{"id":7619,"date":"2023-08-17T21:11:54","date_gmt":"2023-08-17T21:11:54","guid":{"rendered":"http:\/\/d1s07skqdwll4z.cloudfront.net\/mrcc-tool\/5-toxicity-management\/5-3-adverse-reactions-to-checkpoint-inhibitors\/"},"modified":"2024-12-17T14:44:08","modified_gmt":"2024-12-17T14:44:08","slug":"5-3-adverse-reactions-to-checkpoint-inhibitors","status":"publish","type":"page","link":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/mrcc-tool\/5-toxicity-management\/5-3-adverse-reactions-to-checkpoint-inhibitors\/","title":{"rendered":"5.3 Adverse reactions to 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;\">5.3 Bivirkninger til checkpoint inhibitorer<\/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\"><section class=\"av_textblock_section \">\n<div class=\"avia_textblock \">\n<p>Bivirkninger relateret til immunterapi med checkpoint inhibitorer:<\/p>\n<ul>\n<li>Anti CTLA-4<\/li>\n<li>Anti PD-1<\/li>\n<li>Anti PD-L1<\/li>\n<\/ul>\n<\/div>\n<\/section>\n<section class=\"av_textblock_section \">\n<div class=\"avia_textblock \">\n<p>N\u00e5r checkpoint inhibitorer anvendes til behandling af kr\u00e6ft, er det ikke alene kr\u00e6ftcellerne, der rammes af det \u00f8gede immunologiske respons, men det bremser ligeledes den naturlige h\u00e6mning af immunsystemet. Det kan skabe en ubalance i den immunologiske selvtolerans med risiko for udvikling af autoimmunlignende immunrelaterede bivirkninger (immune related adverse events (irAEs)).<\/p>\n<p>Der er nogle organsystemer, der hyppigere rammes af irAEs end andre (udsl\u00e6t, diarr\u00e9, hyperthyroidisme\/hypothyroidisme og tr\u00e6thed), men alle organsystemer kan rammes.<\/p>\n<p>Langt de fleste irAEs er reversible, hvis de behandles i tide. Det er derfor vigtigt, at der reageres tidligt og ad\u00e6kvat p\u00e5 irAEs. Det er af afg\u00f8rende betydning, at patienten er velinformeret og instrueret i at kontakte afdelingen ved mistanke om irAEs.<sup>1<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div><div class=\"fusion-image-element \" style=\"text-align:center;--awb-max-width:77%;--awb-caption-title-font-family:var(--h2_typography-font-family);--awb-caption-title-font-weight:var(--h2_typography-font-weight);--awb-caption-title-font-style:var(--h2_typography-font-style);--awb-caption-title-size:var(--h2_typography-font-size);--awb-caption-title-transform:var(--h2_typography-text-transform);--awb-caption-title-line-height:var(--h2_typography-line-height);--awb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><span class=\" fusion-imageframe imageframe-none imageframe-1 hover-type-none\"><img decoding=\"async\" width=\"1556\" height=\"1026\" title=\"5.3_1\" src=\"https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/08\/16120600\/5.3_1.jpg\" alt class=\"img-responsive wp-image-6562\" srcset=\"https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/08\/16120600\/5.3_1-500x330.jpg 500w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/08\/16120600\/5.3_1-700x462.jpg 700w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/08\/16120600\/5.3_1.jpg 1556w\" sizes=\"(max-width: 1556px) 100vw, 1556px\" \/><\/span><\/div><div class=\"fusion-title title fusion-title-2 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Gradering af irAEs<\/h4><\/div><div class=\"fusion-text fusion-text-2\"><section class=\"av_textblock_section \">\n<div class=\"avia_textblock \">\n<p>irAEs graderes iht. Common Terminology Criteria for Adverse Events (CTC AE) version 5, se <a href=\"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/mrcc-tool\/5-toxicity-management\/5-1-adverse-reactions-to-targeted-treatment\/\">afsnit om bivirkninger til targeteret behandling<\/a>.