002;\" \/>\n\t\t\t\t\t\t\t\t\t\t<div class=\"fusion-slider-loading\"><\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\t<input type=\"hidden\" name=\"post_type[]\" value=\"any\" \/><input type=\"hidden\" name=\"search_limit_to_post_titles\" value=\"0\" \/><input type=\"hidden\" name=\"live_min_character\" value=\"4\" \/><input type=\"hidden\" name=\"live_posts_per_page\" value=\"100\" \/><input type=\"hidden\" name=\"live_search_display_featured_image\" value=\"1\" \/><input type=\"hidden\" name=\"live_search_display_post_type\" value=\"1\" \/><input type=\"hidden\" name=\"fs\" value=\"1\" \/>\n\t\t\t<\/div>\n\n\n\t\t\t\t\t\t\t<div class=\"fusion-search-results-wrapper\"><div class=\"fusion-search-results\"><\/div><\/div>\n\t\t\t\n\t\t<\/form>\n\t\t<\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-margin-top:4px;--awb-background-color:var(--awb-color3);--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-1 fusion-title-center fusion-title-text fusion-title-size-five\" style=\"--awb-text-color:#c1c1c1;--awb-sep-color:#e2e2e2;\"><div class=\"title-sep-container title-sep-container-left\"><div class=\"title-sep sep-single sep-solid\" style=\"border-color:#e2e2e2;\"><\/div><\/div><span class=\"awb-title-spacer\"><\/span><h5 class=\"fusion-title-heading title-heading-center\" style=\"margin:0;\">3.3 Behandlingskriterier ved p\u00e5begyndelse af checkpoint inhibitorer<sup>1<\/sup><\/h5><span class=\"awb-title-spacer\"><\/span><div class=\"title-sep-container title-sep-container-right\"><div class=\"title-sep sep-single sep-solid\" style=\"border-color:#e2e2e2;\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-margin-top:4px;--awb-background-color:var(--awb-color3);--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-1\"><p>(Ipilimumab\/Nivolumab som 1. linje eller Nivolumab, som 2. eller 3. linje behandling).<\/p>\n<p>Ved behandling med checkpoint inhibitorer (CPI) er der for de fleste patienter tale om en pallierende behandling, hvor form\u00e5let er symptomlindring og levetidsforl\u00e6ngelse. Enkelte patienter opn\u00e5r dog komplet respons i en kortere eller l\u00e6ngere periode.<\/p>\n<p>Checkpoint inhibitorer gives intraven\u00f8st enten hver 3. uge (kombinationsimmunterapi) \u2013 i alt 4 serier \u2013 hvorefter der forts\u00e6ttes med <a href=\"https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/opdivo-epar-product-information_da.pdf\" class=\"exitNotifierLink\">Nivolumab<\/a> alene, eller hver 4. uge (monoterapi) dvs. en serie str\u00e6kker sig over enten 3 eller 4 uger. Patienten evalueres med CT-scanning af thorax og abdomen (og MR-scanning af cerebrum ved cerebrale metastaser) hver 3. m\u00e5ned.<\/p>\n<\/div><div class=\"fusion-title title fusion-title-2 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Ved 1. linje kombinationsimmunterapi:<\/h5><\/div><div class=\"fusion-text fusion-text-2\"><ul>\n<li>Den mediane progressionsfri overlevelse (mPFS) hos patienter tilh\u00f8rende intermedi\u00e6r eller d\u00e5rlig prognosegruppe er 11,6 mdr. Den mediane overall survival (mOS) kendes endnu ikke (data ikke modne endnu)<\/li>\n<li>I henhold til <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/da\/mrcc-tool\/3-management-of-mrcc\/3-4-response-evaluation\/\">RECIST<\/a> kriterierne har 72,7% af patienterne effekt af behandlingen enten med:<\/li>\n<\/ul>\n<ol>\n<li>\n<ol>\n<li>Komplet respons (CR) \u2013 10,1%<\/li>\n<li>Partiel respons (PR) \u2013 32%<\/li>\n<li>Stabil sygdom (SD) \u2013 30,6%<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<\/div><div class=\"fusion-title title fusion-title-3 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Ved 2.-3. linje <a class=\"exitNotifierLink\" href=\"https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/opdivo-epar-product-information_da.