{"id":7527,"date":"2023-08-17T06:52:46","date_gmt":"2023-08-17T06:52:46","guid":{"rendered":"http:\/\/d1s07skqdwll4z.cloudfront.net\/mrcc-tool\/3-management-of-mrcc\/3-4-response-evaluation\/"},"modified":"2024-11-27T20:55:57","modified_gmt":"2024-11-27T20:55:57","slug":"3-4-response-evaluation","status":"publish","type":"page","link":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/mrcc-tool\/3-management-of-mrcc\/3-4-response-evaluation\/","title":{"rendered":"3.4 Response evaluation"},"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;\">3.4 Responsevaluering<\/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>Response Evaluation Criteria in Solid Tumours (RECIST) er udarbejdet for at skabe en standardiseret og relativ simpel metode til vurdering af behandlingseffekten p\u00e5 tumorer i protokollerede fors\u00f8g. RECIST kriterierne anvendes dog ogs\u00e5 som et v\u00e6rkt\u00f8j til at evaluere behandlingseffekten hos de fleste onkologiske patienter i standardbehandling (kemoterapi, targeteret behandling, immunterapi, endokrin behandling). RECIST kriterierne blev vedtaget i \u00e5r 2000 og revideret i 2009. Den nuv\u00e6rende standard er RECIST 1.1.<sup>1<\/sup><\/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;\">F\u00f8lgende begreber\/definitioner er vigtige i RECIST version 1.1:<\/h5><\/div><div class=\"fusion-text fusion-text-2\"><ul>\n<li>M\u00e5lbar sygdom (measurable disease)<\/li>\n<li>Ikke-m\u00e5lbar sygdom (non-measurable disease)<\/li>\n<li>Target l\u00e6sioner (target lesions)<\/li>\n<li>Non-target l\u00e6sioner (non-target lesions)<\/li>\n<\/ul>\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;\">Ovenst\u00e5ende kan vurderes ved f\u00f8lgende m\u00e5lemetoder:<\/h5><\/div><div class=\"fusion-text fusion-text-3\"><ul>\n<li>CT- eller MR-scanning<\/li>\n<li>Klinisk<\/li>\n<li>R\u00f8ntgen af thorax<\/li>\n<\/ul>\n<p>Det er vigtigt, at der anvendes den samme modalitet, n\u00e5r man skal evaluere effekten af en behandling.<\/p>\n<\/div><div class=\"fusion-title title fusion-title-4 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">M\u00e5lbar sygdom \u2013 tumorer og lymfeknuder<\/h5><\/div><div class=\"fusion-text fusion-text-4\"><p>Tumorer \u2013 m\u00e5les p\u00e5 l\u00e6ngste diameter, hvor minimum st\u00f8rrelse er:<\/p>\n<ul>\n<li>\u226510 mm ved CT- eller MR-scanning<\/li>\n<li>\u226510 mm ved klinisk unders\u00f8gelse \u2013 synlige\/kutane\/subkutane metastaser<\/li>\n<li>\u226520 mm ved r\u00f8ntgen af thorax<\/li>\n<\/ul>\n<p>Lymfeknuder \u2013 m\u00e5les p\u00e5 den korteste led, hvor minimum st\u00f8rrelse er:<\/p>\n<ul>\n<li>\u226515 mm af lymfeknude \u2013 patologisk forst\u00f8rret lymfeknude<\/li>\n<\/ul>\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;\">Ikke-m\u00e5lbar sygdom \u2013 alle andre l\u00e6sioner og ikke m\u00e5lbare l\u00e6sioner (truly non-measurable lesions)<\/h5><\/div><div class=\"fusion-text fusion-text-5\"><p>Andre l\u00e6sioner:<\/p>\n<ul>\n<li>Sm\u00e5 tumorer\/l\u00e6sioner &lt; 10 mm<\/li>\n<li>10 mm &lt; lymfeknuder &lt; 15 mm<\/li>\n<\/ul>\n<p>Ikke-m\u00e5lbare l\u00e6sioner:<\/p>\n<ul>\n<li>Ascites, pleura- og perikardiev\u00e6ske, leptomeningeal sygdom, inflammatorisk brystkr\u00e6ft, lymfangitis carcinomatosis i lunger og hud, abdominale masser eller organomegali, cystiske l\u00e6sioner, skleroserende knoglemetastaser<\/li>\n<\/ul>\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;\">Target l\u00e6sioner<\/h5><\/div><div class=\"fusion-text fusion-text-6\"><p>Ud fra baseline unders\u00f8gelsen (oftest CT-scanning) defineres m\u00e5lbare tumorer\/lymfeknuder og af disse udv\u00e6lges target l\u00e6sioner, der skal m\u00e5les\/sammenlignes fra unders\u00f8gelse til unders\u00f8gelse mhp. at vurdere effekt af behandlingen. De skal v\u00e6re:<\/p>\n<ul>\n<li>Repr\u00e6sentative for alle involverede organer<\/li>\n<li>Udvalgt p\u00e5 baggrund af st\u00f8rrelse og egnethed til gentagne m\u00e5linger<\/li>\n<li>Ved flere m\u00e5lbare l\u00e6sioner v\u00e6lges op til 5 repr\u00e6sentative i alt, men max 2 l\u00e6sioner pr. organ<\/li>\n<\/ul>\n<p>Diameteren p\u00e5 hver target l\u00e6sion l\u00e6gges sammen til et tal \u2013 baseline sum \u2013 som senere bruges til m\u00e5ling af respons.