<\/p>\n<\/div>\n<\/section>\n<\/div><div class=\"fusion-title title fusion-title-3 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Hyppighed af irAEs (monoterapi vs. kombinationsterapi)<\/h4><\/div><div class=\"fusion-text fusion-text-3\"><section class=\"av_textblock_section \">\n<div class=\"avia_textblock \">\n<p>Der ses flere alvorlige irAEs (imAEs) (grad 3-4) ved kombinationsimmunterapi (anti-CTLA-4+anti-PD-1) end ved monoterapi<sup>2<\/sup>.<\/p>\n<\/div>\n<\/section>\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\">ALLE GRADER AF IRAES<\/th>\n<th align=\"left\">GRAD 3\/4 IRAES<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td align=\"left\">CTLA-4 h\u00e6mning<\/td>\n<td align=\"left\">60% til 85%<\/td>\n<td align=\"left\">10% til 27%<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">PD-1\/PD-L1 h\u00e6mning<\/td>\n<td align=\"left\">58% til 85%<\/td>\n<td align=\"left\">7% til 20%<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Kombination af CTLA-4\/PD-1 h\u00e6mning<\/td>\n<td align=\"left\">95%<\/td>\n<td align=\"left\">55%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<div class=\"fusion-text fusion-text-4\"><p>Kombinationsterapi med CTLA\/PD-1 inhibitorer udg\u00f8r den st\u00f8rste risiko<\/p>\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;\">Karakteristika ved irAEs<sup>4<\/sup><\/h4><\/div><div class=\"fusion-text fusion-text-5\"><section class=\"av_textblock_section \">\n<div class=\"avia_textblock \">\n<ol>\n<li>Flere irAEs kan forekomme hos den samme patient p\u00e5 samme tid eller forskudt over tid<\/li>\n<li>Kan v\u00e6re alt fra forbig\u00e5ende til alvorlig og livstruende<\/li>\n<li>irAEs kan forekomme selv efter oph\u00f8r af behandlingen (selv m\u00e5neder efter)<\/li>\n<\/ol>\n<\/div>\n<\/section>\n<\/div><div class=\"fusion-title title fusion-title-5 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">H\u00e5ndtering af immunrelaterede bivirkninger<sup>5<\/sup><\/h4><\/div><div class=\"fusion-text fusion-text-6\"><p>Nedenfor er den overordnede strategi for behandling af irAEs anf\u00f8rt afh\u00e6ngig af sv\u00e6rhedsgraden af irAEs. Behandling med immunsupprimerende behandling, i form af kortikosteroider, udg\u00f8r en hj\u00f8rnesten i behandlingen af irAEs.<\/p>\n<\/div>\n<div class=\"table-1\">\n<table width=\"100%\">\n<thead>\n<tr>\n<th align=\"left\">GRAD<\/th>\n<th align=\"left\">AMBULANT\/<br \/>INDL\u00c6GGELSE<\/th>\n<th align=\"left\">KORTIKOSTEROID:<br \/>PREDNISOLON<\/th>\n<th align=\"left\">ANDRE<br \/>IMMUNSUPPRESSIVERS<\/th>\n<th align=\"left\">IMMUNTERAPI<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td align=\"left\">1<\/td>\n<td align=\"left\">Ambulant<\/td>\n<td align=\"left\">&#8211;<\/td>\n<td align=\"left\">&#8211;<\/td>\n<td align=\"left\">Forts\u00e6t<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">2<\/td>\n<td align=\"left\">Ambulant<\/td>\n<td align=\"left\">Topikalt eller systemisk<br \/>0,5-1 mg\/kg<\/td>\n<td align=\"left\">&#8211;<\/td>\n<td align=\"left\">Pauser midlertidigt og<br \/>genoptag som oftest<br \/>behandling ved grad 0-1<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">3<\/td>\n<td align=\"left\">Indl\u00e6ggelse<\/td>\n<td align=\"left\">Systemisk, p.o. eller i.v.<br \/>1-2 mg\/kg<\/td>\n<td align=\"left\">Overvejes ved manglende<br \/>respons efter 3-5 dages<br \/>behandling med kortikosteroid<br \/>Konferer med specialist<\/td>\n<td align=\"left\">Pauser og diskuter<br \/>genoptagelse baseret p\u00e5 individuel vurdering af patienten<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">4<\/td>\n<td align=\"left\">Indl\u00e6ggelse<\/td>\n<td align=\"left\">Systemisk, i.v.<br \/>1-2 mg\/kg<\/td>\n<td align=\"left\">Overvejes ved manglende<br \/>respons efter 3-5 dages<br \/>behandling med kortikosteroid<br \/>Konferer med specialist<\/td>\n<td align=\"left\">Seponer<br \/>i.v.