{"id":7525,"date":"2023-08-17T06:25:43","date_gmt":"2023-08-17T06:25:43","guid":{"rendered":"http:\/\/d1s07skqdwll4z.cloudfront.net\/mrcc-tool\/3-management-of-mrcc\/3-3-treatment-criteria-for-initiation-of-checkpoint-inhibitors\/"},"modified":"2024-03-28T17:21:10","modified_gmt":"2024-03-28T17:21:10","slug":"3-3-treatment-criteria-for-initiation-of-checkpoint-inhibitors","status":"publish","type":"page","link":"https:\/\/d1s07skqdwll4z.cloudfront.net\/no\/mrcc-tool\/3-management-of-mrcc\/3-3-treatment-criteria-for-initiation-of-checkpoint-inhibitors\/","title":{"rendered":"3.3 Treatment criteria for initiation of checkpoint inhibitors"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:-60px;--awb-background-color:var(--awb-color3);--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-search-element fusion-search-element-1 fusion-search-form-clean\" style=\"--awb-border-radius:7px;--awb-text-color:var(--awb-color8);--awb-border-color:var(--awb-color8);--awb-bg-color:var(--awb-color3);\">\t\t<form role=\"search\" class=\"searchform fusion-search-form  fusion-live-search fusion-search-form-clean\" method=\"get\" action=\"https:\/\/d1s07skqdwll4z.cloudfront.net\/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;\">3.3 Behandlingskriterier for oppstart av sjekkpunkthemmere<sup>1<\/sup><\/h5><span class=\"awb-title-spacer\"><\/span><div class=\"title-sep-container title-sep-container-right\"><div class=\"title-sep sep-single sep-solid\" style=\"border-color:#e2e2e2;\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-margin-top:4px;--awb-background-color:var(--awb-color3);--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-1\"><p>(Ipilimumab\/nivolumab som f\u00f8rstelinjebehandling eller nivolumab som andre- eller tredjelinjebehandling)<\/p>\n<p>For de fleste pasienter er sjekkpunkthemmere (CPI-er) palliativ behandling med det form\u00e5l \u00e5 lindre symptomer og forlenge livet. Enkelte pasienter oppn\u00e5r imidlertid komplett respons i en kortere eller lengre periode.<\/p>\n<p>Sjekkpunkthemmere gis intraven\u00f8st enten hver 3. uke (kombinasjonsimmunterapi) &#8211; totalt 4 sykluser \u2013 deretter fortsettes med <a href=\"https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/opdivo-epar-product-information_da.pdf\" class=\"exitNotifierLink\">Nivolumab<\/a> alene, eller hver 4. uke (monoterapi) dvs. en syklus strekker seg over enten 3 eller 4 uker. Pasienten unders\u00f8kes med CT thorax og abdomen (og MR av cerebrum ved cerebrale metastaser) hver 3. m\u00e5ned.<\/p>\n<\/div><div class=\"fusion-title title fusion-title-2 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">For f\u00f8rstelinje kombinasjonsimmunterapi:<\/h5><\/div><div class=\"fusion-text fusion-text-2\"><ul>\n<li>Median progresjonsfri overlevelse (mPFS) hos pasienter som tilh\u00f8rer gruppen med middels eller d\u00e5rlig prognose, er 11,6 m\u00e5neder. Median total overlevelse (mOS) er enn\u00e5 ikke kjent (data enn\u00e5 ikke modnet)<\/li>\n<li>I henhold til <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/no\/mrcc-tool\/3-management-of-mrcc\/3-4-response-evaluation\/\">RECIST<\/a>-kriteriene har 72,7 % av pasientene behandlingseffekt med enten:<\/li>\n<\/ul>\n<ol>\n<li>\n<ol>\n<li>Komplett respons (CR) &#8211; 10,1 %<\/li>\n<li>Delvis respons (PR) &#8211; 32 %<\/li>\n<li>Stabil sykdom (SD) &#8211; 30,6 %<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<\/div><div class=\"fusion-title title fusion-title-3 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">For andre- og tredjelinje <a class=\"exitNotifierLink\" href=\"https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/opdivo-epar-product-information_da.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Nivolumab<\/a> (monoterapi):<\/h5><\/div><div class=\"fusion-text fusion-text-3\"><ul>\n<li>mPFS er 4,6 m\u00e5neder og mOS er 25 m\u00e5neder<\/li>\n<li>If\u00f8lge  <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/no\/mrcc-tool\/3-management-of-mrcc\/3-4-response-evaluation\/\">RECIST<\/a>-kriteriene har 59 % av pasientene enten:\n<ol>\n<li>Komplett respons (CR) &#8211; 1 %<\/li>\n<li>Delvis respons (PR) &#8211; 24 %<\/li>\n<li>Stabil sykdom (SD) &#8211; 34 %<\/li>\n<\/ol>\n<\/li>\n<\/ul>\n<\/div><div class=\"fusion-title title fusion-title-4 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">F\u00f8rste bes\u00f8k p\u00e5 onkologisk avdeling<\/h4><\/div><div class=\"fusion-text fusion-text-4\"><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-5 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-5\"><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:<\/li>\n<\/ul>\n<ol>\n<li style=\"list-style-type: none;\">\n<ol>\n<li>Immunsuppressiv behandling, hva og hvorfor<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<ul>\n<li>Sosial