{"id":7521,"date":"2023-08-16T15:29:59","date_gmt":"2023-08-16T15:29:59","guid":{"rendered":"http:\/\/d1s07skqdwll4z.cloudfront.net\/mrcc-tool\/3-management-of-mrcc\/3-2-treatment-criteria-for-initiation-of-tki\/"},"modified":"2024-03-28T17:21:03","modified_gmt":"2024-03-28T17:21:03","slug":"3-2-treatment-criteria-for-initiation-of-tki","status":"publish","type":"page","link":"https:\/\/d1s07skqdwll4z.cloudfront.net\/no\/mrcc-tool\/3-management-of-mrcc\/3-2-treatment-criteria-for-initiation-of-tki\/","title":{"rendered":"3.2 Treatment criteria for initiation of TKI"},"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\/no\/\">\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;\">3.2 Behandlingskriterier for igangsetting av TKI<sup>1<\/sup><\/h5><span class=\"awb-title-spacer\"><\/span><div class=\"title-sep-container title-sep-container-right\"><div class=\"title-sep sep-single sep-solid\" style=\"border-color:#e2e2e2;\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-margin-top:4px;--awb-background-color:var(--awb-color3);--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-1\"><p>Tyrosinkinasehemmere (TKI-er) er palliativ behandling for symptomlindring og livsforlengelse.<\/p>\n<ul>\n<li>Det er en tabletter som skal tas \u00e9n eller to ganger daglig. For noen legemidler er pause inkludert  (<a class=\"exitNotifierLink\" href=\"https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/sutent-epar-product-information_da.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Sunitinib<\/a> tas enten i 4 uker etterfulgt av 2 ukers pause, eller i 2 uker etterfulgt av 1 ukes pause, og dette gjentas. <a class=\"exitNotifierLink\" href=\"https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/fotivda-epar-product-information_da.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Tivozanib<\/a> tas i 3 uker etterfulgt av en pause p\u00e5 1 uke, og dette gjentas).<\/li>\n<li>For noen legemidler b\u00f8r mat ikke inntas rett f\u00f8r eller etter administrering (<a class=\"exitNotifierLink\" href=\"https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/votrient-epar-product-information_da.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Pazopanib<\/a> og <a class=\"exitNotifierLink\" href=\"https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/cabometyx-epar-product-information_da.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Kabozantinib<\/a> b\u00f8r tas minst 1 time f\u00f8r eller minst 2 timer etter matinntak).<\/li>\n<li>En behandlingskur varer i 4 eller 6 uker. Pasienten evalueres med CT thorax og abdomen (og MR av cerebrum ved cerebrale metastaser) hver 3. m\u00e5ned (etter 2 eller 3 behandlingskurer).<\/li>\n<\/ul>\n<p>For f\u00f8rstelinje TKI:<\/p>\n<ul>\n<li>Median progresjonsfri overlevelse (mPFS) er ca. 9 m\u00e5neder. Median totaloverlevelse (mOS) avhenger av IMDC-risikogruppen <span style=\"font-family: var(--awb-text-font-family); font-size: var(--awb-font-size); font-style: var(--awb-text-font-style); letter-spacing: var(--awb-letter-spacing); text-align: var(--awb-content-alignment); text-transform: var(--awb-text-transform);\">(se avsnittet om prognostisk stratifiseringsverkt\u00f8y for pasienter med mRCC)<\/span><\/li>\n<li>I henhold til <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/no\/mrcc-tool\/3-management-of-mrcc\/3-4-response-evaluation\/\">RECIST-kriteriene<\/a>, responderer 60-80 % av pasientene p\u00e5 behandling med enten:\n<ul>\n<li>Regresjon (komplett respons (CR)) &#8211; ses sjelden<\/li>\n<li>Delvis respons (PR) &#8211; ses hos 30-40 %<\/li>\n<li>Stabilisering av sykdommen (stabil sykdom (SD) &#8211; hos 30-40 % i en kortere eller lengre periode<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/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;\">F\u00f8rste bes\u00f8k p\u00e5 onkologisk avdeling<\/h4><\/div><div class=\"fusion-text fusion-text-2\"><p>Ved f\u00f8rste bes\u00f8k p\u00e5 onkologisk avdeling skal det f\u00f8res fullstendig journal med fokus p\u00e5:<\/p>\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;\">Sykehistorikk:<\/h5><\/div><div class=\"fusion-text fusion-text-3\"><ul>\n<li>Disposisjon (kreft i familiehistorikken, med s\u00e6rlig vekt p\u00e5 tilfeller av nyrekreft)<\/li>\n<li>Symptomer (fatigue, vekttap, nedsatt appetitt, svetting\/hetetokter, smerter osv.)