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Nivolumab<\/a> (monoterapi):<\/h5><\/div><div class=\"fusion-text fusion-text-3\"><ul>\n<li>mPFS er 4,6 mdr og mOS er 25 m\u00e5neder<\/li>\n<li>I henhold til <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/da\/mrcc-tool\/3-management-of-mrcc\/3-4-response-evaluation\/\">RECIST criteria<\/a>, har 59% af patienterne effekt af behandlingen enten med:\n<ol>\n<li>Komplet respons (CR) \u2013 1%<\/li>\n<li>Partiel respons (PR) \u2013 24%<\/li>\n<li>Stabil sygdom (SD) \u2013 34%<\/li>\n<\/ol>\n<\/li>\n<\/ul>\n<\/div><div class=\"fusion-title title fusion-title-4 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">F\u00f8rste bes\u00f8g p\u00e5 Onkologisk Afdeling<\/h4><\/div><div class=\"fusion-text fusion-text-4\"><p>Ved f\u00f8rste bes\u00f8g p\u00e5 Onkologisk Afdeling skal der optages en fuld journal med fokus p\u00e5:<\/p>\n<\/div><div class=\"fusion-title title fusion-title-5 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Anamnese:<\/h5><\/div><div class=\"fusion-text fusion-text-5\"><ul>\n<li>Dispositioner (kr\u00e6fttilf\u00e6lde i n\u00e6rmeste familie med s\u00e6rligt fokus p\u00e5 tilf\u00e6lde af nyrekr\u00e6ft)<\/li>\n<li>Symptomer (tr\u00e6thed, v\u00e6gttab, nedsat appetit, svede\/hedeture, smerter, m.m.)<\/li>\n<li>Komorbiditet (hypertension, isk\u00e6misk hjertesygdom, nedsat hjertepumpefunktion (EF) og \u00e5rsagen til dette, rytmeforstyrrelser, apoplexia cerebri, diabetes mellitus, nyreinsufficiens, autoimmune og andre kroniske lidelser)<\/li>\n<li>Fuld medicinstatus. Det skal fremg\u00e5 om patienten er i:<\/li>\n<\/ul>\n<ol>\n<li style=\"list-style-type: none;\">\n<ol>\n<li>Immunsupprimerende behandling, hvilken og \u00e5rsag hertil<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<ul>\n<li>Sociale informationer<\/li>\n<\/ul>\n<ol>\n<li style=\"list-style-type: none;\">\n<ol>\n<li>Civilstatus<\/li>\n<li>Netv\u00e6rk<\/li>\n<li>Besk\u00e6ftigelse (arbejder, sygemeldt, f\u00f8rtidspensioneret, pensionist eller andet)<\/li>\n<li>Funktionsniveau (selvhjulpen, brug for hj\u00e6lp til egen omsorg eller andet)<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<\/div><div class=\"fusion-title title fusion-title-6 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Klinisk vurdering:<\/h5><\/div><div class=\"fusion-text fusion-text-6\"><ul>\n<li>Almen tilstand (god, akut eller kronisk medtaget) inkl.  <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/da\/mrcc-tool\/3-management-of-mrcc\/3-6-performance-status\/\">performance status (PS)<\/a><\/li>\n<li>Vitale v\u00e6rdier inkl. BT, puls, temperatur, saturation og v\u00e6gt<\/li>\n<li>Objektiv unders\u00f8gelse inkl. vurdering af forst\u00f8rrede lymfeknuder, stetoskopi af hjerte og lunger, unders\u00f8gelse af abdomen, ekstremiteter og hud<\/li>\n<\/ul>\n<\/div><div class=\"fusion-title title fusion-title-7 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Paraklinik:<\/h5><\/div><div class=\"fusion-text fusion-text-7\"><p>Ved det f\u00f8rste ambulante fremm\u00f8de skal f\u00f8lgende unders\u00f8ges:<\/p>\n<ul>\n<li>Blodpr\u00f8ver: h\u00e6matologi (Hb, trombocytter, leukocytter + differential-t\u00e6lling), v\u00e6sketal (kreatinin, karbamid, natrium, kalium, ioniseret calcium og magnesium), levertal (ALAT, ASAT, LDH, basisk fosfatase, INR og koagulationstal (2,7 + 10)), CRP, TSH, kortisol, testosteron (m\u00e6nd), amylase, CK-MB og troponin<\/li>\n<li>Ved kombinationsimmunterapi: CK-MB og troponin<\/li>\n<li>EKG: vurdering af rytme, akutte forandringer og QTc-interval<\/li>\n<li>MR-scanning: cerebrum (foretaget eller bestilt)<\/li>\n<li>CT-scanning: thorax og abdomen (baseline skal v\u00e6re &lt; 1 mdr. gammel)<\/li>\n<li>MUGA: vurdering af hjertets pumpefunktion (foretaget eller bestilt)<\/li>\n<li>IMDC: risikostratificering<\/li>\n<\/ul>\n<\/div><div class=\"fusion-title title fusion-title-8 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Behandlingskriterier<\/h4><\/div><div class=\"fusion-text fusion-text-8\"><p>F\u00f8lgende kriterier skal v\u00e6re opfyldt i forbindelse med p\u00e5begyndelse med checkpoint inhibitor. Afvigelser skal konfereres med speciall\u00e6ge, og det skal dokumenteres i journalen.