informasjon<\/li>\n<\/ul>\n<ol>\n<li style=\"list-style-type: none;\">\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<\/ol>\n<\/div><div class=\"fusion-title title fusion-title-6 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Klinisk vurdering:<\/h5><\/div><div class=\"fusion-text fusion-text-6\"><ul>\n<li>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-7 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-7\"><p>Ved f\u00f8rste polikliniske konsultasjon skal f\u00f8lgende utf\u00f8res:<\/p>\n<ul>\n<li>Blodpr\u00f8ver: hematologi (Hb, blodplater, 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, TSH, kortisol, testosteron (menn), amylase, CK-MB og troponin<\/li>\n<li>For kombinasjonsimmunterapi: CK-MB og troponin<\/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-8 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Behandlingskriterier<\/h4><\/div><div class=\"fusion-text fusion-text-8\"><p>F\u00f8lgende kriterier m\u00e5 v\u00e6re oppfylt ved oppstart av sjekkpunkthemmer. Avvik m\u00e5 diskuteres med spesialist, og dette m\u00e5 dokumenteres i journalen.<br \/>\n<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 &#8211; klarcellet histologi med middels eller d\u00e5rlig prognose hvis det brukes kombinasjonsimmunterapi<\/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><br \/><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Monoterapi<\/span><\/span> &lt; 2<br \/><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Kombinasjonsbehandling<\/span><\/span> &lt; 1<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<td align=\"left\">&nbsp;<\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><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\">Sjekkpunkthemmere utskilles ikke via nyrene. Kan derfor tilbys pasienter med d\u00e5rlig nyrefunksjon, men m\u00e5 diskuteres med spesialist<\/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 normalgrense<\/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\">&nbsp;<\/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\">De ovennevnte kriterier er spesielt viktige ved kombinasjonsimmunterapi<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Ingen autoimmune sykdommer<\/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\">Unntak:<\/span><\/span><br \/>\u2022 <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Godt kontrollert diabetes type 1<\/span><\/span><br \/>\u2022 <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Hypotyreose etter autoimmun tyreoiditt som bare krever erstatningsterapi<\/span><\/span><br \/>\u2022 <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Vitiligo<\/span><\/span><br \/><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Ved andre autoimmune sykdommer, konsulter spesialist<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Ingen prednisolonbehandling<\/span><\/span> &gt; <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">10 mg eller annen immunsuppressiv behandling<\/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\">Inhalasjonssteroid eller behandling av binyrebarkinsuffisiens (hydrokortison) er tillatt<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Ikke kjent HIV eller hepatitt B eller C<\/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\">MR-skanning av cerebrum<\/span><\/span><br \/><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">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\">Hvis pasienten er asymptomatisk og har 1-3 hjernemetastaser, henvis til SRK-m\u00f8te med tanke p\u00e5 str\u00e5lebehandling. Behandling med sjekkpunkthemmer kan startes<\/span><\/span><br \/>2) <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Dersom pasienten er symptomatisk og har 1-3 hjernemetastaser, start steroidbehandling i henhold til retningslinjer og henvis til SRK-m\u00f8te. Behandling med sjekkpunkthemmer kan ikke startes f\u00f8r seponering av prednisolon<\/span><\/span><br \/>3) <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Dersom pasienten har flere hjernemetastaser, men er asymptomatisk. Start behandling med sjekkpunkthemmer<\/span><\/span><br \/>4) <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Start steroidbehandling dersom pasienten har flere metastaser og har symptomer. Start TKI-behandling og vurder helhjernestr\u00e5ling<\/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; 1 <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">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-9 fusion-sep-none fusion-title-text fusion-title-size-five\"><h5 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Linker til preparatomtaler:<\/h5><\/div><div class=\"fusion-text fusion-text-9\"><ul>\n<li><a class=\"exitNotifierLink\" href=\"https:\/\/pro.medicin.dk\/medicin\/praeparater\/2582\" target=\"_blank\" rel=\"noopener