<\/p>\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;\">Non-target l\u00e6sioner<\/h5><\/div><div class=\"fusion-text fusion-text-7\"><p>De \u00f8vrige l\u00e6sioner b\u00e5de ikke-m\u00e5lbare l\u00e6sioner og resten af de m\u00e5lbare l\u00e6sioner skal noteres:<\/p>\n<ul>\n<li>M\u00e5lbare tumorer der <b>ikke<\/b> er udvalgt som target l\u00e6sioner<\/li>\n<li>For sm\u00e5 tumorer\/lymfeknuder<\/li>\n<li>Ikke m\u00e5lbare l\u00e6sioner (knoglemetastaser, pleuraexudat, ascites, peritoneal carcinose m.m.)<\/li>\n<li>Tidligere str\u00e5lebehandlede l\u00e6sioner<\/li>\n<\/ul>\n<\/div><div class=\"fusion-title title fusion-title-8 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Responsevaluering:<\/h5><\/div><div class=\"fusion-text fusion-text-8\"><p>Ved responsevaluering kan der v\u00e6re 4 udfald:<\/p>\n<ul>\n<li>CR \u2013 complete response\/komplet respons<\/li>\n<li>PR \u2013 partial response\/partiel respons<\/li>\n<li>PD \u2013 progressive disease\/progressiv sygdom\/progression<\/li>\n<li>SD \u2013 stable disease\/stabil sygdom<\/li>\n<\/ul>\n<\/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;\">CR \u2013 komplet respons<\/h5><\/div><div class=\"fusion-text fusion-text-9\"><ul>\n<li>Svind af alle target l\u00e6sioner og alle patologisk forst\u00f8rrede lymfeknuder er reduceret til &lt; 10 mm p\u00e5 korteste led<\/li>\n<li>Svind af alle non-target l\u00e6sioner<\/li>\n<li>Ikke tilkomst af nye l\u00e6sioner<\/li>\n<\/ul>\n<p><i><b>Alle ovenst\u00e5ende punkter skal v\u00e6re opfyldt.<\/b><\/i><\/p>\n<\/div><div class=\"fusion-title title fusion-title-10 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">PR \u2013 partiel respons<\/h5><\/div><div class=\"fusion-text fusion-text-10\"><ul>\n<li>Mindst 30% reduktion af den samlede sum af target l\u00e6sioner ift. baseline summen<\/li>\n<li>Ikke samtidig utvetydig progression af non-target l\u00e6sioner<\/li>\n<li>Ikke tilkomst af nye l\u00e6sioner<\/li>\n<\/ul>\n<p><i><b>Alle ovenst\u00e5ende punkter skal v\u00e6re opfyldt.<\/b><\/i><\/p>\n<\/div><div class=\"fusion-title title fusion-title-11 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">PD \u2013 progressiv sygdom\/progression<\/h5><\/div><div class=\"fusion-text fusion-text-11\"><ul>\n<li>Mindst 20% \u00f8gning af den samlede sum af target l\u00e6sioner ift. hvor summen var lavest (nadir-sum) og en absolut \u00f8gning p\u00e5 mindst 5 mm fra nadir-summen<\/li>\n<li>Ny l\u00e6sion<\/li>\n<li>Utvetydig progression af non-target l\u00e6sioner<\/li>\n<li>Klinisk progression<\/li>\n<\/ul>\n<p><i><b>Kun \u00e9t af ovenst\u00e5ende punkter skal v\u00e6re opfyldt for at kalde det progressiv sygdom.<\/b><\/i><\/p>\n<\/div><div class=\"fusion-title title fusion-title-12 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">SD \u2013 stabil sygdom<\/h5><\/div><div class=\"fusion-text fusion-text-12\"><ul>\n<li>Hverken PR eller PD<\/li>\n<li>Ingen nye l\u00e6sioner<\/li>\n<\/ul>\n<\/div><div class=\"fusion-text fusion-text-13\"><p>Ovenst\u00e5ende muligheder er her vist i en tabel for at give bedre overblik over overordnet respons iht. RECIST 1.1.