<br \/>\n<small>*Hvis nej, begrund i journal<\/small><\/p>\n<\/div>\n<div class=\"table-1\">\n<table width=\"100%\">\n<thead>\n<tr>\n<th align=\"left\">BEHANDLINGSKRITERIER<\/th>\n<th align=\"left\">JA<\/th>\n<th align=\"left\">NEJ*<\/th>\n<th align=\"left\">TILTAG HVIS SVARET ER NEJ<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td align=\"left\">Bioptisk verificeret mRCC \u2013 clearcelle histologi tilh\u00f8rende intermedi\u00e6r eller d\u00e5rlig prognosegruppe ved kombinationsimmunterapi<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Performance status (PS):<br \/>Monoterapi &lt; 2<br \/>Kombinationsterapi &lt; 1<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Nyrefunktion<br \/>eGFR &gt; 30 ml\/min<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">Checkpoint inhibitorer udskilles ikke renalt. Kan derfor godt tilbydes til patienter med d\u00e5rlig nyrefunktion, men det skal konfereres med speciall\u00e6ge<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Leverfunktion<br \/>Bilirubin &lt; 1,5 x \u00f8vre normalv\u00e6rdi<br \/>ASAT\/ALAT &lt; 3 x \u00f8vre normalv\u00e6rdi eller &lt; 5 ved levermetastaser<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">EKG<br \/>QTcF &lt; 450 ms for m\u00e6nd og &lt; 470 ms for kvinder<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">Gennemg\u00e5 patientens medicinliste for medicin der kan for\u00e5rsage forl\u00e6nget QTc. Konferer med en kardiolog<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Blodtryk &lt; 140\/90 mmHg<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">Overvej white-coat BT og bed patienten tage BT hjemme eller hos egen l\u00e6ge. Hvis fortsat h\u00f8jt BT, p\u00e5begynd antihypertensiva eller intensiver allerede anvendte antihypertensiva via egen l\u00e6ge (se afsnit 5.2.2)<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Ejection fraction (EF) &gt; 40% (m\u00e5lt ved MUGA)<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">Henvis patienten til kardiologisk vurdering mhp. EKKO og p\u00e5begyndelse af antikongestiv behandling, hvis det bekr\u00e6ftes at EF &lt; 40%.<br \/>Ovenst\u00e5ende krav er s\u00e6rligt vigtigt ved kombinationsimmunterapi<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Ingen autoimmunsygdomme<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">Undtagelser:<br \/>\u2022 Velreguleret type 1 diabetes<br \/>\u2022 Hypothyroidisme efter autoimmun thyroiditis der kun har behov for substitutionsbehandling<br \/>\u2022 Vitiligo<br \/>Ved andre autoimmune sygdomme, skal der konfereres med speciall\u00e6ge<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Ingen Prednisolon-behandling &gt; 10 mg eller anden immunsupprimerende behandling<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">Inhalationssteroid eller behandling af binyrebark-insufficiens (hydrocortison) er tilladt<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Ikke kendt med HIV eller hepatitis B eller C<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Ingen st\u00e6rke CYP3A4 inducere eller MR-scanning af cerebrum<br \/>uden cerebrale metastaser<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">Ved cerebrale metastaser:<br \/>1) Hvis patienten er asymptomatisk og har 1-3 cerebrale metastaser, henvis til SRK konference mhp. str\u00e5lebehandling. CPI kan p\u00e5begyndes<br \/>2) Hvis patienten er symptomatisk og har 1-3 cerebrale metastaser, p\u00e5begynd steroid-behandling iht. guidelines og henvis til SRK konference.