{"id":7621,"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":"2024-03-28T17:26:04","modified_gmt":"2024-03-28T17:26:04","slug":"5-3-adverse-reactions-to-checkpoint-inhibitors","status":"publish","type":"page","link":"https:\/\/d1s07skqdwll4z.cloudfront.net\/no\/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\/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;\">5.3 Bivirkninger av sjekkpunkthemmere<\/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 relatert til immunterapi med sjekkpunkt-hemmere:<\/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 sjekkpunkthemmere brukes til behandling av kreft, er det ikke bare kreftcellene som p\u00e5virkes av den forsterkede immunologiske responsen. De redusere ogs\u00e5 hastighenten p\u00e5 den naturlige hemmingen av immunsystemet. Dette kan skape en ubalanse i immunologisk selvtoleranse og risiko for \u00e5 utvikle autoimmun-relaterte bivirkninger (irAE-er).<\/p>\n<p>Noen organsystemer blir oftere p\u00e5virket av irAE-er (utslett, diar\u00e9, hypertyreose\/hypotyreose og fatigue) enn andre, men alle organsystemer kan bli p\u00e5virket.<\/p>\n<p>De aller fleste irAE-er er reversible hvis de behandles i tide. Det er derfor viktig \u00e5 respondere tidlig og adekvat p\u00e5 irAE-er. Det er sv\u00e6rt viktig at pasienten har f\u00e5tt god oppl\u00e6ring og beskjed om \u00e5 kontakte poliklinikken ved mistanke om irAE-er<a href=\"https:\/\/mrcc-tool.com\/5-toxicities\/adverse-reactions-to-checkpoint-inhibitors\/#reference\" class=\"exitNotifierLink\"><sup>1<\/sup><\/a>.<\/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_NO\" src=\"https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120227\/5.3_1_NO.jpg\" alt class=\"img-responsive wp-image-9700\" srcset=\"https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120227\/5.3_1_NO-200x132.jpg 200w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120227\/5.3_1_NO-400x264.jpg 400w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120227\/5.3_1_NO-600x396.jpg 600w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120227\/5.3_1_NO-800x528.jpg 800w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120227\/5.3_1_NO-1200x791.jpg 1200w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120227\/5.3_1_NO.jpg 1556w\" sizes=\"(max-width: 640px) 100vw, 1200px\" \/><\/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 av irAE-er<\/h4><\/div><div class=\"fusion-text fusion-text-2\"><section class=\"av_textblock_section \">\n<div class=\"avia_textblock \">\n<p>irAE-er graderes i henhold til Common Terminology Criteria for Adverse Events (CTCAE) versjon 5, se <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/no\/mrcc-tool\/5-toxicity-management\/5-1-adverse-reactions-to-targeted-treatment\/\">avsnittet om bivirkninger ved m\u00e5lrettet 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;\">Frekvensen av irAE-er (monoterapi kontra kombinasjonsbehandling)<\/h4><\/div><div class=\"fusion-text fusion-text-3\"><section class=\"av_textblock_section \">\n<div class=\"avia_textblock \">\n<p>Det er flere alvorlige irAE-er (imAE-er) (grad 3-4) relatert til kombinert immunterapi (anti-CTLA-4+anti-PD-1) enn til 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 AV IRAE<\/th>\n<th align=\"left\">IRAE GRAD 3\/4<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">CTLA-4-hemming<\/span><\/span><\/td>\n<td align=\"left\">60% <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">til<\/span><\/span> 85%<\/td>\n<td align=\"left\">10% <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">til<\/span><\/span> 27%<\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">PD-1\/PD-L1-hemming<\/span><\/span><\/td>\n<td align=\"left\">58% <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">til<\/span><\/span> 85%<\/td>\n<td align=\"left\">7% <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">til<\/span><\/span> 20%<\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Kombinasjon av CTLA-4\/PD-1-hemming<\/span><\/span><\/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>Kombinasjonsbehandling med CTLA\/PD-1-hemmere utgj\u00f8r den st\u00f8rste risikoen.<\/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 for irAE-er<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 irAE-er kan forekomme hos samme pasient samtidig eller periodisk over tid<\/li>\n<li>De kan v\u00e6re alt fra forbig\u00e5ende til alvorlige og livstruende<\/li>\n<li>irAE-er kan forekomme selv etter avsluttet behandling (ogs\u00e5 m\u00e5neder etterp\u00e5)<\/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 av immunrelaterte bivirkninger<sup>5<\/sup><\/h4><\/div><div class=\"fusion-text fusion-text-6\"><p>Den overordnede strategien for h\u00e5ndtering av irAE-er er listet opp nedenfor, basert p\u00e5 alvorlighetsgraden av bivirkningen. Immunsuppressiv behandling, i form av kortikosteroider, utgj\u00f8r en hj\u00f8rnestein i behandlingen av irAE-er.<\/p>\n<\/div>\n<div class=\"table-1\">\n<table width=\"100%\">\n<thead>\n<tr>\n<th align=\"left\">GRADERING<\/th>\n<th align=\"left\">POLIKLINISK\/SYKEHUSINNLEGGELSE<\/th>\n<th align=\"left\">KORTIKOSTEROID: PREDNISOLON<\/th>\n<th align=\"left\">ANDRE IMMUNSUPPRESSIVE MIDLER<\/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\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Poliklinisk<\/span><\/span><\/td>\n<td align=\"left\">&#8211;<\/td>\n<td align=\"left\">&#8211;<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Forts.<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\">2<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Poliklinisk<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Topisk eller systemisk<\/span><\/span><br \/>0.5\u20131 mg\/kg<\/td>\n<td align=\"left\">&#8211;<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Seponeres midlertidig og behandlingen gjenopptas vanligvis ved grad 0\u20131<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\">3<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Sykehusinnleggelse<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Systemisk, oralt eller IV<\/span><\/span><br \/>1\u20132 mg\/kg<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Vurder om det ikke er respons etter 3-5 dager med kortikosteroidbehandling.