<\/p>\n<\/div>\n<div class=\"table-1\">\n<table width=\"100%\">\n<thead>\n<tr>\n<th align=\"left\">TARGET L\u00c6SION<\/th>\n<th align=\"left\">NON-TARGET L\u00c6SION<\/th>\n<th align=\"left\">NY L\u00c6SION<\/th>\n<th align=\"left\">OVERORDNET RESPONS<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td align=\"left\">CR<\/td>\n<td align=\"left\">CR<\/td>\n<td align=\"left\">Nej<\/td>\n<td align=\"left\">CR<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">CR<\/td>\n<td align=\"left\">SD<\/td>\n<td align=\"left\">Nej<\/td>\n<td align=\"left\">PR<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">CR<\/td>\n<td align=\"left\">Ikke evaluerbar (NE)<\/td>\n<td align=\"left\">Nej<\/td>\n<td align=\"left\">PR<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">PR<\/td>\n<td align=\"left\">SD<\/td>\n<td align=\"left\">Nej<\/td>\n<td align=\"left\">PR<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">SD<\/td>\n<td align=\"left\">SD<\/td>\n<td align=\"left\">Nej<\/td>\n<td align=\"left\">SD<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">PD<\/td>\n<td align=\"left\">CR, PR, SD, PD, NE<\/td>\n<td align=\"left\">Ja eller nej<\/td>\n<td align=\"left\">PD<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Ikke alle evalueret<\/td>\n<td align=\"left\">Ikke PD<\/td>\n<td align=\"left\">Nej<\/td>\n<td align=\"left\">Ikke evaluerbar (NE)<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Hvilken som helst<\/td>\n<td align=\"left\">PD<\/td>\n<td align=\"left\">Ja eller nej<\/td>\n<td align=\"left\">PD<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Hvilken som helst<\/td>\n<td align=\"left\">CR, PR, SD, PD, NE<\/td>\n<td align=\"left\">Ja<\/td>\n<td align=\"left\">PD<\/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-text fusion-text-14\"><p>Eksempel p\u00e5 vurdering:<\/p>\n<\/div>\n<div class=\"table-1\">\n<table width=\"100%\">\n<thead>\n<tr>\n<th align=\"left\">&nbsp;<\/th>\n<th align=\"left\">BASELINE<\/th>\n<th align=\"left\">&nbsp;<\/th>\n<th align=\"left\">1. RESPONS EVALUERING<\/th>\n<th align=\"left\">2. RESPONS EVALUERING<\/th>\n<th align=\"left\">3. RESPONS EVALUERING<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td align=\"left\">TARGET L\u00c6SIONER<\/td>\n<td align=\"left\">ORGAN<\/td>\n<td align=\"left\">mm<\/td>\n<td align=\"left\">mm<\/td>\n<td align=\"left\">mm<\/td>\n<td align=\"left\">mm<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">Lever<\/td>\n<td align=\"left\">47<\/td>\n<td align=\"left\">28<\/td>\n<td align=\"left\">31<\/td>\n<td align=\"left\">45<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">Lunge<\/td>\n<td align=\"left\">30<\/td>\n<td align=\"left\">19<\/td>\n<td align=\"left\">19<\/td>\n<td align=\"left\">25<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">Lymfeknude<\/td>\n<td align=\"left\">25<\/td>\n<td align=\"left\">16<\/td>\n<td align=\"left\">17<\/td>\n<td align=\"left\">24<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Sum af targetl\u00e6sioner<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">102<\/td>\n<td align=\"left\">63<\/td>\n<td align=\"left\">67<\/td>\n<td align=\"left\">94<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">\u00c6ndring i % fra baseline<\/td>\n<td colspan=\"2\" align=\"left\">&nbsp;<\/td>\n<td align=\"left\">-38.2%<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">\u00c6ndring i % fra nadir<\/td>\n<td colspan=\"2\" align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">+6.3%<\/td>\n<td align=\"left\">+49.2%<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Respons for target l\u00e6sioner<\/td>\n<td colspan=\"2\" align=\"left\">&nbsp;<\/td>\n<td align=\"left\">PR<\/td>\n<td align=\"left\">PR<\/td>\n<td align=\"left\">PD<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Non-target l\u00e6sioner<\/td>\n<td colspan=\"2\" align=\"left\">Multiple