<\/li>\n<li>Komorbiditet (hypertensjon, iskemisk hjertesykdom, svekket hjertepumpefunksjon (EF) og \u00e5rsaken, arytmi, cerebral apopleksi, diabetes mellitus, nedsatt nyrefunksjon, autoimmune og andre kroniske sykdommer)<\/li>\n<li>Full medikamentstatus. Det skal fremg\u00e5 om pasienten er p\u00e5:\n<ol>\n<li>Antikoagulerende behandling, hvilket legemiddel samt \u00e5rsak (arytmi, dyp venetrombose (DVT), lungeemboli (LE) eller annen koagulopati)<\/li>\n<li>Kolesterolsenkende legemiddel og hvilket legemiddel<\/li>\n<\/ol>\n<\/li>\n<\/ul>\n<\/div><div class=\"fusion-text fusion-text-4\"><ul>\n<li>Sosial informasjon:\n<ol>\n<li>Sivilstand<\/li>\n<li>Nettverk<\/li>\n<li>Yrke (i arbeid, sykemeldt, f\u00f8rtidspensjonist, pensjonist eller annet)<\/li>\n<li>Funksjonsniv\u00e5 (selvhjulpen, trenger hjelp med egenpleie eller annet)<\/li>\n<\/ol>\n<\/li>\n<\/ul>\n<\/div><div class=\"fusion-title title fusion-title-4 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Klinisk vurdering:<\/h5><\/div><div class=\"fusion-text fusion-text-5\"><ul>\n<li>Generell tilstand (god, akutt eller kronisk tilstand) inkl. <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/no\/mrcc-tool\/3-management-of-mrcc\/3-6-performance-status\/\">funksjonsstatus (PS)<\/a>.<\/li>\n<li>Vitale tegn, inkl. BT, puls, temperatur, oksygenmetning og vekt<\/li>\n<li>Objektiv unders\u00f8kelse, inkl. evaluering av forst\u00f8rrede lymfeknuter, stetoskopi av hjerte og lunger, unders\u00f8kelse av abdomen, ekstremiteter og hud<\/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;\">Paraklinisk<\/h5><\/div><div class=\"fusion-text fusion-text-6\"><p>Ved f\u00f8rste polikliniske konsultasjon skal f\u00f8lgende utf\u00f8res:<\/p>\n<ul>\n<li>Urinstrimmel: obs for protein (hvis +3 for protein, samle d\u00f8gnurin for proteineliminasjon)<\/li>\n<li>Blodpr\u00f8ver: hematologi (Hb, trombocytter, leukocytter + differensialtelling), v\u00e6skeverdier (kreatinin, urea, natrium, kalium, ionisert kalsium og magnesium), leverfunksjonstester (ALAT, ASAT, LDH, alkalisk fosfatase, INR og koagulasjonsverdier (2,7 + 10), CRP og TSH<\/li>\n<li>EKG: hjerterytme, akutte endringer og vurdering av QTc-intervall<\/li>\n<li>MR-unders\u00f8kelse: cerebrum (utf\u00f8rt eller bestilt)<\/li>\n<li>CT-unders\u00f8kelse: thorax og abdomen (baseline m\u00e5 v\u00e6re &lt;1 m\u00e5ned siden)<\/li>\n<li>MUGA: vurdering av hjertets pumpefunksjon (utf\u00f8rt eller bestilt)<\/li>\n<li>IMDC: risikostratifisering<\/li>\n<\/ul>\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;\">Behandlingskriterier<\/h4><\/div><div class=\"fusion-text fusion-text-7\"><p>F\u00f8lgende kriterier m\u00e5 v\u00e6re oppfylt ved oppstart av TKI. Avvik m\u00e5 diskuteres med spesialist, og dette m\u00e5 dokumenteres i journalen.<\/p>\n<p><small>*Hvis nei (forklar i journalen)<\/small><\/p>\n<\/div>\n<div class=\"table-1\">\n<table width=\"100%\">\n<thead>\n<tr>\n<th align=\"left\">BEHANDLINGSKRITERIER<\/th>\n<th align=\"left\">JA<\/th>\n<th align=\"left\">NEI*<\/th>\n<th align=\"left\">TILTAK HVIS SVARET ER NEI<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">mRCC verifisert ved biopsi<\/span><\/span><\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Funksjonsstatus (FS)<\/span><\/span>&nbsp;&lt; 2<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Vurder lavere startdose (50 %)<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Nyrefunksjon<\/span><\/span><br \/><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">eGFR<\/span><\/span> &gt; 30 ml\/min<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">TKI utskilles prim\u00e6rt via leveren, mens en mindre andel utskilles via