Opdivo (Nivolumab)

• Opdivo (nivolumab) is used in oncology to block the PD‑1 pathway, restoring immune surveillance against tumor cells.
• Melanoma: improves overall survival in patients with unresectable or metastatic disease.
• Non‑small cell lung cancer: prolongs progression‑free and overall survival in advanced NSCLC.
• Renal cell carcinoma: enhances response rates in metastatic RCC.
• Classical Hodgkin lymphoma: achieves durable remissions in relapsed or refractory disease.
• Urothelial carcinoma: provides clinical benefit in advanced bladder cancer after prior therapy.
• Head and neck squamous cell carcinoma: increases survival in recurrent or metastatic disease.

• Nivolumab is a fully human IgG4 monoclonal antibody that binds with high affinity to the programmed death‑1 (PD‑1) receptor on activated T‑lymphocytes. By preventing interaction with its ligands PD‑L1 and PD‑L2, the drug releases the inhibitory checkpoint that normally limits T‑cell activity, thereby enhancing tumor‑specific immune responses and facilitating cancer cell elimination.

Nivolumab may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Fatigue: persistent tiredness affecting daily activities.
• Rash: mild skin eruptions that may be itchy.
• Diarrhea: loose stools that can lead to dehydration.
• Nausea: feeling of sickness often without vomiting.

Serious or Rare Side Effects

• Pneumonitis: inflammation of lung tissue that can cause breathing difficulty.
• Hepatitis: liver inflammation presenting with elevated enzymes and jaundice.
• Endocrinopathies: immune‑related thyroid or adrenal dysfunction requiring hormone replacement.

Before initiating Opdivo, several safety considerations should be reviewed.

• Baseline assessment: conduct complete blood count, liver function tests, and thyroid panel prior to therapy.
• Autoimmune history: avoid use in patients with active autoimmune disease unless benefits outweigh risks.
• Concomitant immunosuppression: monitor closely if patient receives steroids or other immunosuppressants.
• Infection risk: screen for active infections, especially hepatitis B/C and HIV, and treat before starting.
• Pregnancy and lactation: drug safety not established; avoid use in pregnant or breastfeeding women.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Nivolumab can interact with other medicines, influencing efficacy or safety.

Major Interactions (Avoid)

• Live vaccines: concurrent administration may cause severe infection; avoid.
• Strong immunosuppressants: agents such as high‑dose corticosteroids can diminish therapeutic effect.

Moderate Interactions (Monitor Closely)

• Anticoagulants: increased risk of bleeding if immune‑related thrombocytopenia occurs.
• CYP‑modulating drugs: not a major pathway but monitor for altered metabolism of concomitant agents.
• Hormone replacement therapy: endocrine side effects may require dose adjustments.