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<div class=\"fusion-text fusion-text-7\"><p><small>i.v. = intraven\u00f8st; p.o. = peroralt.<\/small><\/p>\n<\/div><div class=\"fusion-title title fusion-title-6 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Guideline til vurdering og behandling af irAEs<sup>2,5<\/sup><\/h4><\/div><div class=\"fusion-text fusion-text-8\"><p>Der er udf\u00e6rdiget mange guidelines til vurdering og behandling af irAEs (ESMO, NCCN, ASCO etc.). Der er ligeledes udarbejdet en dansk guideline, hvortil der er lavet en app, <a class=\"exitNotifierLink\" href=\"https:\/\/free.mymedcards.dk\/cards\/rKqtEBhvumU9PDTr2MmV-immuntox-introduktion-samt-patient-og-laegebrev-og-blodproever\" target=\"_blank\" rel=\"noopener noreferrer\">MyMedCards<\/a>, som kan downloades gratis:<\/p>\n<\/div><div class=\"fusion-image-element \" style=\"text-align:center;--awb-max-width:77%;--awb-caption-title-font-family:var(--h2_typography-font-family);--awb-caption-title-font-weight:var(--h2_typography-font-weight);--awb-caption-title-font-style:var(--h2_typography-font-style);--awb-caption-title-size:var(--h2_typography-font-size);--awb-caption-title-transform:var(--h2_typography-text-transform);--awb-caption-title-line-height:var(--h2_typography-line-height);--awb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><span class=\" fusion-imageframe imageframe-none imageframe-2 hover-type-none\"><img decoding=\"async\" width=\"1600\" height=\"969\" title=\"5.3_2-1_DK\" src=\"https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120342\/5.3_2-1_DK.png\" alt class=\"img-responsive wp-image-9063\" srcset=\"https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120342\/5.3_2-1_DK-200x121.png 200w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120342\/5.3_2-1_DK-400x242.png 400w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120342\/5.3_2-1_DK-600x363.png 600w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120342\/5.3_2-1_DK-800x485.png 800w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120342\/5.3_2-1_DK-1200x727.png 1200w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120342\/5.3_2-1_DK.png 1600w\" sizes=\"(max-width: 640px) 100vw, 1200px\" \/><\/span><\/div><div class=\"fusion-title title fusion-title-7 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Forebyggelse og behandling af irAEs<sup>6<\/sup><\/h4><\/div><div class=\"fusion-text fusion-text-9\"><p>Der er flere faktorer, der spiller ind for at kunne forebygge irAEs og kunne behandle irAEs ad\u00e6kvat inkl. afd\u00e6kke mulige risikofaktorer, uddannelse af patient\/p\u00e5r\u00f8rende og l\u00e6ger\/sygeplejersker. Se nedenfor.<\/p>\n<\/div><div class=\"fusion-image-element \" style=\"text-align:center;--awb-max-width:77%;--awb-caption-title-font-family:var(--h2_typography-font-family);--awb-caption-title-font-weight:var(--h2_typography-font-weight);--awb-caption-title-font-style:var(--h2_typography-font-style);--awb-caption-title-size:var(--h2_typography-font-size);--awb-caption-title-transform:var(--h2_typography-text-transform);--awb-caption-title-line-height:var(--h2_typography-line-height);--awb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><span class=\" fusion-imageframe imageframe-none imageframe-3 hover-type-none\"><img decoding=\"async\" width=\"1503\" height=\"1054\" title=\"5.3_3_DK\" src=\"https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120340\/5.3_3_DK.png\" alt class=\"img-responsive wp-image-9068\" srcset=\"https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120340\/5.3_3_DK-200x140.png 200w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120340\/5.3_3_DK-400x281.png 400w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120340\/5.3_3_DK-600x421.png 600w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120340\/5.3_3_DK-800x561.png 