Inden for de seneste \u00e5r er der sket markante fremskridt i den medicinske behandling af metastatisk renalcellecarcinom (mRCC), s\u00e5 der i dag findes flere forskellige behandlingsmuligheder. Adskillige l\u00e6gemidler er godkendt og flere nye behandlinger er under afpr\u00f8vning.<\/p>\n<\/div>
Nogle patienter med mRCC har kun begr\u00e6nset sygdomsbyrde (f.eks. sm\u00e5 lungemetastaser og\/eller let forst\u00f8rrede lymfeknuder over eller under diafragma) samtidig med, at de er asymptomatiske. Hos disse patienter kan man overveje en kortere observationsperiode uden behandling, da sygdommen kan holde sig i ro eller kun vokser meget langsomt i en kortere eller l\u00e6ngere periode. Patienterne skal kontrolleres l\u00f8bende med blodpr\u00f8ver, CT-scanning og klinisk kontrol. Ved signifikant v\u00e6kst\/tilkomst af nye metastaser, vigende blodpr\u00f8ver og\/eller patienten f\u00e5r symptomer (tiltagende tr\u00e6thed, v\u00e6gttab, dyspn\u00f8 og\/eller smerter) skal patienten p\u00e5begynde behandling.1<\/sup><\/p>\n<\/div>2. Metastasekirurgi<\/h4><\/div>Kirurgisk resektion af solit\u00e6re metastaser er associeret med en 5-\u00e5rs overlevelse p\u00e5 35-50%. Ved solit\u00e6re metastaser b\u00f8r behandlingen derfor v\u00e6re radikal fjernelse af metastasen\/metastaserne.2<\/sup><\/p>\n<\/div>3. Stereotaktisk str\u00e5lebehandling (stereotactic body radiotherapy (SBRT)<\/h4><\/div>Stereotaktisk str\u00e5lebehandling (SBRT) er en h\u00f8jdosis, fokuseret str\u00e5lebehandling mod en eller f\u00e5 metastaser givet over 1-5 gange. Form\u00e5let med SBRT er at ramme den\/de p\u00e5g\u00e6ldende metastase(r) med h\u00f8j pr\u00e6cision og med mindst mulig beskadigelse af det omkringliggende normalv\u00e6v.<\/p>\nHvis der er tale om en eller f\u00e5 metastaser, som ikke kan fjernes operativt (cerebrum, lunger, lymfeknude, recidiv sv.t nefrektomi-lejet, knogle mm.), kan man overveje stereotaktisk str\u00e5lebehandling<\/a>.<\/p>\nStillingtagen til stereotaktisk str\u00e5lebehandling, uanset om det er cerebrale eller perifere metastaser, foreg\u00e5r p\u00e5 en MDT-konference. Se n\u00e6rmere i afsnit om str\u00e5lebehandling<\/a>.<\/p>\n<\/div>4. Cytoreduktiv nefrektomi (CN) efterfulgt af onkologisk behandling<\/h4><\/div>\n\n\nDet er dokumenteret, at nefrektomi, ved metastatisk sygdom, kan medf\u00f8re regression af metastatiske l\u00e6sioner, omend det er et sj\u00e6ldent f\u00e6nomen (1%).3<\/sup><\/p>\nI \u00e6raen hvor IL-2 baseret immunterapi blev anvendt, anbefalede man cytoreduktiv nefrektomi (CN) til patienter med god PS f\u00f8r behandling.<\/p>\nEfter tyrosinkinase-inhibitorer (TKI) er blevet standardbehandling, har to prospektive studier unders\u00f8gt indikationen for CN f\u00f8r TKI. Begge studier blev lukket f\u00f8r tid grundet d\u00e5rlig rekruttering, men konklusionen fra begge studier var, at der ikke var en overlevelsesgevinst ved CN f\u00f8r TKI. Der har v\u00e6ret mange kritikpunkter af begge studier og i f\u00f8lge EAU guildelines er data kun st\u00e6rke nok til at konkludere, at patienter tilh\u00f8rende d\u00e5rlig prognosegruppe iht. IMDC (se afsnit om prognostiske stratificeringsv\u00e6rkt\u00f8jer til patienter med mRCC<\/a>) IKKE skal tilbydes CN f\u00f8r TKI.4<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n\n\n\nCytoreduktiv nefrektomi f\u00f8r systemisk behandling kan fortsat anbefales:<\/p>\n\ni kliniske fors\u00f8g<\/li>\ntil patienter i god AT (PS = 0\u20131<\/a>) med stor prim\u00e6r tumor og lav metastase-volumen som ikke har spredt sig til CNS, knogler eller lever<\/li>\ntil patienter som har symptomer fra deres prim\u00e6r tumor i form af h\u00e6maturi eller smerter5<\/sup><\/li>\n<\/ul>\nBeslutningen om CN skal altid tages p\u00e5 en multidisciplin\u00e6r (MDT<\/a>) konference.2, 5-6<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div>5. Deltagelse i klinisk fors\u00f8g<\/h4><\/div>\n\n\nDet skal altid overvejes, om der er mulighed for deltagelse i et klinisk fors\u00f8g, hvor nye l\u00e6gemidler afpr\u00f8ves evt. i kombination med allerede godkendte pr\u00e6parater.<\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>Referencer<\/h4><\/div>\n\nRini BI, Plimack ER, Stus V, Gafanov R, Waddell T, Nosov D, et al. Pembrolizumab plus Axitinib versus Sunitinib for Advanced Renal-Cell Carcinoma. N Engl J Med. 2019;380(12):1116-27.<\/i><\/li>\nDanish Multidisciplinary Cancer Groups (DMCG). DaRenCa Kliniske Retningslinjer 2024. Available from: https:\/\/www.dmcg.dk\/Kliniske-retningslinjer\/kliniske-retningslinjer-opdelt-paa-dmcg\/nyrecancer\/<\/i><\/li>\nFreed SZ, Halperin JP, Gordon M. Radiographic regression of metastases from renal cell carcinoma. J Urol. 1977;118(4):538-42.<\/i><\/li>\nBex A, Albiges L, Ljungberg B, Bensalah K, Dabestani S, Giles RH, et al. Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma. Eur Urol. 2018;74(6):805-9.<\/i><\/li>\nBhindi B, Abel EJ, Albiges L, et al. Systematic review of the role of cytoreductive nephrectomy in the targeted therapy era and beyond: an individualized approach to metastatic renal cell carcinoma. Eur Urol. 2019;111-128.<\/i><\/li>\nESMO Guidelines: European Society for Medical Oncology. ESMO Clinical Practice Guidelines. Available from: https:\/\/www.esmo.org\/guidelines.<\/i><\/li>\n<\/ol>\n<\/div>\n<\/div><\/div><\/div>Tjek din viden<\/h4><\/div><\/div><\/div><\/div><\/div>I en observationsperiode kan f\u00f8lgende symptomer v\u00e6re \u00e5rsag til opstart af behandling:<\/h5><\/div><\/div><\/div><\/div><\/div><\/div><\/div>Tiltagende tr\u00e6thed, v\u00e6gttab, dyspn\u00f8 og h\u00e5rtab<\/label><\/div>Tiltagende tr\u00e6thed, infektion, dyspn\u00f8 og\/eller smerter<\/label><\/div>Tiltagende tr\u00e6thed, v\u00e6gttab, dyspn\u00f8 og\/eller smerter<\/label><\/div><\/fieldset><\/div>(Det er helt anonymt at bruge quiz'en!)<\/small><\/p>\n<\/div><\/div><\/div><\/i><\/div>\n<\/div>Svaret er korrekt!<\/p>\n<\/div><\/i><\/div><\/p>\n<\/div>Svaret er forkert!<\/p>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/form><\/div>Forts\u00e6t til n\u00e6ste afsnit: 4.2 Targeteret behandling<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/span>Udforsk denne kapitelmenu<\/h5><\/span><\/div><\/div><\/div><\/div><\/div><\/div><\/div>4.1 Behandlingsmuligheder ved mRCC<\/span><\/i><\/a><\/div>4.2 Targeteret behandling<\/span><\/i><\/a><\/div>4.3 Immunterapi<\/span><\/i><\/a><\/div>4.4 Str\u00e5lebehandling<\/span><\/i><\/a><\/div>4.5 Underst\u00f8ttende behandling<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":7543,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7547","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547","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=7547"}],"version-history":[{"count":22,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547\/revisions"}],"predecessor-version":[{"id":11937,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547\/revisions\/11937"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7543"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/media?parent=7547"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Kirurgisk resektion af solit\u00e6re metastaser er associeret med en 5-\u00e5rs overlevelse p\u00e5 35-50%. Ved solit\u00e6re metastaser b\u00f8r behandlingen derfor v\u00e6re radikal fjernelse af metastasen\/metastaserne.2<\/sup><\/p>\n<\/div>3. Stereotaktisk str\u00e5lebehandling (stereotactic body radiotherapy (SBRT)<\/h4><\/div>Stereotaktisk str\u00e5lebehandling (SBRT) er en h\u00f8jdosis, fokuseret str\u00e5lebehandling mod en eller f\u00e5 metastaser givet over 1-5 gange. Form\u00e5let med SBRT er at ramme den\/de p\u00e5g\u00e6ldende metastase(r) med h\u00f8j pr\u00e6cision og med mindst mulig beskadigelse af det omkringliggende normalv\u00e6v.<\/p>\nHvis der er tale om en eller f\u00e5 metastaser, som ikke kan fjernes operativt (cerebrum, lunger, lymfeknude, recidiv sv.t nefrektomi-lejet, knogle mm.), kan man overveje stereotaktisk str\u00e5lebehandling<\/a>.<\/p>\nStillingtagen til stereotaktisk str\u00e5lebehandling, uanset om det er cerebrale eller perifere metastaser, foreg\u00e5r p\u00e5 en MDT-konference. Se n\u00e6rmere i afsnit om str\u00e5lebehandling<\/a>.<\/p>\n<\/div>4. Cytoreduktiv nefrektomi (CN) efterfulgt af onkologisk behandling<\/h4><\/div>\n\n\nDet er dokumenteret, at nefrektomi, ved metastatisk sygdom, kan medf\u00f8re regression af metastatiske l\u00e6sioner, omend det er et sj\u00e6ldent f\u00e6nomen (1%).3<\/sup><\/p>\nI \u00e6raen hvor IL-2 baseret immunterapi blev anvendt, anbefalede man cytoreduktiv nefrektomi (CN) til patienter med god PS f\u00f8r behandling.<\/p>\nEfter tyrosinkinase-inhibitorer (TKI) er blevet standardbehandling, har to prospektive studier unders\u00f8gt indikationen for CN f\u00f8r TKI. Begge studier blev lukket f\u00f8r tid grundet d\u00e5rlig rekruttering, men konklusionen fra begge studier var, at der ikke var en overlevelsesgevinst ved CN f\u00f8r TKI. Der har v\u00e6ret mange kritikpunkter af begge studier og i f\u00f8lge EAU guildelines er data kun st\u00e6rke nok til at konkludere, at patienter tilh\u00f8rende d\u00e5rlig prognosegruppe iht. IMDC (se afsnit om prognostiske stratificeringsv\u00e6rkt\u00f8jer til patienter med mRCC<\/a>) IKKE skal tilbydes CN f\u00f8r TKI.4<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n\n\n\nCytoreduktiv nefrektomi f\u00f8r systemisk behandling kan fortsat anbefales:<\/p>\n\ni kliniske fors\u00f8g<\/li>\ntil patienter i god AT (PS = 0\u20131<\/a>) med stor prim\u00e6r tumor og lav metastase-volumen som ikke har spredt sig til CNS, knogler eller lever<\/li>\ntil patienter som har symptomer fra deres prim\u00e6r tumor i form af h\u00e6maturi eller smerter5<\/sup><\/li>\n<\/ul>\nBeslutningen om CN skal altid tages p\u00e5 en multidisciplin\u00e6r (MDT<\/a>) konference.2, 5-6<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div>5. Deltagelse i klinisk fors\u00f8g<\/h4><\/div>\n\n\nDet skal altid overvejes, om der er mulighed for deltagelse i et klinisk fors\u00f8g, hvor nye l\u00e6gemidler afpr\u00f8ves evt. i kombination med allerede godkendte pr\u00e6parater.