Nivolumab is an immunotherapy cancer treatment marketed under the brand name Opdivo. It represents a different approach from traditional methods like chemotherapy. Instead of directly targeting cancer cells, nivolumab works by engaging the body’s own immune system to fight the disease. This therapy is systemic, meaning the drug travels through the bloodstream to act on cancer cells throughout the body.
How Nivolumab Works Against Cancer
The immune system has safeguards called checkpoints to prevent it from attacking the body’s own healthy cells. One such checkpoint involves a protein on the surface of T-cells, a type of immune cell, called PD-1 (programmed cell death protein 1). When T-cells are activated to fight disease, PD-1 acts as a type of “off switch” to keep the immune response in check.
Some cancer cells have learned to exploit this system. These cells produce a corresponding protein on their surface called PD-L1. When the cancer cell’s PD-L1 binds to the PD-1 on a T-cell, it effectively presses that off switch, tricking the immune system into ignoring the cancer cell as if it were normal tissue.
Nivolumab is an immune checkpoint inhibitor, a monoclonal antibody that targets the PD-1 receptor. It works by blocking the PD-1 protein on T-cells, which prevents the cancer cell’s PD-L1 from connecting with the T-cell’s PD-1. By obstructing this signal, nivolumab “releases the brakes” on the immune system, allowing T-cells to recognize and attack cancer cells. This activation may create an immunological “memory,” helping the immune system continue to target cancer cells after treatment concludes.
Cancers Treated With Nivolumab
Nivolumab is approved by the U.S. Food and Drug Administration (FDA) for treating a range of cancers, often when the disease is advanced, has spread (metastasized), or has not responded to other treatments. It is used for unresectable or metastatic melanoma, non-small cell lung cancer, and malignant pleural mesothelioma.
The therapy is also an established treatment for advanced renal cell carcinoma (kidney cancer), classical Hodgkin lymphoma, and various cancers of the head and neck. Nivolumab is also used for urothelial carcinoma, a cancer of the bladder and urinary tract, and certain types of esophageal, gastric, and liver cancers. For some cancers, such as colorectal cancer, its use is specific to tumors with certain genetic features, such as microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR). Depending on the cancer type and stage, it may be used alone or in combination with other cancer drugs.
The Nivolumab Treatment Process
Receiving nivolumab is administered in a clinical setting by a healthcare team. The medication is delivered through an intravenous (IV) infusion. Before treatment begins, patients typically undergo blood tests to check general health markers and screen for certain viruses. The infusion itself is relatively short, usually lasting between 30 and 60 minutes.
The frequency of treatment cycles depends on the specific cancer being treated and whether nivolumab is given alone or with other therapies. A common schedule involves receiving an infusion every two or four weeks when used as a single agent. If it is part of a combination therapy, the schedule might change to every three weeks. The healthcare team determines the appropriate dosage and treatment plan for each individual patient.
Potential Side Effects of Nivolumab
Because nivolumab stimulates the immune system, its side effects are often a result of that increased immune activity. These are known as immune-related adverse events and can occur when the newly active immune system attacks healthy cells and organs, causing inflammation. It is important for patients to report any new or worsening symptoms to their medical team immediately.
Common side effects are generally mild to moderate and can include fatigue, skin issues like rash and itching, musculoskeletal pain, and gastrointestinal problems such as diarrhea, nausea, and decreased appetite. Other frequently reported symptoms include coughing, shortness of breath, and fever.
In some cases, the immune system’s attack on healthy tissues can become more serious. This can lead to significant inflammation in various organs, resulting in conditions like colitis (inflammation of the colon), pneumonitis (lungs), hepatitis (liver), and nephritis (kidneys). The therapy can also cause endocrinopathies, which are problems with hormone-producing glands like the thyroid or pituitary. While less common, these side effects require prompt medical attention to prevent complications.