levermetastaser<\/td>\n<td align=\"left\">Multiple liver metastases<\/td>\n<td align=\"left\">Multiple levermetastaser<\/td>\n<td align=\"left\">Multiple levermetastaser<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Respons for non-target l\u00e6sioner<\/td>\n<td colspan=\"2\" align=\"left\">&nbsp;<\/td>\n<td align=\"left\">SD<\/td>\n<td align=\"left\">SD<\/td>\n<td align=\"left\">Utvetydig progression<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Nye l\u00e6sioner<\/td>\n<td colspan=\"2\" align=\"left\">&nbsp;<\/td>\n<td align=\"left\">Nej<\/td>\n<td align=\"left\">Nej<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Overordnet respons<\/td>\n<td colspan=\"2\" align=\"left\">&nbsp;<\/td>\n<td align=\"left\">PR<\/td>\n<td align=\"left\">PR<\/td>\n<td align=\"left\">PD<\/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-13 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">iRECIST \u2013 RECIST for immunbaseret behandling<\/h4><\/div><div class=\"fusion-text fusion-text-15\"><p>Ved immunterapi udnytter man kroppens eget immunforsvar til m\u00e5lrettet at bek\u00e6mpe kr\u00e6ften <a href=\"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/mrcc-tool\/4-treatment\/4-3-oncology-treatment-immunotherapy\/\">(se afsnit om onkologisk behandling immunterapi)<\/a>. I kliniske studier med immunterapi observerede man anderledes\/us\u00e6dvanlig respons ift. det, man tidligere havde set med andre onkologiske behandlinger. Dvs. initial progression iht. RECIST 1.1 med tiltagende st\u00f8rrelse af target l\u00e6sioner og tilkomst af nye l\u00e6sioner, men efterf\u00f8lgende flot og langvarigt respons. P\u00e5 baggrund af dette besluttede RECIST arbejdsgruppen at lave en guideline med modificerede RECIST kriterier til kliniske studier med immunterapi (iRECIST) for at sikre ensartet design og dataindsamling<sup>2<\/sup>.<\/p>\n<p>iRECIST er baseret p\u00e5 RECIST 1.1, men der er tilf\u00f8jet flere begreber i responsevalueringen:<\/p>\n<ul>\n<li>iCR \u2013 immune complete response\/immun komplet respons<\/li>\n<li>iPR \u2013 immune partial response\/immun partiel respons<\/li>\n<li>iUPD \u2013 immune unconfirmed progressive disease\/immun ikke-konfirmeret progressiv sygdom<\/li>\n<li>iCPD \u2013 immune confirmed progressive disease\/immun konfirmeret progressiv sygdom<\/li>\n<li>iSD \u2013 immune stable disease\/immun stabil sygdom<\/li>\n<li>Nye l\u00e6sioner er subkategoriseret til:\n<ul>\n<li>Target l\u00e6sioner<\/li>\n<li>Non-target l\u00e6sioner<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>De vigtigste forskelle mellem RECIST 1.1 og iRECIST:<\/p>\n<\/div>\n<div class=\"table-1\">\n<table width=\"100%\">\n<thead>\n<tr>\n<th align=\"left\">&nbsp;<\/th>\n<th align=\"left\">RESIST 1.1<\/th>\n<th align=\"left\">IRECIST<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td align=\"left\">Definition af m\u00e5lbar og<br \/>ikke-m\u00e5lbar sygdom;<br \/>antal og udv\u00e6lgelse af<br \/>target l\u00e6sioner<\/td>\n<td align=\"left\">M\u00e5lbare l\u00e6sioner er \u226510 mm i diameter<br \/>(\u226515 mm for lymfeknuder); maksimum fem l\u00e6sioner (to per organ); al anden sygdom<br \/>bliver betragtet som non-target (skal v\u00e6re \u226510 mm p\u00e5 den korte akse for sygdom i<br \/>lymfeknuder)<\/td>\n<td align=\"left\">Ingen \u00e6ndring fra RECIST 1.1; dog vurderes nye l\u00e6sioner ud fra RECIST 1.1, men noteres separat p\u00e5 den p\u00e5g\u00e6ldende case report form (men inkluderes ikke i summen<br \/>af l\u00e6sioner for target l\u00e6sioner identificeret ved baseline)<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Komplet respons,<br \/>partiel respons eller<br \/>stabil sygdom<\/td>\n<td align=\"left\">Kan ikke have opfyldt kriterierne