<\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>Referencer<\/h4><\/div>\n\nRini BI, Plimack ER, Stus V, Gafanov R, Waddell T, Nosov D, et al. Pembrolizumab plus Axitinib versus Sunitinib for Advanced Renal-Cell Carcinoma. N Engl J Med. 2019;380(12):1116-27.<\/i><\/li>\nDanish Multidisciplinary Cancer Groups (DMCG). DaRenCa Kliniske Retningslinjer 2024. Available from: https:\/\/www.dmcg.dk\/Kliniske-retningslinjer\/kliniske-retningslinjer-opdelt-paa-dmcg\/nyrecancer\/<\/i><\/li>\nFreed SZ, Halperin JP, Gordon M. Radiographic regression of metastases from renal cell carcinoma. J Urol. 1977;118(4):538-42.<\/i><\/li>\nBex A, Albiges L, Ljungberg B, Bensalah K, Dabestani S, Giles RH, et al. Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma. Eur Urol. 2018;74(6):805-9.<\/i><\/li>\nBhindi B, Abel EJ, Albiges L, et al. Systematic review of the role of cytoreductive nephrectomy in the targeted therapy era and beyond: an individualized approach to metastatic renal cell carcinoma. Eur Urol. 2019;111-128.<\/i><\/li>\nESMO Guidelines: European Society for Medical Oncology. ESMO Clinical Practice Guidelines. Available from: https:\/\/www.esmo.org\/guidelines.<\/i><\/li>\n<\/ol>\n<\/div>\n<\/div><\/div><\/div>Tjek din viden<\/h4><\/div><\/div><\/div><\/div><\/div>I en observationsperiode kan f\u00f8lgende symptomer v\u00e6re \u00e5rsag til opstart af behandling:<\/h5><\/div><\/div><\/div><\/div><\/div><\/div><\/div>Tiltagende tr\u00e6thed, v\u00e6gttab, dyspn\u00f8 og h\u00e5rtab<\/label><\/div>Tiltagende tr\u00e6thed, infektion, dyspn\u00f8 og\/eller smerter<\/label><\/div>Tiltagende tr\u00e6thed, v\u00e6gttab, dyspn\u00f8 og\/eller smerter<\/label><\/div><\/fieldset><\/div>(Det er helt anonymt at bruge quiz'en!)<\/small><\/p>\n<\/div><\/div><\/div><\/i><\/div>\n<\/div>Svaret er korrekt!<\/p>\n<\/div><\/i><\/div><\/p>\n<\/div>Svaret er forkert!<\/p>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/form><\/div>Forts\u00e6t til n\u00e6ste afsnit: 4.2 Targeteret behandling<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/span>Udforsk denne kapitelmenu<\/h5><\/span><\/div><\/div><\/div><\/div><\/div><\/div><\/div>4.1 Behandlingsmuligheder ved mRCC<\/span><\/i><\/a><\/div>4.2 Targeteret behandling<\/span><\/i><\/a><\/div>4.3 Immunterapi<\/span><\/i><\/a><\/div>4.4 Str\u00e5lebehandling<\/span><\/i><\/a><\/div>4.5 Underst\u00f8ttende behandling<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":7543,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7547","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547","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=7547"}],"version-history":[{"count":22,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547\/revisions"}],"predecessor-version":[{"id":11937,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547\/revisions\/11937"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7543"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/media?parent=7547"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Stereotaktisk str\u00e5lebehandling (SBRT) er en h\u00f8jdosis, fokuseret str\u00e5lebehandling mod en eller f\u00e5 metastaser givet over 1-5 gange. Form\u00e5let med SBRT er at ramme den\/de p\u00e5g\u00e6ldende metastase(r) med h\u00f8j pr\u00e6cision og med mindst mulig beskadigelse af det omkringliggende normalv\u00e6v.<\/p>\n
Hvis der er tale om en eller f\u00e5 metastaser, som ikke kan fjernes operativt (cerebrum, lunger, lymfeknude, recidiv sv.t nefrektomi-lejet, knogle mm.), kan man overveje stereotaktisk str\u00e5lebehandling<\/a>.<\/p>\nStillingtagen til stereotaktisk str\u00e5lebehandling, uanset om det er cerebrale eller perifere metastaser, foreg\u00e5r p\u00e5 en MDT-konference. Se n\u00e6rmere i afsnit om str\u00e5lebehandling<\/a>.<\/p>\n<\/div>4. Cytoreduktiv nefrektomi (CN) efterfulgt af onkologisk behandling<\/h4><\/div>\n\n\nDet er dokumenteret, at nefrektomi, ved metastatisk sygdom, kan medf\u00f8re regression af metastatiske l\u00e6sioner, omend det er et sj\u00e6ldent f\u00e6nomen (1%).3<\/sup><\/p>\nI \u00e6raen hvor IL-2 baseret immunterapi blev anvendt, anbefalede man cytoreduktiv nefrektomi (CN) til patienter med god PS f\u00f8r behandling.