nyrene. Vurder lavere startdose (50 %). Dersom dosen tolereres, kan dose\u00f8kning fors\u00f8kes i syklus 2<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Leverfunksjon<\/span><\/span><br \/><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Bilirubin<\/span><\/span> &lt; 1.5 x <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">\u00f8vre normalgrensel<\/span><\/span><br \/><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">ASAT\/ALAT<\/span><\/span> &lt; 3 x <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">\u00f8vre normalgrense eller<\/span><\/span> &lt; 5 <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">ved levermetastaser<\/span><\/span><\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">TKI utskilles prim\u00e6rt via leveren<\/span><\/span><br \/>1) <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Bruk annen TKI enn pazopanib, siden det er \u00f8kt risiko for forverret leverfunksjonen ved samtidig behandling med pazopanib<\/span><\/span><br \/>2) <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Vurder lavere startdose (50 %) og ukentlig sjekk av leververdier<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">EKG<\/span><\/span><br \/><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">QTcF<\/span><\/span> &lt;450 ms <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">for menn og <\/span><\/span>&lt;470 ms <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">for kvinner<\/span><\/span><\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Gjennomg\u00e5 pasientens legemiddelliste med tanke p\u00e5 legemidler som kan for\u00e5rsake forlenget QTc. R\u00e5df\u00f8r deg med kardiolog<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Blodtrykk<\/span><\/span> &lt; 140\/90 mmHg<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Vurder kontorhypertensjon, og be pasienten m\u00e5le blodtrykket hjemme eller hos fastlegen. Ved vedvarende h\u00f8yt blodtrykk, start behandling med antihypertensiva eller \u00f8k dosen med antihypertensiva som er forskrevet av fastlege (se pkt. 5.2.2)<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Ejeksjonsfraksjon (EF) <\/span><\/span> &gt; 40% <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">(m\u00e5lt med MUGA)<\/span><\/span><\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Henvis pasienten til ekkokardiografi, og start antikongestiv behandling hvis EF <\/span><\/span>&lt; 40% <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">er bekreftet.<\/span><\/span><br \/><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">TKI kan ikke startes f\u00f8r kardiologen har utarbeidet en plan. Vurder redusert dose av TKI p\u00e5 grunn av antatt redusert risiko for kardiotoksisitet<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Proteinutskillelse i urin<\/span><\/span> &lt; 3+<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">D\u00f8gnurin oppsamles hvis:<\/span><\/span><br \/>1) <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">D\u00f8gnurin med et proteininnhold p\u00e5 1-3,4 g\/d\u00f8gn: start TKI ved redusert dose (50 %) og sjekk d\u00f8gnurin ved hvert bes\u00f8k p\u00e5 poliklinikken (dag 28 eller dag 42)<\/span><\/span><br \/>2) <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">D\u00f8gnurin med et proteininnhold p\u00e5<\/span><\/span> &gt; <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">3,5 g\/d\u00f8gn: henvis til nefrolog f\u00f8r oppstart med TKI<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Ikke antikoagulasjonsbehandling med Marevan<\/span><\/span><\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Hvis Marevan brukes, vurder \u00e5 bytte til lavdose heparin (Innohep), da det kan forekomme store fluktuasjoner i INR under TKI-behandling<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Ingen kolesterolsenkende legemidler<\/span><\/span><\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Det er \u00f8kt risiko for levereffekter ved samtidig behandling med pazopanib og simvastatin, eller