<br \/>CPI kan ikke p\u00e5begyndes f\u00f8r udtrapning af Prednisolon<br \/>3) Hvis patienten har multiple cerebrale metastaser, men asymptomatisk. P\u00e5begynd CPI<br \/>4) Hvis patienten har multiple metastaser og har symptomer, p\u00e5begynd steroid-behandling. P\u00e5begynd TKI-behandling og overvej helhjerne-bestr\u00e5ling<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">CT-scanning af thorax og abdomen &lt; 1 mdr. gammel<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">Hvis baseline CT-scanning er &gt; 1 mdr., overvej at bestille en subakut CT-scanning som ny baseline<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-top:20px;margin-bottom:20px;width:100%;\"><\/div><div class=\"fusion-title title fusion-title-9 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Links til produktresum\u00e9er:<\/h5><\/div><div class=\"fusion-text fusion-text-9\"><ul>\n<li><a class=\"exitNotifierLink\" href=\"https:\/\/pro.medicin.dk\/medicin\/praeparater\/2582\" target=\"_blank\" rel=\"noopener noreferrer\">Prednisolon<\/a><\/li>\n<li><a class=\"exitNotifierLink\" href=\"https:\/\/pro.medicin.dk\/medicin\/praeparater\/2659\" target=\"_blank\" rel=\"noopener noreferrer\">Hydrocortison<\/a><\/li>\n<\/ul>\n<\/div><div class=\"fusion-title title fusion-title-10 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Instruktion til patient\/p\u00e5r\u00f8rende<\/h4><\/div><div class=\"fusion-text fusion-text-10\"><ul>\n<li>Gennemgang af de immunrelaterede bivirkninger og CTC-skema samt understrege vigtigheden af at kontakte afdelingen ved symptomer<\/li>\n<li>Udlevering af underst\u00f8ttende medicin (<a class=\"exitNotifierLink\" href=\"https:\/\/pro.medicin.dk\/medicin\/praeparater\/3558\" target=\"_blank\" rel=\"noopener noreferrer\">Domperidon<\/a> og <a class=\"exitNotifierLink\" href=\"https:\/\/pro.medicin.dk\/Medicin\/Praeparater\/9324\" target=\"_blank\" rel=\"noopener noreferrer\">Imolope<\/a>)<\/li>\n<\/ul>\n<\/div><div class=\"fusion-title title fusion-title-11 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Vurdering under behandlingen<\/h4><\/div><div class=\"fusion-text fusion-text-11\"><p>Patienten vurderes i ambulatoriet ved l\u00e6ge eller sygeplejerske hver 3. eller 4. uge, hvor der foretages:<\/p>\n<ul>\n<li>Klinisk vurdering og kontrol af BT, puls, v\u00e6gt og evt. temperatur og saturation<\/li>\n<li>Toxicitetsregistrering iht. CTCAE-version 5.0 <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/da\/mrcc-tool\/5-toxicity-management\/5-1-adverse-reactions-to-targeted-treatment\/\">(se afsnit mhp. gradering)<\/a><\/li>\n<li>Kontrol af blodpr\u00f8ver (h\u00e6matologi, v\u00e6sketal inkl. ioniseret calcium + magnesium, levertal, CRP, TSH, kortisol, testosteron (m\u00e6nd), amylase + CK-MB og troponin ved kombinationsimmunterapi)<\/li>\n<li>Medicinstatus<\/li>\n<li>Vurdering af nytilkomne symptomer<\/li>\n<li>Stillingtagen til uds\u00e6ttelse eller andre tiltag <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/da\/mrcc-tool\/5-toxicity-management\/5-3-adverse-reactions-to-checkpoint-inhibitors\/\">(se afsnit om bivirkninger til checkpoint inhibitorer)<\/a><\/li>\n<\/ul>\n<\/div><div class=\"fusion-title title fusion-title-12 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Vurdering af respons<\/h4><\/div><div class=\"fusion-text fusion-text-12\"><p>Effekten af checkpoint inhibitorer vurderes hver 3. mdr. (12 uger) med CT-scanning af thorax og abdomen og MR-scanning af cerebrum, hvis patienten er kendt med cerebrale metastaser.