Opdivo (Nivolumab)

Opdivo is an immunotherapy that acts on the PD‑1 pathway and is indicated for several advanced malignancies.

• Melanoma: improves survival in patients with unresectable or metastatic disease.
• Non‑small cell lung cancer (NSCLC): used in combination with chemotherapy for first‑line treatment.
• Renal cell carcinoma: used as monotherapy for advanced disease.
• Classical Hodgkin lymphoma: provides durable responses in relapsed or refractory cases.
• Head and neck squamous cell carcinoma: used after platinum‑based therapy failure.
• Urothelial carcinoma: used in patients who have progressed after platinum‑containing regimens.

• Nivolumab is a fully human IgG4 monoclonal antibody that binds to the programmed death‑1 (PD‑1) receptor on T‑cells, blocking its interaction with PD‑L1 and PD‑L2 ligands. This inhibition releases the brake on the immune system, allowing T‑cells to recognise and destroy tumour cells more effectively.

Opdivo may cause a range of immune‑related adverse reactions.

Common Side Effects

• Fatigue
• Rash
• Diarrhoea
• Nausea
• Musculoskeletal pain
• Pruritus

Serious or Rare Side Effects

• Immune‑mediated pneumonitis
• Hepatitis
• Colitis
• Endocrine disorders (e.g., hypothyroidism, adrenal insufficiency)
• Severe skin reactions such as Stevens‑Johnson syndrome
• Nephritis

Before initiating Opdivo, clinicians should assess patient history and monitor for immune‑related events.

• Baseline testing: obtain baseline organ function labs and thyroid panel.
• Autoimmune disease: evaluate risk in patients with pre‑existing autoimmune conditions.
• Concomitant immunosuppression: avoid unless medically necessary.
• Pregnancy and lactation: weigh potential risks and benefits; use only if clearly indicated.
• Infusion reactions: be prepared to manage acute reactions during administration.
• Store at 2‑8°C: keep refrigerated, protect from light, do not freeze or shake.

Opdivo has a limited interaction profile, but certain co‑medications require attention.

Major Interactions (Avoid)

• Live vaccines: concurrent use may lead to uncontrolled infection.

Moderate Interactions (Monitor Closely)

• Systemic corticosteroids: may diminish therapeutic efficacy if used long‑term.
• Other immune checkpoint inhibitors: increased risk of severe immune‑related adverse events.
• Anticoagulants: monitor for bleeding if immune‑mediated thrombocytopenia occurs.
• CYP450 substrates: no direct effect, but monitor clinical response if hepatic function changes.
• Herbal supplements: potential for unpredictable immune modulation.