noreferrer\" 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);\">Prednisolon<\/a><\/li>\n<li><a class=\"exitNotifierLink\" href=\"https:\/\/pro.medicin.dk\/medicin\/praeparater\/2659\" target=\"_blank\" rel=\"noopener noreferrer\">Hydrokortison<\/a><\/li>\n<\/ul>\n<\/div><div class=\"fusion-title title fusion-title-10 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Instruksjoner til pasient\/slektning<\/h4><\/div><div class=\"fusion-text fusion-text-10\"><ul>\n<li>Gjennomgang av immunrelaterte bivirkninger og CTC-skjema og oppfordring om \u00e5 kontakte avdelingen ved symptomer<\/li>\n<li>Dosere st\u00f8ttende legemiddel  (<a class=\"exitNotifierLink\" href=\"https:\/\/pro.medicin.dk\/medicin\/praeparater\/3558\" target=\"_blank\" rel=\"noopener noreferrer\">Domperidon<\/a> og <a class=\"exitNotifierLink\" href=\"https:\/\/pro.medicin.dk\/Medicin\/Praeparater\/9324\" target=\"_blank\" rel=\"noopener noreferrer\">Loperamid<\/a>)<\/li>\n<\/ul>\n<\/div><div class=\"fusion-title title fusion-title-11 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Evaluering under behandling<\/h4><\/div><div class=\"fusion-text fusion-text-11\"><p>Pasienten evalueres av lege eller sykepleier p\u00e5 poliklinikken hver 3. eller 4. uke, hvor:<\/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 avsnittet om gradering)<\/a><\/li>\n<li>Kontroll av blodpr\u00f8ver (hematologi, v\u00e6skeverdier, inkl. ionisert kalsium + magnesium, leverfunksjonspr\u00f8ver, CRP, TSH, kortisol, testosteron (menn), amylase + CK-MB og troponin under kombinasjonsimmunterapi)<\/li>\n<li>Medikamentstatus<\/li>\n<li>Vurdering av nye symptomer<\/li>\n<li>Vedtak om utsettelse eller andre tiltak <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/no\/mrcc-tool\/5-toxicity-management\/5-3-adverse-reactions-to-checkpoint-inhibitors\/\">(se avsnittet om bivirkninger av sjekkpunkthemmere)<\/a><\/li>\n<\/ul>\n<\/div><div class=\"fusion-title title fusion-title-12 fusion-sep-none fusion-title-text fusion-title-size-four\"><h4 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Responsevaluering<\/h4><\/div><div class=\"fusion-text fusion-text-12\"><p>Effekten av sjekkpunkthemmere vurderes hver 3. m\u00e5ned. (12 uker) med CT thorax og abdomen og MR av cerebrum hvis man vet at 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-13 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-13\"><ol>\n<li><em>The Cancer Department, Herlev Hospital<\/em><\/li>\n<\/ol>\n<\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-4 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-overflow:hidden;--awb-bg-size:cover;--awb-border-radius:7px 7px 7px 7px;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\" data-scroll-devices=\"small-visibility,medium-visibility,large-visibility\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div style=\"text-align:center;\"><a class=\"fusion-button button-flat fusion-button-default-size button-default fusion-button-default button-1 fusion-button-default-span fusion-button-default-type\" target=\"_self\" data-hover=\"icon_slide\" href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/no\/mrcc-tool\/3-management-of-mrcc\/3-4-response-evaluation\/\"><span class=\"fusion-button-text\">Se neste avsnitt: 3.4 Responsevaluering<\/span><i class=\"fa-arrow-alt-circle-right fas button-icon-right\" aria-hidden=\"true\"><\/i><\/a><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-5 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:7px;--awb-border-radius-top-right:7px;--awb-border-radius-bottom-right:7px;--awb-border-radius-bottom-left:7px;--awb-overflow:hidden;--awb-margin-top:4px;--awb-background-color:var(--awb-color3);--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-5 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-14 fusion-title-center fusion-title-text fusion-title-size-five\" style=\"--awb-text-color:#c1c1c1;--awb-margin-top:25px;--awb-sep-color:#e2e2e2;\"><div class=\"title-sep-container title-sep-container-left\"><div class=\"title-sep sep-single sep-solid\" style=\"border-color:#e2e2e2;\"><\/div><\/div><span class=\"awb-title-spacer\"><\/span><h5 class=\"fusion-title-heading title-heading-center\" style=\"margin:0;\">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-7525","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/no\/wp-json\/wp\/v2\/pages\/7525","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=7525"}],"version-history":[{"count":46,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/no\/wp-json\/wp\/v2\/pages\/7525\/revisions"}],"predecessor-version":[{"id":11143,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/no\/wp-json\/wp\/v2\/pages\/7525\/revisions\/11143"}],"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=7525"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}