Nivolumab Treatment: Dosage, Side Effects, and Cancer Therapy

Summary of Key Points

Nivolumab is a prescription medication used to treat various types of cancer, including melanoma, lung cancer, and kidney cancer. It works by enhancing the immune system’s ability to target and destroy cancer cells. Nivolumab is administered as an intravenous (IV) infusion by a healthcare professional. It is essential to follow your doctor’s instructions carefully and report any side effects you may experience. For personalized advice regarding Nivolumab treatment, you can consult one of our telemedicine providers.

Names of Medication

US Brand Name: Opdivo

Generic Name: Nivolumab

The generic name refers to the active ingredient in the medication, which is listed in parentheses after the brand name.

Pharmacologic Category

Anti-PD-1 Monoclonal Antibody

Nivolumab Dosage and Treatment Schedule

Nivolumab is prescribed to treat several types of cancer in adults. The dosage and treatment schedule depend on the specific cancer being treated. Always consult your healthcare provider before making any changes to your dosage. You can also schedule a telemedicine appointment with one of our providers for more detailed information on Nivolumab dosing and treatment options.

Melanoma

Dosage: 240 mg every 2 weeks or 480 mg every 4 weeks, administered as an IV infusion over 30 minutes.

Non-Small Cell Lung Cancer (NSCLC)

Dosage: 240 mg every 2 weeks or 480 mg every 4 weeks, administered as an IV infusion over 30 minutes.

Renal Cell Carcinoma

Dosage: 240 mg every 2 weeks or 480 mg every 4 weeks, administered as an IV infusion over 30 minutes.

Hodgkin Lymphoma

Dosage: 240 mg every 2 weeks or 480 mg every 4 weeks, administered as an IV infusion over 30 minutes.

Head and Neck Squamous Cell Carcinoma

Dosage: 240 mg every 2 weeks or 480 mg every 4 weeks, administered as an IV infusion over 30 minutes.

Urothelial Carcinoma

Dosage: 240 mg every 2 weeks or 480 mg every 4 weeks, administered as an IV infusion over 30 minutes.

Colorectal Cancer

Dosage: 240 mg every 2 weeks or 480 mg every 4 weeks, administered as an IV infusion over 30 minutes.

Gastric Cancer

Dosage: 240 mg every 2 weeks or 480 mg every 4 weeks, administered as an IV infusion over 30 minutes.

Esophageal Cancer

Dosage: 240 mg every 2 weeks or 480 mg every 4 weeks, administered as an IV infusion over 30 minutes.

Liver Cancer

Dosage: 240 mg every 2 weeks or 480 mg every 4 weeks, administered as an IV infusion over 30 minutes.

Dosage Forms and Strengths

Nivolumab is available in the following dosage forms:

1. Injection: 40 mg/4 mL (10 mg/mL) solution in a single-dose vial
2. Injection: 100 mg/10 mL (10 mg/mL) solution in a single-dose vial

Administration Instructions for Nivolumab

Nivolumab is administered as an intravenous (IV) infusion by a healthcare provider, typically over a 30-minute period. It is important to attend all scheduled infusion appointments. If you miss a dose, contact your healthcare provider as soon as possible to reschedule. Do not attempt to administer this medication on your own. If you have any questions about your Nivolumab treatment plan, speak with one of our telemedicine providers for guidance.

Nivolumab Side Effects and Adverse Reactions

As with any medication, Nivolumab may cause side effects. Some are more common, while others can be more serious. Always inform your healthcare provider if you experience any side effects during your treatment with Nivolumab.

1. Fatigue: Feeling unusually tired or weak is a common side effect.
2. Rash: Skin irritation or rash may occur.
3. Diarrhea: Loose or frequent stools are a possible side effect.
4. Nausea: Feeling nauseous or sick to your stomach is a common reaction.
5. Fever: A mild fever may develop after treatment.
6. Serious Immune Reactions: In rare cases, Nivolumab may cause the immune system to attack healthy organs, leading to conditions such as pneumonitis (lung inflammation), hepatitis (liver inflammation), or colitis (inflammation of the colon). Contact your doctor immediately if you experience symptoms such as difficulty breathing, yellowing of the skin, or severe abdominal pain.

Contraindications for Nivolumab Treatment

A contraindication is a specific condition or situation where a particular treatment or medication should not be used because it may cause harm. For Nivolumab, there are certain conditions where its use is not recommended due to potential risks.

1. Severe autoimmune diseases: Nivolumab activates the immune system, which can worsen autoimmune conditions such as lupus, rheumatoid arthritis, or multiple sclerosis. In these cases, the immune system is already overactive, and Nivolumab could exacerbate the condition.
2. Organ transplant recipients: Nivolumab can increase the risk of organ rejection by stimulating the immune system, which may attack the transplanted organ.
3. Severe liver disease: Patients with severe liver disease may not process Nivolumab effectively, leading to increased side effects or toxicity.
4. Allergic reactions: If you have had a severe allergic reaction to Nivolumab or any of its components, it should not be used. Symptoms of an allergic reaction can include rash, itching, swelling, or difficulty breathing.

