{"id":7522,"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":"2024-03-28T17:52:37","modified_gmt":"2024-03-28T17:52:37","slug":"3-2-treatment-criteria-for-initiation-of-tki","status":"publish","type":"page","link":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/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\/sv\/\">\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 vid ins\u00e4ttning 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>Tyrosinkinash\u00e4mmare (TKI) \u00e4r palliativa behandlingar som syftar till symtomlindring och f\u00f6rl\u00e4ngt liv<\/p>\n<ul>\n<li>Det \u00e4r en tablettbehandling som ska tas antingen en eller tv\u00e5 g\u00e5nger dagligen. F\u00f6r vissa l\u00e4kemedel ing\u00e5r en paus (<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 antingen i 4 veckor f\u00f6ljt av 2 veckors paus eller 2 veckors behandling f\u00f6ljt av en 1 veckas paus, som upprepas. <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 veckor f\u00f6ljt av en 1 veckas paus, som upprepas).<\/li>\n<li>F\u00f6r vissa l\u00e4kemedel ska f\u00f6da inte intas omedelbart f\u00f6re eller efter 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> och <a class=\"exitNotifierLink\" href=\"https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/cabometyx-epar-product-information_da.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Cabozantinib<\/a> ska tas minst 1 timme f\u00f6re eller minst 2 timmar efter m\u00e5ltid).<\/li>\n<li>En behandlingsomg\u00e5ng varar i 4 eller 6 veckor. Patienten utv\u00e4rderas med datortomografi av thorax och buk (och MR av hj\u00e4rnan f\u00f6r cerebrala metastaser) var 3:e m\u00e5nad (efter 2 eller 3 behandlingsomg\u00e5ngar)<\/li>\n<\/ul>\n<p>F\u00f6r f\u00f6rsta linjens TKI:<\/p>\n<ul>\n<li>Medianv\u00e4rdet f\u00f6r progressionsfri \u00f6verlevnad (mPFS) \u00e4r cirka 9 m\u00e5nader. Medianv\u00e4rdet f\u00f6r total \u00f6verlevnad (mOS) beror p\u00e5 IMDC-riskgruppen (<a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/mrcc-tool\/2-symptoms-and-diagnosis\/2-4-prognostic-stratification-tools-for-patients-with-mrcc\/\">se avsnittet om verktyg f\u00f6r prognostisk stratifiering av patienter med mRCC<\/a>)<\/li>\n<li>Enligt <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/mrcc-tool\/3-management-of-mrcc\/3-4-response-evaluation\/\">RECIST<\/a> kriterierna svarar 60\u201380 % av patienterna p\u00e5 behandlingen med antingen:\n<ul>\n<li>Regression (komplett respons (CR) \u2013 ses s\u00e4llan<\/li>\n<li>Partiell respons (PR) \u2013 ses hos 30\u201340 %<\/li>\n<li>Stabilisering av sjukdomen (stabil sjukdom (SD)) \u2013 hos 30\u201340 % under kortare eller l\u00e4ngre tid<\/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\u00f6rsta bes\u00f6ket p\u00e5 onkologiska avdelningen<\/h4><\/div><div class=\"fusion-text fusion-text-2\"><p>Vid det f\u00f6rsta bes\u00f6ket p\u00e5 onkologiska avdelningen m\u00e5ste en fullst\u00e4ndig patientjournal f\u00f6ras 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;\">Anamnes:<\/h5><\/div><div class=\"fusion-text fusion-text-3\"><ul>\n<li>Sjukdomar (cancer i sl\u00e4kten med s\u00e4rskild tonvikt p\u00e5 fall av njurcancer)<\/li>\n<li>Symtom (tr\u00f6tthet, viktminskning, minskad aptit, svettning\/vallningar, sm\u00e4rta osv.)