<\/p>\n<p>Vurdering af respons afh\u00e6nger af:<\/p>\n<ol>\n<li>Almen tilstand<\/li>\n<li>Biokemi (s\u00e6rligt Hb, neutrofile, trombocytter, ioniseret calcium, LDH og CRP)<\/li>\n<li>CT-scanning af thorax og abdomen<\/li>\n<\/ol>\n<\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-4 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-13 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Reference<\/h4><\/div><div class=\"fusion-text fusion-text-13\"><ol>\n<li><em>The Cancer Department, Herlev Hospital<\/em><\/li>\n<\/ol>\n<\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-4 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-overflow:hidden;--awb-bg-size:cover;--awb-border-radius:7px 7px 7px 7px;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\" data-scroll-devices=\"small-visibility,medium-visibility,large-visibility\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div style=\"text-align:center;\"><a class=\"fusion-button button-flat fusion-button-default-size button-default fusion-button-default button-1 fusion-button-default-span fusion-button-default-type\" target=\"_self\" data-hover=\"icon_slide\" href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/da\/mrcc-tool\/3-management-of-mrcc\/3-4-response-evaluation\/\"><span class=\"fusion-button-text\">Forts\u00e6t til n\u00e6ste afsnit: 3.4 Responsevaluering<\/span><i class=\"fa-arrow-alt-circle-right fas button-icon-right\" aria-hidden=\"true\"><\/i><\/a><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-5 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:7px;--awb-border-radius-top-right:7px;--awb-border-radius-bottom-right:7px;--awb-border-radius-bottom-left:7px;--awb-overflow:hidden;--awb-margin-top:4px;--awb-background-color:var(--awb-color3);--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-5 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-14 fusion-title-center fusion-title-text fusion-title-size-five\" style=\"--awb-text-color:#c1c1c1;--awb-margin-top:25px;--awb-sep-color:#e2e2e2;\"><div class=\"title-sep-container title-sep-container-left\"><div class=\"title-sep sep-single sep-solid\" style=\"border-color:#e2e2e2;\"><\/div><\/div><span class=\"awb-title-spacer\"><\/span><h5 class=\"fusion-title-heading title-heading-center\" style=\"margin:0;\">Udforsk denne kapitelmenu<\/h5><span class=\"awb-title-spacer\"><\/span><div class=\"title-sep-container title-sep-container-right\"><div class=\"title-sep sep-single sep-solid\" style=\"border-color:#e2e2e2;\"><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-6 fusion_builder_column_1_6 1_6 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:16.666666666667%;--awb-margin-top-large:0px;--awb-spacing-right-large:11.52%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:11.52%;--awb-width-medium:16.666666666667%;--awb-order-medium:0;--awb-spacing-right-medium:11.52%;--awb-spacing-left-medium:11.52%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-7 fusion_builder_column_2_3 2_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:66.666666666667%;--awb-margin-top-large:0px;--awb-spacing-right-large:2.88%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:2.88%;--awb-width-medium:66.666666666667%;--awb-order-medium:0;--awb-spacing-right-medium:2.88%;--awb-spacing-left-medium:2.88%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div style=\"text-align:center;\"><a class=\"fusion-button button-flat fusion-button-default-size button-custom fusion-button-default button-2 fusion-button-span-yes