{"id":7622,"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":"2024-03-28T17:58:18","modified_gmt":"2024-03-28T17:58:18","slug":"5-3-adverse-reactions-to-checkpoint-inhibitors","status":"publish","type":"page","link":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/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\/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;\">5.3 Biverkningar av checkpointh\u00e4mmare<\/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>Biverkningar relaterade till immunterapi med checkpointh\u00e4mmare:<\/p>\n<ul>\n<li>CTLA-4-h\u00e4mmare<\/li>\n<li>PD-1-h\u00e4mmare<\/li>\n<li>PD-L1-h\u00e4mmare<\/li>\n<\/ul>\n<\/div>\n<\/section>\n<section class=\"av_textblock_section \">\n<div class=\"avia_textblock \">\n<p>N\u00e4r checkpointh\u00e4mmare anv\u00e4nds f\u00f6r att behandla cancer \u00e4r det inte bara cancercellerna som p\u00e5verkas av det \u00f6kade immunsvaret, utan behandlingen bromsar ocks\u00e5 den naturliga h\u00e4mningen av immunsystemet. Detta kan skapa en obalans i immunologisk sj\u00e4lvtolerans med risk f\u00f6r utveckling av immunrelaterade biverkningar.<\/p>\n<p>Vissa organsystem drabbas oftare av immunrelaterade biverkningar (hudutslag, diarr\u00e9, hypertyreos\/hypotyreos och tr\u00f6tthet) \u00e4n andra, men alla organsystem kan p\u00e5verkas.<\/p>\n<p><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);\">De allra flesta immunrelaterade biverkningarna \u00e4r reversibla om de behandlas i tid. Det \u00e4r d\u00e4rf\u00f6r viktigt att reagera tidigt och adekvat p\u00e5 immunrelaterade biverkningar. Det \u00e4r viktigt att patienten \u00e4r v\u00e4linformerad och underr\u00e4ttad om att kontakta \u00f6ppenv\u00e5rdsmottagningen vid misstanke om immunrelaterade biverkningar.<\/span><sup>1<\/sup><\/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\" src=\"https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/08\/16120600\/5.3_1.jpg\" alt class=\"img-responsive wp-image-6565\" srcset=\"https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/08\/16120600\/5.3_1-500x330.jpg 500w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/08\/16120600\/5.3_1-700x462.jpg 700w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/08\/16120600\/5.3_1.jpg 1556w\" sizes=\"(max-width: 1556px) 100vw, 1556px\" \/><\/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 immunrelaterade biverkningar<\/h4><\/div><div class=\"fusion-text fusion-text-2\"><section class=\"av_textblock_section \">\n<div class=\"avia_textblock \">\n<p>Immunrelaterade biverkningar graderas enligt CTCAE (Common Terminology Criteria for Adverse Events) version 5, se <a href=\"http:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/mrcc-tool\/5-toxicity-management\/5-1-adverse-reactions-to-targeted-treatment\/\">avsnittet om biverkningar av m\u00e5lriktad 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;\">Frekvens av immunrelaterade biverkningar (monoterapi kontra kombinationsterapi)<\/h4><\/div><div class=\"fusion-text fusion-text-3\"><section class=\"av_textblock_section \">\n<div class=\"avia_textblock \">\n<p>Kombinerad immunterapi \u00e4r f\u00f6renad med allvarligare immunrelaterade biverkningar (immunmedierade biverkningar) (grad 3\u20134) (CTLA-4-h\u00e4mmare + PD-1-h\u00e4mmare) \u00e4n 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\"><\/th>\n<th align=\"left\">ALLA GRADER AV IMMUNRELATERADE BIVERKNINGAR<\/th>\n<th align=\"left\">IMMUNRELATERADE BIVERKNINGAR AV 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-h\u00e4mning<\/span><\/span><\/td>\n<td align=\"left\">60% <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">till<\/span><\/span> 85%<\/td>\n<td align=\"left\">10% <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">till<\/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-h\u00e4mning<\/span><\/span><\/td>\n<td align=\"left\">58% <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">till<\/span><\/span> 85%<\/td>\n<td align=\"left\">7% <span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">till<\/span><\/span> 20%<\/td>\n<\/tr>\n<tr>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Kombination av CTLA-4-\/PD-1-h\u00e4mning&#8221;<\/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>Kombinationsbehandling med CTLA-h\u00e4mmare + PD-1-h\u00e4mmare \u00e4r f\u00f6renad med st\u00f6rst risk<\/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 hos immunrelaterade biverkningar<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>Flera immunrelaterade biverkningar kan upptr\u00e4da hos samma patient samtidigt eller intermittent \u00f6ver tid<\/li>\n<li>Kan vara allt fr\u00e5n \u00f6verg\u00e5ende till allvarliga och livshotande<\/li>\n<li>Immunrelaterade biverkningar kan ocks\u00e5 uppst\u00e5 efter avslutad behandling (\u00e4ven efter flera m\u00e5nader)<\/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;\">Hantering av immunrelaterade biverkningar<sup>5<\/sup><\/h4><\/div><div class=\"fusion-text fusion-text-6\"><p>Den \u00f6vergripande strategin f\u00f6r hantering av immunrelaterade biverkningar listas nedan, beroende p\u00e5 sv\u00e5righetsgrad. Immunsuppressiv behandling, i form av kortikosteroider, utg\u00f6r en h\u00f6rnsten i behandlingen av immunrelaterade biverkningar.<\/p>\n<\/div>\n<div class=\"table-1\">\n<table width=\"100%\">\n<thead>\n<tr>\n<th align=\"left\">GRAD<\/th>\n<th align=\"left\">\u00d6PPENV\u00c5RD\/SJUKHUSV\u00c5RD<\/th>\n<th align=\"left\">KORTIKOSTEROID:<br \/>\nPREDNISOLON<\/th>\n<th align=\"left\">ANDRA<br \/>\nIMMUNREPRESSIVA L\u00c4KEMEDEL<\/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\">\u00d6ppenv\u00e5rd<\/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\u00e4tter<\/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\">\u00d6ppenv\u00e5rd<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Topiskt eller systemiskt<\/span><\/span><br \/>\n<span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">0,5\u20131 mg\/kg<\/span><\/span><\/td>\n<td align=\"left\">&#8211;<\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">G\u00f6r ett tillf\u00e4lligt uppeh\u00e5ll och \u00e5teruppta vanligen behandlingen vid 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\">Sjukhusinl\u00e4ggning<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Systemisk, oral eller i.v.