<\/li>\n<li>Komorbiditet (hypertoni, ischemisk hj\u00e4rtsjukdom, nedsatt pumpf\u00f6rm\u00e5ga hos hj\u00e4rtat (EF) och dess orsak, arytmier, cerebral apoplexi, diabetes mellitus, njursvikt, autoimmuna och andra kroniska sjukdomar)<\/li>\n<li>Fullst\u00e4ndig l\u00e4kemedelsstatus. Det ska framg\u00e5 om patienten st\u00e5r p\u00e5:\n<ol>\n<li>Antikoagulantiabehandling, vilket l\u00e4kemedel och orsak (arytmier, djup ventrombos (DVT), lungembolism (LE) eller annan koagulopati)<\/li>\n<li>Kolesterols\u00e4nkande l\u00e4kemedel och vilket l\u00e4kemedel<\/li>\n<\/ol>\n<\/li>\n<\/ul>\n<\/div><div class=\"fusion-text fusion-text-4\"><ul>\n<li>Sociala uppgifter:\n<ol>\n<li>Civilst\u00e5nd<\/li>\n<li>N\u00e4tverk<\/li>\n<li>Syssels\u00e4ttning (arbetar, sjukskriven, f\u00f6rtidspensionerad, pension\u00e4r eller annan)<\/li>\n<li>Funktionsf\u00f6rm\u00e5ga (klarar sig sj\u00e4lv, beh\u00f6ver hj\u00e4lp med egenv\u00e5rd eller annat)<\/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 bed\u00f6mning:<\/h5><\/div><div class=\"fusion-text fusion-text-5\"><ul>\n<li>Allm\u00e4ntillst\u00e5nd (bra, akut eller kroniskt tillst\u00e5nd) inkl. <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/mrcc-tool\/3-management-of-mrcc\/3-6-performance-status\/\">funktionsstatus (PS)<\/a>.<\/li>\n<li>Vitala parametrar, inkl. BT, puls, temperatur, syrem\u00e4ttnad och vikt<\/li>\n<li>Objektiv unders\u00f6kning inkl. utv\u00e4rdering av f\u00f6rstorade lymfk\u00f6rtlar, stetoskopi av hj\u00e4rta och lungor, unders\u00f6kning av buk, extremiteter och 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;\">Parakliniskt:<\/h5><\/div><div class=\"fusion-text fusion-text-6\"><p>Vid det f\u00f6rsta \u00f6ppenv\u00e5rdsbes\u00f6ket ska f\u00f6ljande unders\u00f6kas:<\/p>\n<ul>\n<li>Urinsticka: obs f\u00f6r protein (om +3 f\u00f6r protein, utf\u00f6r 24-timmars urin f\u00f6r eliminering av protein)<\/li>\n<li>Blodprover: hematologi (Hb, trombocyter, leukocyter + differentialr\u00e4kning), v\u00e4tskev\u00e4rden (kreatinin, urea, natrium, kalium, joniserat kalcium och magnesium), leverfunktionsv\u00e4rden (ALAT, ASAT, LDH, alkaliskt fosfatas, INR och koagulationsv\u00e4rden (2,7 + 10), CRP och TSH<\/li>\n<li>EKG: rytm, akuta f\u00f6r\u00e4ndringar och bed\u00f6mning av QTc-intervall<\/li>\n<li>MR-unders\u00f6kning: cerebrum (utf\u00f6rd eller best\u00e4lld)<\/li>\n<li>Datortomografi: thorax och buk (baslinjen m\u00e5ste vara &lt;1 m\u00e5nad gammal)<\/li>\n<li>MUGA: bed\u00f6mning av hj\u00e4rtats pumpfunktion (utf\u00f6rs eller best\u00e4lls)<\/li>\n<li>IMDC: riskstratifiering<\/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\u00f6ljande kriterier ska vara uppfyllda i samband med initiering av TKI. Avvikelser ska diskuteras med specialist och dokumenteras i journalen.<\/p>\n<p><small>*Om nej (f\u00f6rklara 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\">NEJ*<\/th>\n<th align=\"left\">\u00c5TG\u00c4RDER OM SVARET \u00c4R NEJ<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Biopsiverifierad mRCC<\/span><\/span><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Funktionsstatus (PS) &lt; 2<\/span><\/span><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">\u00d6verv\u00e4g l\u00e4gre startdos (50\u00a0%)<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Njurfunktion<\/span><\/span><br \/>\neGFR &gt; 30 ml\/min<\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">TKI uts\u00f6ndras huvudsakligen via levern, men en mindre del uts\u00f6ndras via njurarna. \u00d6verv\u00e4g l\u00e4gre startdos (50\u00a0%). Om dosen tolereras kan man f\u00f6rs\u00f6ka h\u00f6ja dosen i cykel 2<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Leverfunktion<\/span><\/span><br \/>\n<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\">\u00f6vre normalgr\u00e4nsen<\/span><\/span><br \/>\nAST\/ALT &lt; 3 x <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">\u00f6vre normalgr\u00e4nsen eller<\/span><\/span> &lt; 5 <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">vid levermetastaser<\/span><\/span><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">TKI uts\u00f6ndras fr\u00e4mst via levern<\/span><\/span><br \/>\n1) <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Anv\u00e4nd annan TKI \u00e4nPazopanib, eftersom risken f\u00f6r f\u00f6rs\u00e4mrad leverfunktion \u00f6kar vid samtidig behandling med