fusion-has-button-gradient\" style=\"--button_bevel_color:rgba(89,96,104,0.7);--button_bevel_color_hover:rgba(89,96,104,0.9);--button_accent_color:var(--awb-color6);--button_border_color:#e0e0e0;--button_accent_hover_color:var(--awb-color1);--button_border_hover_color:var(--awb-color3);--button_border_width-top:1px;--button_border_width-right:1px;--button_border_width-bottom:1px;--button_border_width-left:1px;--button_gradient_top_color:rgba(89,96,104,0.07);--button_gradient_bottom_color:rgba(89,96,104,0.33);--button_gradient_top_color_hover:#003c68;--button_gradient_bottom_color_hover:#003c68;--button_padding-top:20px;--button_padding-bottom:20px;--button_margin-top:15px;--button_margin-bottom:3px;\" target=\"_self\" data-hover=\"icon_slide\" href=\"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/mrcc-tool\/3-management-of-mrcc\/3-1-treatment-algorithm\/\"><span class=\"fusion-button-text\">3.1 Behandlingsalgoritme<\/span><i class=\"fa-angle-right fas button-icon-right\" aria-hidden=\"true\"><\/i><\/a><\/div><div style=\"text-align:center;\"><a class=\"fusion-button button-flat fusion-button-default-size button-custom fusion-button-default button-3 fusion-button-span-yes fusion-has-button-gradient\" style=\"--button_accent_color:var(--awb-color6);--button_border_color:#e0e0e0;--button_accent_hover_color:var(--awb-color1);--button_border_hover_color:var(--awb-color3);--button_border_width-top:1px;--button_border_width-right:1px;--button_border_width-bottom:1px;--button_border_width-left:1px;--button_gradient_top_color:rgba(89,96,104,0.07);--button_gradient_bottom_color:rgba(89,96,104,0.33);--button_gradient_top_color_hover:#003c68;--button_gradient_bottom_color_hover:#003c68;--button_padding-top:20px;--button_padding-bottom:20px;--button_margin-top:3px;--button_margin-bottom:3px;\" target=\"_self\" data-hover=\"icon_slide\" href=\"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/mrcc-tool\/3-management-of-mrcc\/3-2-treatment-criteria-for-initiation-of-tki\/\"><span class=\"fusion-button-text\">3.2 Behandlingskriterier ved p\u00e5begyndelse af TKI<\/span><i class=\"fa-angle-right fas button-icon-right\" aria-hidden=\"true\"><\/i><\/a><\/div><div style=\"text-align:center;\"><a class=\"fusion-button button-flat fusion-button-default-size button-custom fusion-button-default button-4 fusion-button-span-yes fusion-has-button-gradient\" style=\"--button_accent_color:var(--awb-color6);--button_border_color:#e0e0e0;--button_accent_hover_color:var(--awb-color1);--button_border_hover_color:var(--awb-color3);--button_border_width-top:1px;--button_border_width-right:1px;--button_border_width-bottom:1px;--button_border_width-left:1px;--button_gradient_top_color:rgba(89,96,104,0.07);--button_gradient_bottom_color:rgba(89,96,104,0.33);--button_gradient_top_color_hover:#003c68;--button_gradient_bottom_color_hover:#003c68;--button_padding-top:20px;--button_padding-bottom:20px;--button_margin-top:3px;--button_margin-bottom:3px;\" target=\"_self\" data-hover=\"icon_slide\" href=\"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/mrcc-tool\/3-management-of-mrcc\/3-3-treatment-criteria-for-initiation-of-checkpoint-inhibitors\/\"><span class=\"fusion-button-text\">3.3 Behandlingskriterier ved p\u00e5begyndelse af checkpoint inhibitorer<\/span><i class=\"fa-angle-right fas button-icon-right\" aria-hidden=\"true\"><\/i><\/a><\/div><div style=\"text-align:center;\"><a class=\"fusion-button button-flat fusion-button-default-size button-custom fusion-button-default button-5 fusion-button-span-yes fusion-has-button-gradient\" style=\"--button_accent_color:var(--awb-color6);--button_border_color:#e0e0e0;--button_accent_hover_color:var(--awb-color1);--button_border_hover_color:var(--awb-color3);--button_border_width-top:1px;--button_border_width-right:1px;--button_border_width-bottom:1px;--button_border_width-left:1px;--button_gradient_top_color:rgba(89,96,104,0.07);--button_gradient_bottom_color:rgba(89,96,104,0.33);--button_gradient_top_color_hover:#003c68;--button_gradient_bottom_color_hover:#003c68;--button_padding-top:20px;--button_padding-bottom:20px;--button_margin-top:3px;--button_margin-bottom:3px;\" target=\"_self\" data-hover=\"icon_slide\" href=\"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/mrcc-tool\/3-management-of-mrcc\/3-4-response-evaluation\/\"><span