{"id":7526,"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":"2024-03-28T17:52:43","modified_gmt":"2024-03-28T17:52:43","slug":"3-3-treatment-criteria-for-initiation-of-checkpoint-inhibitors","status":"publish","type":"page","link":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/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\/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;\">3.3 Behandlingskriterier f\u00f6r initiering av checkpointh\u00e4mmare<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\u00f6rsta linjens behandling eller nivolumab som andra eller tredje linjens behandling).<\/p>\n<p>Checkpointh\u00e4mmare (CPI) \u00e4r f\u00f6r de flesta patienter palliativ behandling i syfte att lindra symtom och f\u00f6rl\u00e4nga livet. Vissa patienter uppn\u00e5r dock komplett respons under en kortare eller l\u00e4ngre tidsperiod.<\/p>\n<p>Checkpointh\u00e4mmare ges intraven\u00f6st antingen var 3:e vecka (kombinationsimmunterapi) \u2013 totalt 4 cykler \u2013 varefter <a class=\"exitNotifierLink\" href=\"https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/opdivo-epar-product-information_da.pdf\">Nivolumab<\/a> ges ensamt eller var 4:e vecka (monoterapi) dvs. en cykel str\u00e4cker sig \u00f6ver 3 eller 4 veckor. Patienten utv\u00e4rderas med datortomografi av thorax och buk (och MR-unders\u00f6kning av hj\u00e4rnan vid cerebrala metastaser) var 3:e m\u00e5nad.<\/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;\">Vid f\u00f6rsta linjens kombinationsimmunterapi:<\/h5><\/div><div class=\"fusion-text fusion-text-2\"><ul>\n<li>Medianv\u00e4rdet f\u00f6r progressionsfri \u00f6verlevnad (mPFS) hos patienter som tillh\u00f6r gruppen med medell\u00e5ng eller d\u00e5lig prognos \u00e4r 11,6 m\u00e5nader. Medianv\u00e4rdet f\u00f6r total \u00f6verlevnad (mOS) \u00e4r \u00e4nnu inte k\u00e4nt (data \u00e4nnu inte mogna)<\/li>\n<li>Enligt <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/mrcc-tool\/3-management-of-mrcc\/3-4-response-evaluation\/\">RECIST <\/a>-kriterierna har 72,7 % av patienterna effekt av behandling med antingen<span style=\"font-family: var(--awb-text-font-family); font-size: var(--awb-font-size); font-style: var(--awb-text-font-style); letter-spacing: var(--awb-letter-spacing); text-align: var(--awb-content-alignment); text-transform: var(--awb-text-transform);\">:<\/span><\/li>\n<\/ul>\n<ol>\n<li>\n<ol>\n<li>Komplett respons (CR) \u2013 10.1%<\/li>\n<li>Partiell respons (PR) \u2013 32%<\/li>\n<li>Stabil sjukdom (SD) \u2013 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;\">F\u00f6r andra och tredje linjens <a class=\"exitNotifierLink\" style=\"font-family: var(--h5_typography-font-family); font-size: 1em; font-style: var(--h5_typography-font-style,normal); font-weight: var(--h5_typography-font-weight); letter-spacing: var(--h5_typography-letter-spacing); text-transform: var(--h5_typography-text-transform);\" href=\"https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/opdivo-epar-product-information_da.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Nivolumab<\/a><span style=\"font-family: var(--h5_typography-font-family); font-size: 1em; font-style: var(--h5_typography-font-style,normal); font-weight: var(--h5_typography-font-weight); letter-spacing: var(--h5_typography-letter-spacing); text-transform: var(--h5_typography-text-transform);\"> (<\/span>monoterapi<span style=\"font-family: var(--h5_typography-font-family); font-size: 1em; font-style: var(--h5_typography-font-style,normal); font-weight: var(--h5_typography-font-weight); letter-spacing: var(--h5_typography-letter-spacing); text-transform: var(--h5_typography-text-transform);\">):<\/span><\/h5><\/div><div class=\"fusion-text fusion-text-3\"><ul>\n<li>mPFS \u00e4r 4,6 m\u00e5nader och mOS \u00e4r 25 m\u00e5nader<\/li>\n<li>Enligt <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/mrcc-tool\/3-management-of-mrcc\/3-4-response-evaluation\/\">RECIST kriterierna<\/a>, har 59 % av patienterna antingen:\n<ol>\n<li>Komplett respons (CR) \u2013 1%<\/li>\n<li>Partiell respons (PR) \u2013 24%<\/li>\n<li>Stabil sjukdom (SD) \u2013 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\u00f6rsta bes\u00f6ket p\u00e5 onkologiska avdelningen<\/h4><\/div><div class=\"fusion-text fusion-text-4\"><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-5 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-5\"><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:<\/li>\n<\/ul>\n<ol>\n<li style=\"list-style-type: none;\">\n<ol>\n<li>Immunsuppressiv behandling, vilken och varf\u00f6r<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<ul>\n<li>Sociala uppgifter<\/li>\n<\/ul>\n<ol>\n<li style=\"list-style-type: none;\">\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<\/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 bed\u00f6mning:<\/h5><\/div><div class=\"fusion-text fusion-text-6\"><ul>\n<li>Allm\u00e4ntillst\u00e5nd (bra, akut eller kroniskt tillst\u00e5nd) inkl. <a class=\"exitNotifierLink\" href=\"https:\/\/mrcc-tool.com\/haandtering-af-mrcc\/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-7 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-7\"><p>Vid det f\u00f6rsta \u00f6ppenv\u00e5rdsbes\u00f6ket ska f\u00f6ljande unders\u00f6kas:<\/p>\n<ul>\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, TSH, kortisol, testosteron (man), amylas, CK-MB och troponin<\/li>\n<li>Vid kombinationsimmunterapi: CK-MB och troponin<\/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-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\u00f6ljande kriterier ska vara uppfyllda i samband med initiering av checkpointh\u00e4mmare. 