Opdualag (Nivolumab, Relatlimab)

• Opdualag is indicated for melanoma, acting through dual PD‑1 and LAG‑3 checkpoint inhibition.
• Unresectable melanoma: provides disease control in patients whose tumors cannot be surgically removed.
• Metastatic melanoma: extends overall survival in patients with distant spread.
• Advanced melanoma: offers a therapeutic option after prior systemic therapy failure.

• Opdualag combines nivolumab, a monoclonal antibody that blocks the PD‑1 receptor on T cells, with relatlimab, which inhibits the LAG‑3 receptor. By simultaneously disabling these two immune checkpoints, the drug restores T‑cell activation and proliferation, enhancing the immune system’s ability to recognize and destroy tumor cells.

Opdualag may cause a range of immune‑related adverse reactions, which are categorized by frequency.

Common Side Effects

• Fatigue: persistent tiredness affecting daily activities.
• Rash or pruritus: skin irritation or itching.
• Diarrhea: loose stools that may require supportive care.
• Nausea: feeling of sickness often managed with anti‑emetics.

Serious or Rare Side Effects

• Immune‑mediated pneumonitis: inflammation of lung tissue that can impair breathing.
• Colitis: severe inflammation of the colon leading to abdominal pain and diarrhea.
• Hepatitis: liver inflammation that may elevate transaminases.
• Endocrinopathies: disorders of thyroid, pituitary, or adrenal glands requiring hormone replacement.

• Before initiating Opdualag, clinicians should observe several precautionary measures to minimize risk.
• Baseline organ assessment: evaluate liver, kidney, and pulmonary function prior to therapy.
• Monitor for immune‑related events: conduct regular clinical and laboratory surveillance for signs of inflammation.
• Avoid live vaccines: patients should not receive live attenuated vaccines during treatment.
• Caution in autoimmune disease: assess risk‑benefit in patients with pre‑existing autoimmune conditions.
• Discontinue for severe toxicity: hold or stop therapy if grade 3‑4 adverse events occur.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Opdualag can interact with other medicines, requiring careful management.

Major Interactions (Avoid)

• Concurrent immune checkpoint inhibitors: may amplify immune‑related toxicity.
• Systemic immunosuppressants (e.g., high‑dose steroids): can reduce therapeutic efficacy.
• Live vaccines: increase risk of infection due to immune modulation.

Moderate Interactions (Monitor Closely)

• Corticosteroids used for other conditions: monitor for additive immunosuppression.
• Anticoagulants: watch for bleeding if immune‑mediated thrombocytopenia develops.
• Hormone replacement therapies: adjust dosing if endocrine dysfunction occurs.