for progression f\u00f8r komplet respons, partiel<br \/>respons eller stabil sygdom<\/td>\n<td align=\"left\">Kan have haft iUPD (en eller flere gange), men ikke iCPD f\u00f8r iCR, iPR, eller iSD<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Bekr\u00e6ftelse af komplet<br \/>respons eller partiel<br \/>respons<\/td>\n<td align=\"left\">Kun kr\u00e6vet ved ikke-randomiserede fors\u00f8g<\/td>\n<td align=\"left\">Svarende til RECIST 1.1<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Bekr\u00e6ftelse af stabil<br \/>sygdom<\/td>\n<td align=\"left\">Ikke p\u00e5kr\u00e6vet<\/td>\n<td align=\"left\">Svarende til RECIST 1.1<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Nye l\u00e6sioner<\/td>\n<td align=\"left\">Resulterer i progression; registreret men ikke m\u00e5lt<\/td>\n<td align=\"left\">Resulterer i iUPD, men iCPD opn\u00e5s kun hvis n\u00e6ste scanning p\u00e5viser nye l\u00e6sioner eller de nytilkomne l\u00e6sioner p\u00e5 forrige scanning er tiltaget i st\u00f8rrelse (\u22655 mm for summen af nye target l\u00e6sioner eller tiltagende st\u00f8rrelse af nye non-target l\u00e6sioner, uanset st\u00f8rrelsesv\u00e6kst<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Uafh\u00e6ngigt blindet<br \/>review og central<br \/>vurdering af scanninger<\/td>\n<td align=\"left\">Anbefalet i nogle tilf\u00e6lde \u2013 f.eks. i nogle fors\u00f8g med progressionsbaserede<br \/>endpoints til marketingsgodkendelse<\/td>\n<td align=\"left\">Indsamling af alle scanninger (men ikke uafh\u00e6ngigt review) anbefales til alle fors\u00f8g<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Bekr\u00e6ftelse af<br \/>progression<\/td>\n<td align=\"left\">Ikke p\u00e5kr\u00e6vet (medmindre tvetydig)<\/td>\n<td align=\"left\">P\u00e5kr\u00e6vet<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Vurdering af almen<br \/>tilstand<\/td>\n<td align=\"left\">Ikke inkluderet i vurderingen<\/td>\n<td align=\"left\">U\u00e6ndret almen tilstand\/PS tages i betragtning, n\u00e5r det skal besluttes om behandling skal forts\u00e6tte efter iUPD<\/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-text fusion-text-16\"><p>Der kan l\u00e6ses yderligere om iRECIST og h\u00e5ndtering af nye l\u00e6sioner samt iUPD i \u201diRECIST: guidelines for response criteria for use in trials testing immunotherapeutics\u201d, Seymour et al. Lancet Oncol 2017.<sup>2<\/sup><\/p>\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-14 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Referencer<\/h4><\/div><div class=\"fusion-text fusion-text-17\"><div>\n<ol>\n<li><i>Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228-47.<\/i><\/li>\n<li><i>Seymour L, Bogaerts J, Perrone A, Ford R, Schwartz LH, Mandrekar S, et al. iRECIST: guidelines for response criteria for use in trials testing immunotherapeutics. Lancet Oncol. 2017;18(3):e143-52.<\/i><\/li>\n<\/ol>\n<\/div>\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=\"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/mrcc-tool\/3-management-of-mrcc\/3-5-malignant-hypercalcaemia\/\"><span class=\"fusion-button-text\">Forts\u00e6t til n\u00e6ste afsnit: 3.5 Malign hypercalc\u00e6mi<\/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-15 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-7527","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7527","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=7527"}],"version-history":[{"count":32,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7527\/revisions"}],"predecessor-version":[{"id":11934,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7527\/revisions\/11934"}],"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=7527"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}