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\u00a0\u2013 klarcellig histologi med intermedi\u00e4r eller d\u00e5lig prognos om i kombination med immunterapi<\/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):<\/span><\/span><br \/>\n<span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Monoterapi<\/span><\/span> &lt; 2<br \/>\n<span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Kombinationsbehandling<\/span><\/span> &lt; 1<\/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\">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\">Checkpointh\u00e4mmare uts\u00f6ndras inte via njurarna. Kan d\u00e4rf\u00f6r erbjudas patienter med nedsatt njurfunktion, men m\u00e5ste diskuteras med en specialist<\/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 \/>\n<span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">ASAT<\/span><\/span>\/<span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">ALAT<\/span><\/span> &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\"><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">EKG<\/span><\/span><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<\/span><\/span> (EF) &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\">Ovanst\u00e5ende krav \u00e4r s\u00e4rskilt viktiga vid kombinationsimmunterapi<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Inga autoimmuna sjukdomar<\/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\">Undantag:<\/span><\/span><br \/>\n\u2022 <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">V\u00e4lreglerad typ 1-diabetes<\/span><\/span><br \/>\n\u2022 <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Hypotyreos efter autoimmun tyreoidit som endast kr\u00e4ver substitutionsbehandling<\/span><\/span><br \/>\n\u2022 <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Vitiligo<\/span><\/span><br \/>\n<span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Vid andra autoimmuna sjukdomar, kontakta specialist<\/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 <\/span><\/span>\u00a0<span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">eller annan immunsuppressiv behandling<\/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\">Inhalationssteroid eller behandling av binjurebarksinsufficiens (hydrokortison) \u00e4r till\u00e5ten<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Ingen k\u00e4nd hiv eller hepatit B eller C<\/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\">MR-unders\u00f6kning av cerebrum \u00a0utan 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, remittera till SRK-konferens f\u00f6r str\u00e5lbehandling. CPI kan s\u00e4ttas in<\/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 riktlinjerna och remittera till SRK-konferens.<\/span><\/span><br \/>\n<span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">CPI kan inte s\u00e4ttas in f\u00f6rr\u00e4n prednisolonbehandlingen har satts ut<\/span><\/span><br \/>\n3) <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">om patienten har multipla cerebrala metastaser men \u00e4r asymtomatisk. S\u00e4tt in CPI<\/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. S\u00e4tt in TKI-behandling och \u00f6verv\u00e4g helhj\u00e4rnsstr\u00e5lning<\/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 baslinjes-DT \u00e4r &amp;gt; 1 m\u00e5nad, \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-9 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\u00e9er:<\/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\">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;\">Anvisningar f\u00f6r patient\/anh\u00f6rig<\/h4><\/div><div class=\"fusion-text fusion-text-10\"><ul>\n<li>G\u00e5 igenom immunrelaterade biverkningar och cirkulerande tum\u00f6rceller och betona vikten av att kontakta avdelningen vid symtom<\/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> och <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;\">Bed\u00f6mning under behandling<\/h4><\/div><div class=\"fusion-text fusion-text-11\"><p>Patienten bed\u00f6ms p\u00e5 \u00f6ppenv\u00e5rdsmottagningen av l\u00e4kare eller sjuksk\u00f6terska var 3:e eller 4:e vecka med:<\/p>\n<ul>\n<li>Klinisk bed\u00f6mning och kontroll av blodtryck, puls, vikt, temperatur och syrem\u00e4ttnad, om till\u00e4mpligt<\/li>\n<li>Registrering av toxiciteter 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, leverfunktionstester, CRP, TSH, kortisol, testosteron (man), amylas + CK-MB och troponin under kombinationsimmunterapi)<\/li>\n<li>L\u00e4kemedelsstatus<\/li>\n<li>Bed\u00f6mning av nya symtom<\/li>\n<li>Beslut om behandlingsuppeh\u00e5ll eller andra \u00e5tg\u00e4rder <a class=\"exitNotifierLink\" href=\"https:\/\/mrcc-tool.com\/haandtering-af-toksiciteter\/io\/\">(se avsnittet om biverkningar av checkpointh\u00e4mmare)<\/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;\">Utv\u00e4rdering av behandlingssvar<\/h4><\/div><div class=\"fusion-text fusion-text-12\"><p>Effekten av checkpointh\u00e4mmare bed\u00f6ms var 3:e m\u00e5nad. (Vecka 12) med datortomografi av thorax och buk samt MR-unders\u00f6kning av cerebrum 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-13 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-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\/sv\/mrcc-tool\/3-management-of-mrcc\/3-4-response-evaluation\/\"><span class=\"fusion-button-text\">Forts\u00e4tt till n\u00e4sta avsnitt: 3.4 Utv\u00e4rdering av behandlingssvar<\/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;\"><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-7526","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7526","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=7526"}],"version-history":[{"count":19,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7526\/revisions"}],"predecessor-version":[{"id":11174,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7526\/revisions\/11174"}],"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=7526"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}