Pazopanib<\/span><\/span><br \/>\n2) <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">\u00d6verv\u00e4g l\u00e4gre startdos (50\u00a0%) med kontroll av leverv\u00e4rden varje vecka<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\">ECG<br \/>\nQTcF &lt;450 ms <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">f\u00f6r m\u00e4n och <\/span><\/span>&lt;470 ms <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">f\u00f6r kvinnor<\/span><\/span><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">G\u00e5 igenom patientens l\u00e4kemedelslista f\u00f6r l\u00e4kemedel som kan orsaka f\u00f6rl\u00e4ngt QTc. R\u00e5dg\u00f6r med kardiolog<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Blodtryck<\/span><\/span> &lt; 140\/90 mmHg<\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">\u00d6verv\u00e4g vitrockshypertoni och be patienten att ta blodtrycket hemma eller hos sin husl\u00e4kare . Vid fortsatt h\u00f6gt blodtryck, s\u00e4tt in blodtryckss\u00e4nkande l\u00e4kemedel eller intensifiera blodtryckss\u00e4nkande behandling som redan anv\u00e4nds via husl\u00e4karen (se avsnitt 5.2.2).<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Ejektionsfraktion (EF)<\/span><\/span> &gt; 40% <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">(m\u00e4tt med MUGA)<\/span><\/span><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Remittera patienten f\u00f6r kardiologisk bed\u00f6mning med ECHO och ins\u00e4ttning av hj\u00e4rtsviktsbehandling om EF <\/span><\/span>&lt; 40% <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">bekr\u00e4ftas<\/span><\/span>.<br \/>\n<span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">TKI f\u00e5r inte p\u00e5b\u00f6rjas f\u00f6rr\u00e4n kardiologen har gjort upp en plan. \u00d6verv\u00e4g minskad dos av TKI p\u00e5 grund av f\u00f6rmodad minskad risk f\u00f6r kardiotoxicitet<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Proteinuts\u00f6ndring i urin<\/span><\/span> &lt; 3+<\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">24-timmars urinprov om:<\/span><\/span><br \/>\n1) <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">24-timmars urinprotein \u00e4r 1-3,4 g\/dag: s\u00e4tt in TKI med reducerad dos (50\u00a0%) med dygnsm\u00e4tning av urinprotein vid varje bes\u00f6k p\u00e5 \u00f6ppenv\u00e5rdsmottagningen (dag 28 eller dag 42)<\/span><\/span><br \/>\n2) <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">24-timmars urinprotein<\/span><\/span> &gt; 3.5 g\/dag: <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">remittera till nefrolog innan TKI s\u00e4tts in<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Inget Marevan som antikoagulationsbehandling<\/span><\/span><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Om Marevan, \u00f6verv\u00e4g att byta till l\u00e5gdosheparin (Innohep), eftersom INR kan fluktuera kraftigt under TKI-behandling<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Ingen kolesterols\u00e4nkande medicinering<\/span><\/span><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Risken f\u00f6r leverp\u00e5verkan \u00f6kar vid samtidig behandling med pazopanib och simvastatin, eller tivozanib och rosuvastatin (och troligen \u00e4ven andra kolesterols\u00e4nkande l\u00e4kemedel). Simvastatin\/rosuvastatin\/kolesterols\u00e4nkande l\u00e4kemedel ska d\u00e4rf\u00f6r s\u00e4ttas ut tillf\u00e4lligt n\u00e4r pazopanib s\u00e4tts in<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Inga starka CYP3A4-inducerare eller -h\u00e4mmare (se avsnitt 5.4)<\/span><\/span><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">\u00d6verv\u00e4g vikten av andra l\u00e4kemedel eller om de kan ers\u00e4ttas med andra l\u00e4kemedel<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Cerebral TCI\/cerebral apoplexi eller hj\u00e4rtinfarkt f\u00f6r mer \u00e4n 1 m\u00e5nad sedan<\/span><\/span><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">TKI kan f\u00f6rv\u00e4rra dessa tillst\u00e5nd. Patienten\/n\u00e4rst\u00e5ende m\u00e5ste informeras om detta behandlingskriterium \u00e4ventyras<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Ingen st\u00f6rre operation inom 4 veckor<\/span><\/span><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">TKI f\u00f6rs\u00e4mrar s\u00e5rl\u00e4kningen. S\u00e5ret m\u00e5ste d\u00e4rf\u00f6r vara v\u00e4l l\u00e4kt innan TKI s\u00e4tts in<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">MR-unders\u00f6kning av cerebrum utan cerebrala metastaser<\/span><\/span><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Vid cerebrala metastaser:<\/span><\/span><br \/>\n1) <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Om patienten \u00e4r asymtomatisk och har 1\u20133 cerebrala metastaser, \u00f6verv\u00e4g str\u00e5lbehandling. TKI kan s\u00e4ttas in men m\u00e5ste s\u00e4ttas ut tillf\u00e4lligt i samband med str\u00e5lbehandling<\/span><\/span><br \/>\n2) <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Om patienten \u00e4r symtomatisk och har 1\u20133 cerebrala metastaser, p\u00e5b\u00f6rja steroidbehandling enligt riktlinjer och \u00f6verv\u00e4g str\u00e5lning. TKI kan s\u00e4ttas in<\/span><\/span><br \/>\n3) <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Om patienten har flera cerebrala metastaser men \u00e4r asymtomatisk. S\u00e4tt in TKI<\/span><\/span><br \/>\n4) <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Om patienten har multipla metastaser och har symtom, p\u00e5b\u00f6rja steroidbehandling och \u00f6verv\u00e4g helhj\u00e4rnsstr\u00e5lning innan TKI s\u00e4tts in<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">DT br\u00f6st och buk <\/span><\/span> &lt; 1 <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">m\u00e5nad<\/span><\/span><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Om DT vid baslinjen \u00e4r <\/span><\/span>&gt; 1 <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">m\u00e5nad<\/span><\/span>, <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">\u00f6verv\u00e4g att best\u00e4lla en subakut DT som ny baslinje<\/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;\">L\u00e4nkar till produktresum\u00e9n i tabellen:<\/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\">Axitinib<\/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;\">Anvisningar f\u00f6r patient\/anh\u00f6rig<\/h4><\/div><div class=\"fusion-text fusion-text-9\"><ul>\n<li>Blodtrycksm\u00e4tning<\/li>\n<li>Dosera st\u00f6djande l\u00e4kemedel (<a class=\"exitNotifierLink\" href=\"https:\/\/pro.medicin.dk\/medicin\/praeparater\/3558\" target=\"_blank\" rel=\"noopener noreferrer\">Domperidon<\/a>, <a class=\"exitNotifierLink\" href=\"https:\/\/pro.medicin.dk\/Medicin\/Praeparater\/9324\" target=\"_blank\" rel=\"noopener noreferrer\">loperamid<\/a>, kr\u00e4m f\u00f6r h\u00e4nder och f\u00f6tter, munv\u00e5rdsprodukter)<\/li>\n<li>Blodprover mellan cykler (<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>: midway through cycle 2 and 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>: halvv\u00e4gs genom cykel 2 och 3; <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 cykel 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>: halvv\u00e4gs genom cykel 1, 2 och 3)<\/li>\n<li>Hantering av biverkningar och tillhandah\u00e5llande av dagbok + CTC-formul\u00e4r<\/li>\n<li>Kontakt med avdelningen vid oacceptabla biverkningar<\/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;\">Bed\u00f6mning under TKI-behandling<\/h4><\/div><div class=\"fusion-text fusion-text-10\"><p>Patienten bed\u00f6ms p\u00e5 \u00f6ppenv\u00e5rdsmottagningen av l\u00e4kare eller sjuksk\u00f6terska var 4:e till 6:e vecka d\u00e4r