Drug to Drug Interactions

Nivolumab can interact with other medications, potentially increasing side effects or reducing the effectiveness of either drug. It’s essential to inform your healthcare provider about all the medications you’re taking, including over-the-counter drugs and supplements.

Corticosteroids (e.g., Prednisone): Corticosteroids can suppress the immune system, which may reduce the effectiveness of Nivolumab.

Immunosuppressants (e.g., Tacrolimus, Cyclosporine): These medications, commonly used in organ transplant patients to prevent rejection, may counteract the immune-boosting effects of Nivolumab.

Live vaccines (e.g., MMR, Varicella): Live vaccines may be less effective while taking Nivolumab, and there’s a risk of infection from the vaccine itself due to Nivolumab’s impact on the immune system.

Nivolumab in Pregnancy

Is it Safe to Take Nivolumab When Pregnant?

Nivolumab is generally not recommended during pregnancy unless absolutely necessary. While data on its safety in pregnant women is limited, animal studies suggest potential harm to the fetus. Since Nivolumab stimulates the immune system, it could affect the developing baby. If you are pregnant or planning to become pregnant, it’s important to discuss the risks and benefits with your healthcare provider. Together, you can weigh the potential risks to the fetus against the benefits of Nivolumab for your condition.

Nivolumab While Breastfeeding

Is it Safe to Take Nivolumab While Breastfeeding?

It is currently unknown whether Nivolumab passes into breast milk. Due to the potential for serious side effects in a nursing infant, breastfeeding is not recommended while taking Nivolumab. If you are breastfeeding or planning to breastfeed, consult your healthcare provider. You may need to consider stopping breastfeeding or exploring alternative treatments.

Estimated Cost of Nivolumab

The cost of Nivolumab can vary depending on your location, pharmacy, and insurance coverage. Without insurance, a 30-day supply using a GoodRx coupon is estimated to cost between $10,000 and $15,000. However, insurance or patient assistance programs can significantly reduce this cost. For more accurate pricing based on your specific situation, consult your healthcare provider or pharmacist.

Possible Alternatives to Nivolumab

If Nivolumab isn’t suitable for you, there are alternative treatments and lifestyle changes that may help manage your condition. Always discuss these options with your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to help you explore these alternatives.

1. Melanoma: Alternatives include targeted therapies like Vemurafenib (Zelboraf) or Dabrafenib (Tafinlar) for patients with specific genetic mutations. Immunotherapies such as Pembrolizumab (Keytruda) may also be considered. Sun protection and regular skin checks are important lifestyle changes.
2. Non-small cell lung cancer: Other immunotherapies, such as Pembrolizumab (Keytruda) or Atezolizumab (Tecentriq), may be used. Quitting smoking and maintaining a healthy diet can also improve outcomes.
3. Renal cell carcinoma: Targeted therapies like Sunitinib (Sutent) or Pazopanib (Votrient) are alternatives. Staying physically active and managing blood pressure can support overall health.
4. Hodgkin lymphoma: Brentuximab vedotin (Adcetris) or chemotherapy regimens may be considered. A balanced diet and stress management can support treatment.
5. Head and neck squamous cell carcinoma: Cetuximab (Erbitux) or radiation therapy may be alternatives. Avoiding tobacco and alcohol can help reduce the risk of recurrence.
6. Urothelial carcinoma: Pembrolizumab (Keytruda) or chemotherapy may be used. Staying hydrated and avoiding smoking can support treatment.
7. Colorectal cancer: Targeted therapies like Bevacizumab (Avastin) or chemotherapy may be alternatives. A high-fiber diet and regular exercise can improve outcomes.
8. Gastric cancer: Ramucirumab (Cyramza) or chemotherapy may be considered. Eating small, frequent meals and managing weight can help manage symptoms.
9. Esophageal cancer: Chemotherapy or radiation therapy may be alternatives. Avoiding smoking and alcohol, along with a healthy diet, can support treatment.
10. Liver cancer: Sorafenib (Nexavar) or Lenvatinib (Lenvima) may be alternatives. Avoiding alcohol and maintaining a healthy weight can help protect liver health.

Recent Updates on Nivolumab Research

Recent research on Nivolumab continues to explore its effectiveness in combination with other therapies. For example, studies are investigating the use of Nivolumab with Ipilimumab (Yervoy) for various cancers, including melanoma and renal cell carcinoma. Early results suggest that combining these two immunotherapies may improve outcomes for some patients. Additionally, ongoing trials are examining Nivolumab’s potential in treating other cancers, such as pancreatic and ovarian cancer.

Researchers are also studying biomarkers that could help predict which patients will respond best to Nivolumab. This could lead to more personalized treatment plans in the future. As new data emerges, it’s important to stay informed and discuss any updates with your healthcare provider. If you have questions about how this research might affect your treatment, our telemedicine providers are available to assist you.

James Kingsley

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