med tivozanib og rosuvastatin (og sannsynligvis ogs\u00e5 de andre kolesterolsenkende legemidlene). Behandling med simvastatin\/rosuvastatin\/kolesterolsenkende legemidler b\u00f8r derfor pauses ved oppstart med pazopanib<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Ingen sterke CYP3A4-induktorer eller -hemmere (se pkt. 5.4)<\/span><\/span><\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Vurder betydningen av andre legemidler og om de kan erstattes av andre legemidler<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Cerebral TCI\/cerebral apopleksi eller hjerteinfarkt for mer enn 1 m\u00e5ned siden<\/span><\/span><\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">TKI kan forverre disse tilstandene. Pasienten\/slektningene m\u00e5 informeres hvis dette behandlingskriteriet ikke er oppfylt<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Ingen st\u00f8rre operasjoner de f\u00f8rste 4 ukene<\/span><\/span><\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">TKI reduserer s\u00e5rtilheling. S\u00e5ret m\u00e5 derfor v\u00e6re godt tilhelet f\u00f8r oppstart med TKI<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">MR-skanning av cerebrum uten hjernemetastaser<\/span><\/span><\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Ved hjernemetastaser:<\/span><\/span><br \/>1) <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Vurder str\u00e5lebehandling dersom pasienten er asymptomatisk og har 1\u20133 hjernemetastaser. Behandling med TKI kan igangsettes, men m\u00e5 pauses i forbindelse med str\u00e5lebehandling<\/span><\/span><br \/>2) <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Dersom pasienten har symptomer og 1\u20133 hjernemetastaser, skal behandling med steroider igangsettes i henhold til retningslinjer og str\u00e5lebehandling skal vurderes. Behandling med TKI kan startes<\/span><\/span><br \/>3)<span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Dersom pasienten har flere hjernemetastaser, men er asymptomatisk. Start TKI<\/span><\/span><br \/>4) <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Dersom pasienten har flere metastaser og har symptomer, start steroidbehandling og vurder helhjernestr\u00e5ling f\u00f8r oppstart med TKI<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">CT-skanning av bryst og abdomen<\/span><\/span> &lt; 1 <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">m\u00e5ned<\/span><\/span><\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Hvis baseline CT-skanning er<\/span><\/span> &gt; <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">1 m\u00e5ned, vurder \u00e5 bestille en subakutt CT-skanning som ny baseline<\/span><\/span><\/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-7 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Link til preparatomtale fra tabell:<\/h5><\/div><div class=\"fusion-text fusion-text-8\"><ul>\n<li><a class=\"exitNotifierLink\" href=\"https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/votrient-epar-product-information_da.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Pazopanib<\/a><\/li>\n<li><a class=\"exitNotifierLink\" href=\"https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/inlyta-epar-product-information_da.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Aksitinib<\/a><\/li>\n<li><a class=\"exitNotifierLink\" href=\"https:\/\/pro.medicin.dk\/medicin\/praeparater\/4196\" target=\"_blank\" rel=\"noopener noreferrer\">Simvastatin<\/a><\/li>\n<li><a class=\"exitNotifierLink\" href=\"https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/fotivda-epar-product-information_da.