<\/p>\nEfter tyrosinkinase-inhibitorer (TKI) er blevet standardbehandling, har to prospektive studier unders\u00f8gt indikationen for CN f\u00f8r TKI. Begge studier blev lukket f\u00f8r tid grundet d\u00e5rlig rekruttering, men konklusionen fra begge studier var, at der ikke var en overlevelsesgevinst ved CN f\u00f8r TKI. Der har v\u00e6ret mange kritikpunkter af begge studier og i f\u00f8lge EAU guildelines er data kun st\u00e6rke nok til at konkludere, at patienter tilh\u00f8rende d\u00e5rlig prognosegruppe iht. IMDC (se afsnit om prognostiske stratificeringsv\u00e6rkt\u00f8jer til patienter med mRCC<\/a>) IKKE skal tilbydes CN f\u00f8r TKI.4<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n\n\n\nCytoreduktiv nefrektomi f\u00f8r systemisk behandling kan fortsat anbefales:<\/p>\n\ni kliniske fors\u00f8g<\/li>\ntil patienter i god AT (PS = 0\u20131<\/a>) med stor prim\u00e6r tumor og lav metastase-volumen som ikke har spredt sig til CNS, knogler eller lever<\/li>\ntil patienter som har symptomer fra deres prim\u00e6r tumor i form af h\u00e6maturi eller smerter5<\/sup><\/li>\n<\/ul>\nBeslutningen om CN skal altid tages p\u00e5 en multidisciplin\u00e6r (MDT<\/a>) konference.2, 5-6<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div>5. Deltagelse i klinisk fors\u00f8g<\/h4><\/div>\n\n\nDet skal altid overvejes, om der er mulighed for deltagelse i et klinisk fors\u00f8g, hvor nye l\u00e6gemidler afpr\u00f8ves evt. i kombination med allerede godkendte pr\u00e6parater.<\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>Referencer<\/h4><\/div>\n\nRini BI, Plimack ER, Stus V, Gafanov R, Waddell T, Nosov D, et al. Pembrolizumab plus Axitinib versus Sunitinib for Advanced Renal-Cell Carcinoma. N Engl J Med. 2019;380(12):1116-27.<\/i><\/li>\nDanish Multidisciplinary Cancer Groups (DMCG). DaRenCa Kliniske Retningslinjer 2024. Available from: https:\/\/www.dmcg.dk\/Kliniske-retningslinjer\/kliniske-retningslinjer-opdelt-paa-dmcg\/nyrecancer\/<\/i><\/li>\nFreed SZ, Halperin JP, Gordon M. Radiographic regression of metastases from renal cell carcinoma. J Urol. 1977;118(4):538-42.<\/i><\/li>\nBex A, Albiges L, Ljungberg B, Bensalah K, Dabestani S, Giles RH, et al. Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma. Eur Urol. 2018;74(6):805-9.<\/i><\/li>\nBhindi B, Abel EJ, Albiges L, et al. Systematic review of the role of cytoreductive nephrectomy in the targeted therapy era and beyond: an individualized approach to metastatic renal cell carcinoma. Eur Urol. 2019;111-128.<\/i><\/li>\nESMO Guidelines: European Society for Medical Oncology. ESMO Clinical Practice Guidelines. Available from: https:\/\/www.esmo.org\/guidelines.<\/i><\/li>\n<\/ol>\n<\/div>\n<\/div><\/div><\/div>Tjek din viden<\/h4><\/div><\/div><\/div><\/div><\/div>I en observationsperiode kan f\u00f8lgende symptomer v\u00e6re \u00e5rsag til opstart af behandling:<\/h5><\/div><\/div><\/div><\/div><\/div><\/div><\/div>Tiltagende tr\u00e6thed, v\u00e6gttab, dyspn\u00f8 og h\u00e5rtab<\/label><\/div>Tiltagende tr\u00e6thed, infektion, dyspn\u00f8 og\/eller smerter<\/label><\/div>Tiltagende tr\u00e6thed, v\u00e6gttab, dyspn\u00f8 og\/eller smerter<\/label><\/div><\/fieldset><\/div>(Det er helt anonymt at bruge quiz'en!)<\/small><\/p>\n<\/div><\/div><\/div><\/i><\/div>\n<\/div>Svaret er korrekt!<\/p>\n<\/div><\/i><\/div><\/p>\n<\/div>Svaret er forkert!<\/p>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/form><\/div>Forts\u00e6t til n\u00e6ste afsnit: 4.2 Targeteret behandling<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/span>Udforsk denne kapitelmenu<\/h5><\/span><\/div><\/div><\/div><\/div><\/div><\/div><\/div>4.1 Behandlingsmuligheder ved mRCC<\/span><\/i><\/a><\/div>4.2 Targeteret behandling<\/span><\/i><\/a><\/div>4.3 Immunterapi<\/span><\/i><\/a><\/div>4.4 Str\u00e5lebehandling<\/span><\/i><\/a><\/div>4.5 Underst\u00f8ttende behandling<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":7543,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7547","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547","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=7547"}],"version-history":[{"count":22,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547\/revisions"}],"predecessor-version":[{"id":11937,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547\/revisions\/11937"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7543"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/media?parent=7547"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Stillingtagen til stereotaktisk str\u00e5lebehandling, uanset om det er cerebrale eller perifere metastaser, foreg\u00e5r p\u00e5 en MDT-konference. Se n\u00e6rmere i afsnit om str\u00e5lebehandling<\/a>.<\/p>\n<\/div>4. Cytoreduktiv nefrektomi (CN) efterfulgt af onkologisk behandling<\/h4><\/div>\n\n\nDet er dokumenteret, at nefrektomi, ved metastatisk sygdom, kan medf\u00f8re regression af metastatiske l\u00e6sioner, omend det er et sj\u00e6ldent f\u00e6nomen (1%).3<\/sup><\/p>\nI \u00e6raen hvor IL-2 baseret immunterapi blev anvendt, anbefalede man cytoreduktiv nefrektomi (CN) til patienter med god PS f\u00f8r behandling.