class=\"fusion-button-text\">3.4 Responsevaluering<\/span><i class=\"fa-angle-right fas button-icon-right\" aria-hidden=\"true\"><\/i><\/a><\/div><div style=\"text-align:center;\"><a class=\"fusion-button button-flat fusion-button-default-size button-custom fusion-button-default button-6 fusion-button-span-yes fusion-has-button-gradient\" style=\"--button_accent_color:var(--awb-color6);--button_border_color:#e0e0e0;--button_accent_hover_color:var(--awb-color1);--button_border_hover_color:var(--awb-color3);--button_border_width-top:1px;--button_border_width-right:1px;--button_border_width-bottom:1px;--button_border_width-left:1px;--button_gradient_top_color:rgba(89,96,104,0.07);--button_gradient_bottom_color:rgba(89,96,104,0.33);--button_gradient_top_color_hover:#003c68;--button_gradient_bottom_color_hover:#003c68;--button_padding-top:20px;--button_padding-bottom:20px;--button_margin-top:3px;--button_margin-bottom:3px;\" target=\"_self\" data-hover=\"icon_slide\" href=\"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/mrcc-tool\/3-management-of-mrcc\/3-5-malignant-hypercalcaemia\/\"><span class=\"fusion-button-text\">3.5 Malign hypercalc\u00e6mi<\/span><i class=\"fa-angle-right fas button-icon-right\" aria-hidden=\"true\"><\/i><\/a><\/div><div style=\"text-align:center;\"><a class=\"fusion-button button-flat fusion-button-default-size button-custom fusion-button-default button-7 fusion-button-span-yes fusion-has-button-gradient\" style=\"--button_accent_color:var(--awb-color6);--button_border_color:#e0e0e0;--button_accent_hover_color:var(--awb-color1);--button_border_hover_color:var(--awb-color3);--button_border_width-top:1px;--button_border_width-right:1px;--button_border_width-bottom:1px;--button_border_width-left:1px;--button_gradient_top_color:rgba(89,96,104,0.07);--button_gradient_bottom_color:rgba(89,96,104,0.33);--button_gradient_top_color_hover:#003c68;--button_gradient_bottom_color_hover:#003c68;--button_padding-top:20px;--button_padding-bottom:20px;--button_margin-top:3px;--button_margin-bottom:3px;\" target=\"_self\" data-hover=\"icon_slide\" href=\"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/mrcc-tool\/3-management-of-mrcc\/3-6-performance-status\/\"><span class=\"fusion-button-text\">3.6 Performance status<\/span><i class=\"fa-angle-right fas button-icon-right\" aria-hidden=\"true\"><\/i><\/a><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-8 fusion_builder_column_1_6 1_6 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:16.666666666667%;--awb-margin-top-large:0px;--awb-spacing-right-large:11.52%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:11.52%;--awb-width-medium:16.666666666667%;--awb-order-medium:0;--awb-spacing-right-medium:11.52%;--awb-spacing-left-medium:11.52%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":7511,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7523","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7523","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/comments?post=7523"}],"version-history":[{"count":18,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7523\/revisions"}],"predecessor-version":[{"id":11069,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7523\/revisions\/11069"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7511"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/media?parent=7523"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}