<br \/>Konsulter spesialist<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Avbryt og diskuter&nbsp; gjenopptagelse av behandlingen basert p\u00e5 individuell vurdering av pasienten<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\">4<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Sykehusinnleggelse<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Systemisk, i.v.<\/span><\/span><br \/>1\u20132 mg\/kg<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Vurder om det ikke er respons etter 3-5 dager med&nbsp; kortikosteroidbehandling.<br \/>Konsulter spesialist<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Seponer&nbsp;<\/span><\/span><br \/>IV<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<div class=\"fusion-text fusion-text-7\"><p><small>IV = 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;\">Retningslinjer for evaluering og behandling av IrAE-er<sup>2,5,6,7<\/sup><\/h4><\/div><div class=\"fusion-text fusion-text-8\"><p>Det er utarbeidet mange retningslinjer for vurdering og behandling av irAE-er (ESMO, NCCN, ASCO osv.). <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);\">Det er ogs\u00e5 utviklet danske retningslinjer som det finnes en app for, <\/span><a class=\"exitNotifierLink\" href=\"https:\/\/free.mymedcards.dk\/cards\/rKqtEBhvumU9PDTr2MmV-immuntox-introduktion-samt-patient-og-laegebrev-og-blodproever\" 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);\">MyMedCards<\/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);\">, som du kan laste ned gratis:<\/span><\/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=\"1030\" height=\"624\" title=\"5.3_2_NO\" src=\"https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120223\/5.3_2_NO.jpg\" alt class=\"img-responsive wp-image-9705\" srcset=\"https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120223\/5.3_2_NO-200x121.jpg 200w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120223\/5.3_2_NO-400x242.jpg 400w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120223\/5.3_2_NO-600x363.jpg 600w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120223\/5.3_2_NO-800x485.jpg 800w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120223\/5.3_2_NO.jpg 1030w\" sizes=\"(max-width: 640px) 100vw, 1030px\" \/><\/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;\">Forebygging og behandling av irAE-er<sup>8<\/sup><\/h4><\/div><div class=\"fusion-text fusion-text-9\"><p>Det er flere faktorer som er involvert i forebygging og adekvat behandling av irAE-er, inkludert identifisering av mulige risikofaktorer og oppl\u00e6ring av pasient\/omsorgsperson samt leger\/sykepleiere. 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_NO\" src=\"https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120221\/5.3_3_NO.jpg\" alt class=\"img-responsive wp-image-9710\" srcset=\"https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120221\/5.3_3_NO-200x140.jpg 200w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120221\/5.3_3_NO-400x281.jpg 400w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120221\/5.3_3_NO-600x421.jpg 600w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120221\/5.3_3_NO-800x561.jpg 800w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120221\/5.3_3_NO-1200x842.jpg 1200w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/11\/16120221\/5.3_3_NO.jpg 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;\">Referanse<\/h4><\/div><div class=\"fusion-text fusion-text-10\"><ol>\n<li><em>Poskow et al, NEJM 2018<\/em><\/li>\n<li><em>Haanen JB et al, ann oncol, 2017;28;IV 119\u2013141<\/em><\/li>\n<li><em>Brahmer JR et, JCO 2018<\/em><\/li>\n<li><em>Nagai et al, Int J Clin Oncol 2018<\/em><\/li>\n<li><em>Immunotherapy is cancer treatment with a completely new adverse reaction profile. Kondrup et al. The Danish medical journal, Ugeskrift for l\u00e6ger. 2017<\/em><\/li>\n<li><em>Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.<\/em><\/li>\n<li><em>Management of Immunotherapy-Related Toxicities, Version 1,2019; Thompson JA. J Natl Compr Canc Netw. 2019.)<\/em><\/li>\n<li><em>Champiat et al, Ann Oncol 2016<\/em><\/li>\n<\/ol>\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=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/no\/mrcc-tool\/5-toxicity-management\/5-4-interactions-between-medicinal-products\/\"><span class=\"fusion-button-text\">Se neste avsnitt: 5.4 Legemiddelinteraksjoner<\/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;\">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-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=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/no\/mrcc-tool\/5-toxicity-management\/5-1-adverse-reactions-to-targeted-treatment\/\"><span class=\"fusion-button-text\">5.1 Bivirkninger ved m\u00e5lrettet 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=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/no\/mrcc-tool\/5-toxicity-management\/5-2-management-of-tki-side-effects\/\"><span class=\"fusion-button-text\">5.2 H\u00e5ndtering av 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=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/no\/mrcc-tool\/5-toxicity-management\/5-3-adverse-reactions-to-checkpoint-inhibitors\/\"><span class=\"fusion-button-text\">5.3 Bivirkninger 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\/5-toxicity-management\/5-4-interactions-between-medicinal-products\/\"><span class=\"fusion-button-text\">5.4 Legemiddelinteraksjoner<\/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":7569,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7621","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/no\/wp-json\/wp\/v2\/pages\/7621","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=7621"}],"version-history":[{"count":28,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/no\/wp-json\/wp\/v2\/pages\/7621\/revisions"}],"predecessor-version":[{"id":11163,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/no\/wp-json\/wp\/v2\/pages\/7621\/revisions\/11163"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/no\/wp-json\/wp\/v2\/pages\/7569"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/no\/wp-json\/wp\/v2\/media?parent=7621"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}