<\/p>\nEfter tyrosinkinase-inhibitorer (TKI) er blevet standardbehandling, har to prospektive studier unders\u00f8gt indikationen for CN f\u00f8r TKI. Begge studier blev lukket f\u00f8r tid grundet d\u00e5rlig rekruttering, men konklusionen fra begge studier var, at der ikke var en overlevelsesgevinst ved CN f\u00f8r TKI. Der har v\u00e6ret mange kritikpunkter af begge studier og i f\u00f8lge EAU guildelines er data kun st\u00e6rke nok til at konkludere, at patienter tilh\u00f8rende d\u00e5rlig prognosegruppe iht. IMDC (se afsnit om prognostiske stratificeringsv\u00e6rkt\u00f8jer til patienter med mRCC<\/a>) IKKE skal tilbydes CN f\u00f8r TKI.4<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n\n\n\nCytoreduktiv nefrektomi f\u00f8r systemisk behandling kan fortsat anbefales:<\/p>\n\ni kliniske fors\u00f8g<\/li>\ntil patienter i god AT (PS = 0\u20131<\/a>) med stor prim\u00e6r tumor og lav metastase-volumen som ikke har spredt sig til CNS, knogler eller lever<\/li>\ntil patienter som har symptomer fra deres prim\u00e6r tumor i form af h\u00e6maturi eller smerter5<\/sup><\/li>\n<\/ul>\nBeslutningen om CN skal altid tages p\u00e5 en multidisciplin\u00e6r (MDT<\/a>) konference.2, 5-6<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div>5. Deltagelse i klinisk fors\u00f8g<\/h4><\/div>\n\n\nDet skal altid overvejes, om der er mulighed for deltagelse i et klinisk fors\u00f8g, hvor nye l\u00e6gemidler afpr\u00f8ves evt. i kombination med allerede godkendte pr\u00e6parater.<\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>Referencer<\/h4><\/div>\n\nRini BI, Plimack ER, Stus V, Gafanov R, Waddell T, Nosov D, et al. Pembrolizumab plus Axitinib versus Sunitinib for Advanced Renal-Cell Carcinoma. N Engl J Med. 2019;380(12):1116-27.<\/i><\/li>\nDanish Multidisciplinary Cancer Groups (DMCG). DaRenCa Kliniske Retningslinjer 2024. Available from: https:\/\/www.dmcg.dk\/Kliniske-retningslinjer\/kliniske-retningslinjer-opdelt-paa-dmcg\/nyrecancer\/<\/i><\/li>\nFreed SZ, Halperin JP, Gordon M. Radiographic regression of metastases from renal cell carcinoma. J Urol. 1977;118(4):538-42.<\/i><\/li>\nBex A, Albiges L, Ljungberg B, Bensalah K, Dabestani S, Giles RH, et al. Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma. Eur Urol. 2018;74(6):805-9.<\/i><\/li>\nBhindi B, Abel EJ, Albiges L, et al. Systematic review of the role of cytoreductive nephrectomy in the targeted therapy era and beyond: an individualized approach to metastatic renal cell carcinoma. Eur Urol. 2019;111-128.<\/i><\/li>\nESMO Guidelines: European Society for Medical Oncology. ESMO Clinical Practice Guidelines. Available from: https:\/\/www.esmo.org\/guidelines.<\/i><\/li>\n<\/ol>\n<\/div>\n<\/div><\/div><\/div>Tjek din viden<\/h4><\/div><\/div><\/div><\/div><\/div>I en observationsperiode kan f\u00f8lgende symptomer v\u00e6re \u00e5rsag til opstart af behandling:<\/h5><\/div><\/div><\/div><\/div><\/div><\/div><\/div>Tiltagende tr\u00e6thed, v\u00e6gttab, dyspn\u00f8 og h\u00e5rtab<\/label><\/div>Tiltagende tr\u00e6thed, infektion, dyspn\u00f8 og\/eller smerter<\/label><\/div>Tiltagende tr\u00e6thed, v\u00e6gttab, dyspn\u00f8 og\/eller smerter<\/label><\/div><\/fieldset><\/div>(Det er helt anonymt at bruge quiz'en!)<\/small><\/p>\n<\/div><\/div><\/div><\/i><\/div>\n<\/div>Svaret er korrekt!<\/p>\n<\/div><\/i><\/div><\/p>\n<\/div>Svaret er forkert!<\/p>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/form><\/div>Forts\u00e6t til n\u00e6ste afsnit: 4.2 Targeteret behandling<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/span>Udforsk denne kapitelmenu<\/h5><\/span><\/div><\/div><\/div><\/div><\/div><\/div><\/div>4.1 Behandlingsmuligheder ved mRCC<\/span><\/i><\/a><\/div>4.2 Targeteret behandling<\/span><\/i><\/a><\/div>4.3 Immunterapi<\/span><\/i><\/a><\/div>4.4 Str\u00e5lebehandling<\/span><\/i><\/a><\/div>4.5 Underst\u00f8ttende behandling<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":7543,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7547","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547","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=7547"}],"version-history":[{"count":22,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547\/revisions"}],"predecessor-version":[{"id":11937,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547\/revisions\/11937"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7543"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/media?parent=7547"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Det er dokumenteret, at nefrektomi, ved metastatisk sygdom, kan medf\u00f8re regression af metastatiske l\u00e6sioner, omend det er et sj\u00e6ldent f\u00e6nomen (1%).3<\/sup><\/p>\nI \u00e6raen hvor IL-2 baseret immunterapi blev anvendt, anbefalede man cytoreduktiv nefrektomi (CN) til patienter med god PS f\u00f8r behandling.