<\/span><\/span><br \/>\n<span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">1\u20132 mg\/kg<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">\u00d6verv\u00e4g om ingen respons efter 3\u20135 dagars kortikosteroidbehandling<br \/>\nR\u00e5dg\u00f6r med specialist<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Avbryt och diskutera \u00e5terins\u00e4ttning p\u00e5 basis av individuell bed\u00f6mning av patienten<\/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\">Sjukhusinl\u00e4ggning<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Systemisk, i.v.<\/span><\/span><br \/>\n<span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">1\u20132 mg\/kg<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">\u00d6verv\u00e4g om ingen respons efter 3\u20135 dagars kortikosteroidbehandling<br \/>\nR\u00e5dg\u00f6r med specialist<\/span><\/span><\/td>\n<td align=\"left\"><span aria-labelledby=\"value\"><span class=\"objectBox objectBox-string\">Avbryt i.v.<\/span><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<div class=\"fusion-text fusion-text-7\"><p><small>i.v. = intraven\u00f6st; 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;\">Riktlinjer f\u00f6r utv\u00e4rdering och behandling av immunrelaterade biverkningar<sup>2,5,6,7<\/sup><\/h4><\/div><div class=\"fusion-text fusion-text-8\"><p>M\u00e5nga riktlinjer har tagits fram f\u00f6r bed\u00f6mning och behandling av immunrelaterade biverkningar (ESMO, NCCN, ASCO osv.). En dansk riktlinje har ocks\u00e5 tagits fram f\u00f6r vilken en app, <a class=\"exitNotifierLink\" href=\"https:\/\/free.mymedcards.dk\/cards\/rKqtEBhvumU9PDTr2MmV-immuntox-introduktion-samt-patient-og-laegebrev-og-blodproever\" target=\"_blank\" rel=\"noopener noreferrer\">MyMedCards<\/a>, har skapats och kan laddas ned kostnadsfritt:<\/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\" src=\"https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/12\/16120118\/5.3_2.jpg\" alt class=\"img-responsive wp-image-10126\" srcset=\"https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/12\/16120118\/5.3_2-200x121.jpg 200w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/12\/16120118\/5.3_2-400x242.jpg 400w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/12\/16120118\/5.3_2-600x363.jpg 600w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/12\/16120118\/5.3_2-800x485.jpg 800w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/12\/16120118\/5.3_2.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;\">F\u00f6rebyggande och behandling av immunrelaterade biverkningar<sup>8<\/sup><\/h4><\/div><div class=\"fusion-text fusion-text-9\"><p>Det finns flera faktorer som \u00e4r viktiga n\u00e4r det g\u00e4ller att f\u00f6rebygga och behandla immunrelaterade biverkningar p\u00e5 ett adekvat s\u00e4tt, bland annat identifiering av m\u00f6jliga riskfaktorer, utbildning av patienter\/v\u00e5rdare och l\u00e4kare\/sjuksk\u00f6terskor. Se nedan.<\/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\" src=\"https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/12\/16120110\/5.3_3.jpg\" alt class=\"img-responsive wp-image-10165\" srcset=\"https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/12\/16120110\/5.3_3-200x140.jpg 200w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/12\/16120110\/5.3_3-400x281.jpg 400w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/12\/16120110\/5.3_3-600x421.jpg 600w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/12\/16120110\/5.3_3-800x561.jpg 800w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/12\/16120110\/5.3_3-1200x842.jpg 1200w, https:\/\/wave-eu-west-1.s3.eu-west-1.amazonaws.com\/websites\/oncologynow_eu\/wp-content\/uploads\/2023\/12\/16120110\/5.3_3.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;\">Referenser<\/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\/sv\/mrcc-tool\/5-toxicity-management\/5-4-interactions-between-medicinal-products\/\"><span class=\"fusion-button-text\">Forts\u00e4tt till n\u00e4sta avsnitt: 5.4 L\u00e4kemedelsinteraktioner<\/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;\">Utforska den h\u00e4r kapitelmenyn<\/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\/sv\/mrcc-tool\/5-toxicity-management\/5-1-adverse-reactions-to-targeted-treatment\/\"><span class=\"fusion-button-text\">5.1 Biverkningar av m\u00e5lriktad 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\/sv\/mrcc-tool\/5-toxicity-management\/5-2-management-of-tki-side-effects\/\"><span class=\"fusion-button-text\">5.2 Hantering av TKI-biverkningar<\/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\/5-toxicity-management\/5-3-adverse-reactions-to-checkpoint-inhibitors\/\"><span class=\"fusion-button-text\">5.3 Biverkningar 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\/5-toxicity-management\/5-4-interactions-between-medicinal-products\/\"><span class=\"fusion-button-text\">5.4 L\u00e4kemedelsinteraktioner<\/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":7570,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7622","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7622","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=7622"}],"version-history":[{"count":24,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7622\/revisions"}],"predecessor-version":[{"id":10211,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7622\/revisions\/10211"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7570"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/media?parent=7622"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}