Opdivo® is an immunotherapy that is a monoclonal antibody. Antibodies are a normal part of the immune system that attach to antigens (such as germs) to mark them for destruction by the immune system. Monoclonal antibodies are created in a laboratory to attach to specific antigens on the surface of cancer cells. Nivolumab targets the PD-1 receptor and blocks the interaction with the proteins which bind to the receptor, PD-L1 and PD-L2. Some cancer cells affect the PD-1 pathway. When this pathway is affected by the cancer cells, the cancer can grow and spread without being kept in check by the T-cells and the immune system. By blocking the PD-1 pathway, nivolumab can help the body’s T-cells and immune system fight the cancer.1,2
Treating lung cancer with nivolumab
Nivolumab is used to treat patients with metastatic (spread to distant parts of the body) non-small cell lung cancer (NSCLC) that has progressed after being treated with chemotherapy containing platinum. If the patient’s tumor has an abnormal EGFR or ALK gene, treatment for these abnormalities with an approved therapy should be tried and did not work, or is no longer working, before treatment with nivolumab.
Additionally, nivolumab may be an option for some patients with small cell lung cancer (SCLC) where the cancer is metastatic and has gotten worse after receiving platinum based chemotherapy and at least one other form of treatment. Nivolumab is also used to treat other types of cancer, such as melanoma, renal cell carcinoma (a form of kidney cancer), and Hodgkin lymphoma.1,2
Nivolumab is also approved to treat certain forms of NSCLC in combination with another immunotherapy medication, Yervoy (ipilimumab). Depending on the specific form of NSCLC, this combination may be used with or without chemotherapy.3
Nivolumab is given as an infusion that is administered through an IV (intravenous) line. The dosage of Opdivo is determined based on the type of cancer, and may take into account a patient's weight.2
Side effects of nivolumab
Nivolumab may cause side effects, and in some cases, these side effects can be severe. Any side effects should be reported to a health care professional. Side effects experienced in greater than approximately 30 percent of patients taking nivolumab include fatigue, lymphocytopenia (a low count of a specific type of white blood cell which may increase the risk of infection), low sodium, shortness of breath, musculoskeletal pain, decreased appetite, and cough.
Less common side effects experienced in approximately 10-29 percent of patients receiving Opdivo include nausea, low red blood cells (anemia), constipation, increased creatinine in the blood (creatinine is used to monitor kidney function), colitis (inflammation of the colon), high or low potassium, low magnesium, high or low calcium, vomiting, weakness, diarrhea, swelling, fever, rash, abdominal pain, low blood platelets (increasing the risk of bruising or bleeding), chest pain, weight loss, joint pain, itching, pneumonia, and pain.
Rarely, Opdivo can cause severe immune-mediated side effects, including pneumonitis (inflammation in the air sacs of the lungs), colitis, hepatitis (inflammation in the liver), nephritis (kidney inflammation) and renal dysfunction, hypothyroidism or hyperthyroidism. Patients receiving nivolumab should seek medical care immediately if they experience any of the following symptoms: fever of 100.4°F (38°C) or higher, chills, or signs of an allergic reaction, including rash, hives, itching, red or peeling skin, blisters, tightness in the chest or throat, wheezing, trouble breathing or talking, unusual hoarseness, or swelling of the lips, mouth, face, throat, or tongue. For most people, side effects from nivolumab are reversible and tend to go away after treatment is complete.2
This is not an exhaustive list of all potential side effects of nivolumab. Talk to your healthcare provider or pharmacist for further information.
Patients receiving nivolumab should talk to their doctor about any other medications (prescription and over-the-counter), herbal remedies, and any supplements they are taking, as well as any other health conditions.
Patients who are pregnant or may become pregnant during treatment should discuss their condition with their doctor prior to starting nivolumab, as it may be hazardous to the fetus. Women who could become pregnant should use birth control while receiving nivolumab and for at least 5 months following the final dose (patients should discuss appropriate birth control methods with their doctor). It is not known whether nivolumab passes into breast milk, and women should not breastfeed while receiving nivolumab and for 5 months following the final dose. Patients should talk to their doctor if they have any questions, or if they have questions regarding their nivolumab regimen.2