<\/p>\nEfter tyrosinkinase-inhibitorer (TKI) er blevet standardbehandling, har to prospektive studier unders\u00f8gt indikationen for CN f\u00f8r TKI. Begge studier blev lukket f\u00f8r tid grundet d\u00e5rlig rekruttering, men konklusionen fra begge studier var, at der ikke var en overlevelsesgevinst ved CN f\u00f8r TKI. Der har v\u00e6ret mange kritikpunkter af begge studier og i f\u00f8lge EAU guildelines er data kun st\u00e6rke nok til at konkludere, at patienter tilh\u00f8rende d\u00e5rlig prognosegruppe iht. IMDC (se afsnit om prognostiske stratificeringsv\u00e6rkt\u00f8jer til patienter med mRCC<\/a>) IKKE skal tilbydes CN f\u00f8r TKI.4<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n\n\n\nCytoreduktiv nefrektomi f\u00f8r systemisk behandling kan fortsat anbefales:<\/p>\n\ni kliniske fors\u00f8g<\/li>\ntil patienter i god AT (PS = 0\u20131<\/a>) med stor prim\u00e6r tumor og lav metastase-volumen som ikke har spredt sig til CNS, knogler eller lever<\/li>\ntil patienter som har symptomer fra deres prim\u00e6r tumor i form af h\u00e6maturi eller smerter5<\/sup><\/li>\n<\/ul>\nBeslutningen om CN skal altid tages p\u00e5 en multidisciplin\u00e6r (MDT<\/a>) konference.2, 5-6<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div>5. Deltagelse i klinisk fors\u00f8g<\/h4><\/div>\n\n\nDet skal altid overvejes, om der er mulighed for deltagelse i et klinisk fors\u00f8g, hvor nye l\u00e6gemidler afpr\u00f8ves evt. i kombination med allerede godkendte pr\u00e6parater.<\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>Referencer<\/h4><\/div>\n\nRini BI, Plimack ER, Stus V, Gafanov R, Waddell T, Nosov D, et al. Pembrolizumab plus Axitinib versus Sunitinib for Advanced Renal-Cell Carcinoma. N Engl J Med. 2019;380(12):1116-27.<\/i><\/li>\nDanish Multidisciplinary Cancer Groups (DMCG). DaRenCa Kliniske Retningslinjer 2024. Available from: https:\/\/www.dmcg.dk\/Kliniske-retningslinjer\/kliniske-retningslinjer-opdelt-paa-dmcg\/nyrecancer\/<\/i><\/li>\nFreed SZ, Halperin JP, Gordon M. Radiographic regression of metastases from renal cell carcinoma. J Urol. 1977;118(4):538-42.<\/i><\/li>\nBex A, Albiges L, Ljungberg B, Bensalah K, Dabestani S, Giles RH, et al. Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma. Eur Urol. 2018;74(6):805-9.<\/i><\/li>\nBhindi B, Abel EJ, Albiges L, et al. Systematic review of the role of cytoreductive nephrectomy in the targeted therapy era and beyond: an individualized approach to metastatic renal cell carcinoma. Eur Urol. 2019;111-128.<\/i><\/li>\nESMO Guidelines: European Society for Medical Oncology. ESMO Clinical Practice Guidelines. Available from: https:\/\/www.esmo.org\/guidelines.<\/i><\/li>\n<\/ol>\n<\/div>\n<\/div><\/div><\/div>Tjek din viden<\/h4><\/div><\/div><\/div><\/div><\/div>I en observationsperiode kan f\u00f8lgende symptomer v\u00e6re \u00e5rsag til opstart af behandling:<\/h5><\/div><\/div><\/div><\/div><\/div><\/div><\/div>Tiltagende tr\u00e6thed, v\u00e6gttab, dyspn\u00f8 og h\u00e5rtab<\/label><\/div>Tiltagende tr\u00e6thed, infektion, dyspn\u00f8 og\/eller smerter<\/label><\/div>Tiltagende tr\u00e6thed, v\u00e6gttab, dyspn\u00f8 og\/eller smerter<\/label><\/div><\/fieldset><\/div>(Det er helt anonymt at bruge quiz'en!)<\/small><\/p>\n<\/div><\/div><\/div><\/i><\/div>\n<\/div>Svaret er korrekt!<\/p>\n<\/div><\/i><\/div><\/p>\n<\/div>Svaret er forkert!<\/p>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/form><\/div>Forts\u00e6t til n\u00e6ste afsnit: 4.2 Targeteret behandling<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/span>Udforsk denne kapitelmenu<\/h5><\/span><\/div><\/div><\/div><\/div><\/div><\/div><\/div>4.1 Behandlingsmuligheder ved mRCC<\/span><\/i><\/a><\/div>4.2 Targeteret behandling<\/span><\/i><\/a><\/div>4.3 Immunterapi<\/span><\/i><\/a><\/div>4.4 Str\u00e5lebehandling<\/span><\/i><\/a><\/div>4.5 Underst\u00f8ttende behandling<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":7543,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7547","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547","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=7547"}],"version-history":[{"count":22,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547\/revisions"}],"predecessor-version":[{"id":11937,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547\/revisions\/11937"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7543"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/media?parent=7547"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
I \u00e6raen hvor IL-2 baseret immunterapi blev anvendt, anbefalede man cytoreduktiv nefrektomi (CN) til patienter med god PS f\u00f8r behandling.<\/p>\n