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Tivozanib<\/a><\/li>\n<li><a class=\"exitNotifierLink\" href=\"https:\/\/pro.medicin.dk\/Medicin\/Praeparater\/8558\" target=\"_blank\" rel=\"noopener noreferrer\">Rosuvastatin<\/a><\/li>\n<\/ul>\n<\/div><div class=\"fusion-title title fusion-title-8 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Instruksjoner til pasient\/slektning<\/h4><\/div><div class=\"fusion-text fusion-text-9\"><ul>\n<li>Blodtrykksm\u00e5ling<\/li>\n<li>Forskriv st\u00f8ttebehandling  (<a class=\"exitNotifierLink\" href=\"https:\/\/pro.medicin.dk\/medicin\/praeparater\/3558\" target=\"_blank\" rel=\"noopener noreferrer\" style=\"font-family: var(--awb-text-font-family); font-size: var(--awb-font-size); font-style: var(--awb-text-font-style); letter-spacing: var(--awb-letter-spacing); text-align: var(--awb-content-alignment); text-transform: var(--awb-text-transform);\">domperidon<\/a><span style=\"font-family: var(--awb-text-font-family); font-size: var(--awb-font-size); font-style: var(--awb-text-font-style); letter-spacing: var(--awb-letter-spacing); text-align: var(--awb-content-alignment); text-transform: var(--awb-text-transform);\">, <\/span><a class=\"exitNotifierLink\" href=\"https:\/\/pro.medicin.dk\/Medicin\/Praeparater\/9324\" target=\"_blank\" rel=\"noopener noreferrer\" style=\"font-family: var(--awb-text-font-family); font-size: var(--awb-font-size); font-style: var(--awb-text-font-style); letter-spacing: var(--awb-letter-spacing); text-align: var(--awb-content-alignment); text-transform: var(--awb-text-transform);\">loperamid<\/a><span style=\"font-family: var(--awb-text-font-family); font-size: var(--awb-font-size); font-style: var(--awb-text-font-style); letter-spacing: var(--awb-letter-spacing); text-align: var(--awb-content-alignment); text-transform: var(--awb-text-transform);\">, <\/span>krem til hender og f\u00f8tter, munnpleieprodukter)<\/li>\n<li>Blodpr\u00f8ver mellom sykluser  (<a class=\"exitNotifierLink\" href=\"https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/votrient-epar-product-information_da.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Pazopanib<\/a>: midtveis gjennom syklus 2 og 3; <a class=\"exitNotifierLink\" href=\"https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/cabometyx-epar-product-information_da.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Kabozantinib<\/a>: midtveis gjennom syklus 1 og 2; <a class=\"exitNotifierLink\" href=\"https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/sutent-epar-product-information_da.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Sunitinib<\/a>: dag 28 i syklus 1; <a class=\"exitNotifierLink\" href=\"https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/fotivda-epar-product-information_da.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Tivozanib<\/a>: midtveis gjennom syklus 1, 2 og 3)<\/li>\n<li>H\u00e5ndtering av bivirkninger og skriving av dagbok + CTC-skjema<\/li>\n<li>Kontakt avdelingen ved eventuelle uakseptable bivirkninger<\/li>\n<\/ul>\n<\/div><div class=\"fusion-title title fusion-title-9 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Evaluering under TKI-behandling<\/h4><\/div><div class=\"fusion-text fusion-text-10\"><p>Pasienten unders\u00f8kes av lege eller sykepleier p\u00e5 poliklinkk hver 4. eller 6. uke, hvor f\u00f8lgende utf\u00f8res:<\/p>\n<ul>\n<li>Klinisk evaluering og kontroll av BT, puls, vekt, temperatur og oksygenmetning, hvis aktuelt<\/li>\n<li>Toksisitetsregistrering i henhold til CTCAE versjon 5.0 <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/no\/mrcc-tool\/5-toxicity-management\/5-1-adverse-reactions-to-targeted-treatment\/\">(se avsnitt om gradering)<\/a><\/li>\n<li>Kontroll av blodpr\u00f8ver (hematologi, v\u00e6skeverdier, inkl. ionisert kalsium + magnesium, leververdier, CRP+TSH)<\/li>\n<li>Medikamentstatus<\/li>\n<li>Vurdering av nye symptomer<\/li>\n<li>Beslutning om dosejustering og\/eller andre tiltak <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/no\/mrcc-tool\/5-toxicity-management\/5-2-management-of-tki-side-effects\/\">(se avsnittet om h\u00e5ndtering av bivirkninger)<\/a><\/li>\n<li>Urinstrimmel med tanke p\u00e5 proteinuri (hver 3. m\u00e5ned)<\/li>\n<\/ul>\n<\/div><div class=\"fusion-title title fusion-title-10 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Responsevaluering<\/h4><\/div><div class=\"fusion-text fusion-text-11\"><p>Effekten av TKI vurderes hver 3. m\u00e5ned. (12 uker) med CT thorax og abdomen og MR av cerebrum hvis pasienten har cerebrale metastaser.