800w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120340\/5.3_3_DK-1200x842.png 1200w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120340\/5.3_3_DK.png 1503w\" sizes=\"(max-width: 640px) 100vw, 1200px\" \/><\/span><\/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-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-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-8 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-10\"><div>\n<ol>\n<li><i>Postow MA, Sidlow R, Hellmann MD. Immune-Related Adverse Events Associated with Immune Checkpoint Blockade. N Engl J Med. 2018;378(2):158-168.<\/i><\/li>\n<li><i> Haanen JBAG, Carbonnel F, Robert C, Kerr KM, Peters S, Larkin J, Jordan K; ESMO Guidelines Committee. Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017;28(suppl_4):iv119-iv141<\/i><\/li>\n<li><i>Brahmer JR, Lacchetti C, Schneider BJ, et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2018;36(17):1714-1768<\/i><\/li>\n<li><i>Nagai H, Muto M. Optimal management of immune-related adverse events resulting from treatment with immune checkpoint inhibitors: a review and update. Int J Clin Oncol. 2018;23(3):410-420<\/i><\/li>\n<li><i>Kondrup M, Raunkilde L, Svane IM, Schmidt H, Bastholt L. Immunotherapy is cancer treatment with a completely new adverse reaction profile. Ugeskr Laeger. 2017;179(2):138-142<\/i><\/li>\n<li><i>Kennedy LB, Salama AKS. A review of cancer immunotherapy toxicity. CA Cancer J Clin. 2020;70(2):86-104<\/i><\/li>\n<li><i>Champiat S, Lambotte O, Barreau E, Belkhir R, Berdelou A, Carbonnel F, et al. Management of immune checkpoint blockade dysimmune toxicities: a collaborative position paper. Ann Oncol. 2016;27(4):559-574<\/i><\/li>\n<\/ol>\n<\/div>\n<\/div><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\/5-toxicity-management\/5-4-interactions-between-medicinal-products\/\"><span class=\"fusion-button-text\">Forts\u00e6t til n\u00e6ste afsnit: 5.4 L\u00e6gemiddelinteraktioner<\/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-4 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-9 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;\">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-5 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-6 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\/5-toxicity-management\/5-1-adverse-reactions-to-targeted-treatment\/\"><span class=\"fusion-button-text\">5.1 Bivirkninger til targeteret behandling<\/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\/5-toxicity-management\/5-2-management-of-tki-side-effects\/\"><span class=\"fusion-button-text\">5.2 H\u00e5ndtering af TKI bivirkninger<\/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\/5-toxicity-management\/5-3-adverse-reactions-to-checkpoint-inhibitors\/\"><span class=\"fusion-button-text\">5.3 Bivirkninger til 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\/5-toxicity-management\/5-4-interactions-between-medicinal-products\/\"><span class=\"fusion-button-text\">5.4 L\u00e6gemiddelinteraktioner<\/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-7 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":7567,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7619","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7619","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=7619"}],"version-history":[{"count":22,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7619\/revisions"}],"predecessor-version":[{"id":12079,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7619\/revisions\/12079"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/pages\/7567"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/da\/wp-json\/wp\/v2\/media?parent=7619"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}