Efter tyrosinkinase-inhibitorer (TKI) er blevet standardbehandling, har to prospektive studier unders\u00f8gt indikationen for CN f\u00f8r TKI. Begge studier blev lukket f\u00f8r tid grundet d\u00e5rlig rekruttering, men konklusionen fra begge studier var, at der ikke var en overlevelsesgevinst ved CN f\u00f8r TKI. Der har v\u00e6ret mange kritikpunkter af begge studier og i f\u00f8lge EAU guildelines er data kun st\u00e6rke nok til at konkludere, at patienter tilh\u00f8rende d\u00e5rlig prognosegruppe iht. IMDC (se afsnit om prognostiske stratificeringsv\u00e6rkt\u00f8jer til patienter med mRCC<\/a>) IKKE skal tilbydes CN f\u00f8r TKI.4<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n\n\n\nCytoreduktiv nefrektomi f\u00f8r systemisk behandling kan fortsat anbefales:<\/p>\n\ni kliniske fors\u00f8g<\/li>\ntil patienter i god AT (PS = 0\u20131<\/a>) med stor prim\u00e6r tumor og lav metastase-volumen som ikke har spredt sig til CNS, knogler eller lever<\/li>\ntil patienter som har symptomer fra deres prim\u00e6r tumor i form af h\u00e6maturi eller smerter5<\/sup><\/li>\n<\/ul>\nBeslutningen om CN skal altid tages p\u00e5 en multidisciplin\u00e6r (MDT<\/a>) konference.2, 5-6<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div>5. Deltagelse i klinisk fors\u00f8g<\/h4><\/div>\n\n\nDet skal altid overvejes, om der er mulighed for deltagelse i et klinisk fors\u00f8g, hvor nye l\u00e6gemidler afpr\u00f8ves evt. i kombination med allerede godkendte pr\u00e6parater.<\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>Referencer<\/h4><\/div>\n\nRini BI, Plimack ER, Stus V, Gafanov R, Waddell T, Nosov D, et al. Pembrolizumab plus Axitinib versus Sunitinib for Advanced Renal-Cell Carcinoma. N Engl J Med. 2019;380(12):1116-27.<\/i><\/li>\nDanish Multidisciplinary Cancer Groups (DMCG). DaRenCa Kliniske Retningslinjer 2024. Available from: https:\/\/www.dmcg.dk\/Kliniske-retningslinjer\/kliniske-retningslinjer-opdelt-paa-dmcg\/nyrecancer\/<\/i><\/li>\nFreed SZ, Halperin JP, Gordon M. Radiographic regression of metastases from renal cell carcinoma. J Urol. 1977;118(4):538-42.<\/i><\/li>\nBex A, Albiges L, Ljungberg B, Bensalah K, Dabestani S, Giles RH, et al. Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma. Eur Urol. 2018;74(6):805-9.<\/i><\/li>\nBhindi B, Abel EJ, Albiges L, et al. Systematic review of the role of cytoreductive nephrectomy in the targeted therapy era and beyond: an individualized approach to metastatic renal cell carcinoma. Eur Urol. 2019;111-128.<\/i><\/li>\nESMO Guidelines: European Society for Medical Oncology. ESMO Clinical Practice Guidelines. Available from: https:\/\/www.esmo.org\/guidelines.<\/i><\/li>\n<\/ol>\n<\/div>\n<\/div><\/div><\/div>Tjek din viden<\/h4><\/div><\/div><\/div><\/div><\/div>I en observationsperiode kan f\u00f8lgende symptomer v\u00e6re \u00e5rsag til opstart af behandling:<\/h5><\/div><\/div><\/div><\/div><\/div><\/div><\/div>Tiltagende tr\u00e6thed, v\u00e6gttab, dyspn\u00f8 og h\u00e5rtab<\/label><\/div>Tiltagende tr\u00e6thed, infektion, dyspn\u00f8 og\/eller smerter<\/label><\/div>Tiltagende tr\u00e6thed, v\u00e6gttab, dyspn\u00f8 og\/eller smerter<\/label><\/div><\/fieldset><\/div>(Det er helt anonymt at bruge quiz'en!)<\/small><\/p>\n<\/div><\/div><\/div><\/i><\/div>\n<\/div>Svaret er korrekt!<\/p>\n<\/div><\/i><\/div><\/p>\n<\/div>Svaret er forkert!<\/p>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/form><\/div>Forts\u00e6t til n\u00e6ste afsnit: 4.2 Targeteret behandling<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/span>Udforsk denne kapitelmenu<\/h5><\/span><\/div><\/div><\/div><\/div><\/div><\/div><\/div>4.1 Behandlingsmuligheder ved mRCC<\/span><\/i><\/a><\/div>4.2 Targeteret behandling<\/span><\/i><\/a><\/div>4.3 Immunterapi<\/span><\/i><\/a><\/div>4.4 Str\u00e5lebehandling<\/span><\/i><\/a><\/div>4.5 Underst\u00f8ttende behandling<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":7543,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7547","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547","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=7547"}],"version-history":[{"count":22,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547\/revisions"}],"predecessor-version":[{"id":11937,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547\/revisions\/11937"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7543"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/media?parent=7547"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Cytoreduktiv nefrektomi f\u00f8r systemisk behandling kan fortsat anbefales:<\/p>\n