<\/p>\n<p>Responsvurdering skal baseres p\u00e5:<\/p>\n<ol>\n<li>Generell tilstand<\/li>\n<li>Biokjemi (spesielt Hb, n\u00f8ytrofiler, trombocytter, ionisert kalsium, LDH og CRP)<\/li>\n<li>CT thorax og abdomen<\/li>\n<\/ol>\n<\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-4 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-11 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Referanse<\/h4><\/div><div class=\"fusion-text fusion-text-12\"><ol>\n<li><em>The Cancer Department, Herlev Hospital<\/em><\/li>\n<\/ol>\n<\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-4 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-overflow:hidden;--awb-bg-size:cover;--awb-border-radius:7px 7px 7px 7px;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\" data-scroll-devices=\"small-visibility,medium-visibility,large-visibility\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div style=\"text-align:center;\"><a class=\"fusion-button button-flat fusion-button-default-size button-default fusion-button-default button-1 fusion-button-default-span fusion-button-default-type\" target=\"_self\" data-hover=\"icon_slide\" href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/no\/mrcc-tool\/3-management-of-mrcc\/3-3-treatment-criteria-for-initiation-of-checkpoint-inhibitors\/\"><span class=\"fusion-button-text\">Se neste avsnitt: 3.3 Behandlingskriterier for oppstart av sjekkpunkthemmere<\/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-12 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;\">Utforsk denne kapittelmenyen<\/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=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/no\/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=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/no\/mrcc-tool\/3-management-of-mrcc\/3-2-treatment-criteria-for-initiation-of-tki\/\"><span class=\"fusion-button-text\">3.2 Behandlingskriterier for igangsetting av 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=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/no\/mrcc-tool\/3-management-of-mrcc\/3-3-treatment-criteria-for-initiation-of-checkpoint-inhibitors\/\"><span class=\"fusion-button-text\">3.3 Behandlingskriterier for oppstart av sjekkpunkthemmere<\/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=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/no\/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=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/no\/mrcc-tool\/3-management-of-mrcc\/3-5-malignant-hypercalcaemia\/\"><span class=\"fusion-button-text\">3.5 Malign hyperkalsemi<\/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=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/no\/mrcc-tool\/3-management-of-mrcc\/3-6-performance-status\/\"><span class=\"fusion-button-text\">3.6 Funksjonsstatus (PS)<\/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":7513,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7521","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/no\/wp-json\/wp\/v2\/pages\/7521","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/no\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/no\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/no\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/no\/wp-json\/wp\/v2\/comments?post=7521"}],"version-history":[{"count":35,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/no\/wp-json\/wp\/v2\/pages\/7521\/revisions"}],"predecessor-version":[{"id":11142,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/no\/wp-json\/wp\/v2\/pages\/7521\/revisions\/11142"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/no\/wp-json\/wp\/v2\/pages\/7513"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/no\/wp-json\/wp\/v2\/media?parent=7521"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}