f\u00f6ljande utf\u00f6rs:<\/p>\n<ul>\n<li>Klinisk bed\u00f6mning och kontroll av blodtryck, puls, vikt, temperatur och syrem\u00e4ttnad, om till\u00e4mpligt<\/li>\n<li>Toxicitetsregistrering enligt CTCAE version 5.0 <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/mrcc-tool\/5-toxicity-management\/5-1-adverse-reactions-to-targeted-treatment\/\">(se avsnittet om klassificering)<\/a><\/li>\n<li>Kontroll av blodprover (hematologi, v\u00e4tskev\u00e4rden inkl. joniserat kalcium + magnesium, leverv\u00e4rden, CRP + TSH)<\/li>\n<li>L\u00e4kemedelsstatus<\/li>\n<li>Bed\u00f6mning av nya symtom<\/li>\n<li>Beslut om dosjustering och\/eller andra \u00e5tg\u00e4rder <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/mrcc-tool\/5-toxicity-management\/5-2-management-of-tki-side-effects\/\">(se avsnittet om hantering av biverkningar)<\/a><\/li>\n<li>Urinsticka f\u00f6r proteinuri (var 3:e m\u00e5nad)<\/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;\">Utv\u00e4rdering av behandlingssvar<\/h4><\/div><div class=\"fusion-text fusion-text-11\"><p>Effekten av TKI bed\u00f6ms var 3:e m\u00e5nad. (Vecka 12) med datortomografi av thorax och buk samt MR av hj\u00e4rnan vid k\u00e4nda hj\u00e4rnmetastaser.<\/p>\n<p>Bed\u00f6mning av behandlingssvaret beror p\u00e5:<\/p>\n<ol>\n<li>Allm\u00e4ntillst\u00e5nd<\/li>\n<li>Biokemi (s\u00e4rskilt Hb, neutrofiler, trombocyter, joniserat kalcium, LDH och CRP)<\/li>\n<li>DT thorax och buk<\/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;\">Referenser<\/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\/sv\/mrcc-tool\/3-management-of-mrcc\/3-3-treatment-criteria-for-initiation-of-checkpoint-inhibitors\/\"><span class=\"fusion-button-text\">Forts\u00e4tt till n\u00e4sta avsnitt: 3.3 Behandlingskriterier f\u00f6r initiering av checkpointh\u00e4mmare<\/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;\"><p style=\"text-align: center;\">Utforska den h\u00e4r kapitelmenyn<\/p><\/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\/sv\/mrcc-tool\/3-management-of-mrcc\/3-1-treatment-algorithm\/\"><span class=\"fusion-button-text\">3.1 Behandlingsalgoritm<\/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\/sv\/mrcc-tool\/3-management-of-mrcc\/3-2-treatment-criteria-for-initiation-of-tki\/\"><span class=\"fusion-button-text\">3.2 Behandlingskriterier vid ins\u00e4ttning 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\/sv\/mrcc-tool\/3-management-of-mrcc\/3-3-treatment-criteria-for-initiation-of-checkpoint-inhibitors\/\"><span class=\"fusion-button-text\">3.3 Behandlingskriterier f\u00f6r initiering av checkpointh\u00e4mmare<\/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\/sv\/mrcc-tool\/3-management-of-mrcc\/3-4-response-evaluation\/\"><span class=\"fusion-button-text\">3.4 Utv\u00e4rdering av behandlingssvar<\/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\/sv\/mrcc-tool\/3-management-of-mrcc\/3-5-malignant-hypercalcaemia\/\"><span class=\"fusion-button-text\">3.5 Malign hyperkalcemi<\/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\/sv\/mrcc-tool\/3-management-of-mrcc\/3-6-performance-status\/\"><span class=\"fusion-button-text\">3.6 Funktionsstatus (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":7514,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7522","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7522","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/comments?post=7522"}],"version-history":[{"count":34,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7522\/revisions"}],"predecessor-version":[{"id":11173,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7522\/revisions\/11173"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7514"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/media?parent=7522"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}