Beslutningen om CN skal altid tages p\u00e5 en multidisciplin\u00e6r (MDT<\/a>) konference.2, 5-6<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div>5. Deltagelse i klinisk fors\u00f8g<\/h4><\/div>\n\n\nDet skal altid overvejes, om der er mulighed for deltagelse i et klinisk fors\u00f8g, hvor nye l\u00e6gemidler afpr\u00f8ves evt. i kombination med allerede godkendte pr\u00e6parater.<\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>Referencer<\/h4><\/div>\n\nRini BI, Plimack ER, Stus V, Gafanov R, Waddell T, Nosov D, et al. Pembrolizumab plus Axitinib versus Sunitinib for Advanced Renal-Cell Carcinoma. N Engl J Med. 2019;380(12):1116-27.<\/i><\/li>\nDanish Multidisciplinary Cancer Groups (DMCG). DaRenCa Kliniske Retningslinjer 2024. Available from: https:\/\/www.dmcg.dk\/Kliniske-retningslinjer\/kliniske-retningslinjer-opdelt-paa-dmcg\/nyrecancer\/<\/i><\/li>\nFreed SZ, Halperin JP, Gordon M. Radiographic regression of metastases from renal cell carcinoma. J Urol. 1977;118(4):538-42.<\/i><\/li>\nBex A, Albiges L, Ljungberg B, Bensalah K, Dabestani S, Giles RH, et al. Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma. Eur Urol. 2018;74(6):805-9.<\/i><\/li>\nBhindi B, Abel EJ, Albiges L, et al. Systematic review of the role of cytoreductive nephrectomy in the targeted therapy era and beyond: an individualized approach to metastatic renal cell carcinoma. Eur Urol. 2019;111-128.<\/i><\/li>\nESMO Guidelines: European Society for Medical Oncology. ESMO Clinical Practice Guidelines. Available from: https:\/\/www.esmo.org\/guidelines.<\/i><\/li>\n<\/ol>\n<\/div>\n<\/div><\/div><\/div>Tjek din viden<\/h4><\/div><\/div><\/div><\/div><\/div>I en observationsperiode kan f\u00f8lgende symptomer v\u00e6re \u00e5rsag til opstart af behandling:<\/h5><\/div><\/div><\/div><\/div><\/div><\/div><\/div>Tiltagende tr\u00e6thed, v\u00e6gttab, dyspn\u00f8 og h\u00e5rtab<\/label><\/div>Tiltagende tr\u00e6thed, infektion, dyspn\u00f8 og\/eller smerter<\/label><\/div>Tiltagende tr\u00e6thed, v\u00e6gttab, dyspn\u00f8 og\/eller smerter<\/label><\/div><\/fieldset><\/div>(Det er helt anonymt at bruge quiz'en!)<\/small><\/p>\n<\/div><\/div><\/div><\/i><\/div>\n<\/div>Svaret er korrekt!<\/p>\n<\/div><\/i><\/div><\/p>\n<\/div>Svaret er forkert!<\/p>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/form><\/div>Forts\u00e6t til n\u00e6ste afsnit: 4.2 Targeteret behandling<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/span>Udforsk denne kapitelmenu<\/h5><\/span><\/div><\/div><\/div><\/div><\/div><\/div><\/div>4.1 Behandlingsmuligheder ved mRCC<\/span><\/i><\/a><\/div>4.2 Targeteret behandling<\/span><\/i><\/a><\/div>4.3 Immunterapi<\/span><\/i><\/a><\/div>4.4 Str\u00e5lebehandling<\/span><\/i><\/a><\/div>4.5 Underst\u00f8ttende behandling<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":7543,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7547","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547","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=7547"}],"version-history":[{"count":22,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547\/revisions"}],"predecessor-version":[{"id":11937,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547\/revisions\/11937"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7543"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/media?parent=7547"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Det skal altid overvejes, om der er mulighed for deltagelse i et klinisk fors\u00f8g, hvor nye l\u00e6gemidler afpr\u00f8ves evt. i kombination med allerede godkendte pr\u00e6parater.<\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>
(Det er helt anonymt at bruge quiz'en!)<\/small><\/p>\n<\/div><\/div><\/div><\/i><\/div>\n<\/div>Svaret er korrekt!<\/p>\n<\/div><\/i><\/div><\/p>\n<\/div>Svaret er forkert!<\/p>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/form><\/div>Forts\u00e6t til n\u00e6ste afsnit: 4.2 Targeteret behandling<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/span>Udforsk denne kapitelmenu<\/h5><\/span><\/div><\/div><\/div><\/div><\/div><\/div><\/div>4.1 Behandlingsmuligheder ved mRCC<\/span><\/i><\/a><\/div>4.2 Targeteret behandling<\/span><\/i><\/a><\/div>4.3 Immunterapi<\/span><\/i><\/a><\/div>4.4 Str\u00e5lebehandling<\/span><\/i><\/a><\/div>4.5 Underst\u00f8ttende behandling<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":7543,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7547","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547","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=7547"}],"version-history":[{"count":22,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547\/revisions"}],"predecessor-version":[{"id":11937,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7547\/revisions\/11937"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7543"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/media?parent=7547"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Svaret er korrekt!<\/p>\n<\/div>
Svaret er forkert!<\/p>\n<\/div>\n<\/div><\/div>