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Opdivo (nivolumab)

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 the interaction with the molecules 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

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 with an approved therapy should be tried and did not work or is no longer working. Currently, nivolumab may be used for certain patients with metastatic SCLC with progression after platinum-based chemotherapy and at least one other line of therapy. 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

Receiving nivolumab

Nivolumab is given as an infusion that is administered through an IV (intravenous) line over 30 minutes. 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 30% 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 10-29% 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. Side effects from Opdivo are almost always reversible and tend to go away after treatment is complete.2

Precautions

Patients receiving nivolumab should talk to their doctor about other medications, herbal remedies, and any supplements they are taking, as well as any other health conditions. Patients should talk to their doctor before receiving immunizations or vaccinations while taking nivolumab to make sure they are appropriate. 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. It is not recommended for men or women to conceive a child while taking nivolumab, and patients are advised to use contraception, such as condoms. It is not known whether nivolumab passes into breast milk, and patients should not breastfeed while taking Opdivo.2

Written by: Emily Downward | Last reviewed: April 2019.
  1. Opdivo product website, Bristol-Myers Squibb Company. Accessed online on 9/29/16 at http://www.opdivo.bmscustomerconnect.com/advanced-nsclc.
  2. Chemocare. Accessed online on 9/27/16 at http://chemocare.com/chemotherapy/drug-info/Nivolumab.aspx.