How it is administered

Nivolumab is administered as an intravenous (IV) infusion, typically over 30 to 60 minutes, depending on the specific regimen. It is supplied in single-use vials and must be diluted before use. The medication is given by a healthcare professional in a clinical setting. There is also a subcutaneous version (in combination with hyaluronidase), but the most common and studied method is IV infusion.

How it works

Nivolumab is an immunotherapy medicine known as a checkpoint inhibitor. It works by blocking a protein called PD-1 (programmed death receptor-1) found on the surface of certain immune cells called T cells. Normally, when PD-1 binds to its ligands (PD-L1 or PD-L2), it acts as a brake on the immune system, preventing T cells from attacking normal cells in the body. However, some cancer cells use this pathway to hide from the immune system.

By blocking PD-1, nivolumab releases this brake, allowing T cells to recognize and attack cancer cells more effectively. This can help the body’s own immune system fight cancer, including some blood cancers like classical Hodgkin lymphoma. The effect is to enhance the immune response against tumor cells, which may slow or stop the growth of cancer.

Who Should take it

Nivolumab is approved for use in adults with several types of cancer, including certain blood cancers. For blood cancers, it is specifically indicated for adults with classical Hodgkin lymphoma (cHL) that has relapsed or progressed after autologous stem cell transplant and brentuximab vedotin, or after three or more lines of systemic therapy that includes autologous stem cell transplant.

It may also be used in other cancers such as melanoma, lung cancer, kidney cancer, and others. The decision to use nivolumab depends on the type and stage of cancer, previous treatments, and overall health. It is not specifically approved for Adult T-cell Leukemia/Lymphoma, but may be considered in clinical trials or special circumstances.

Who should not take it

There are no absolute contraindications listed for nivolumab, but it should not be used in patients with a known severe allergy to any of its components. Caution is advised in patients with active autoimmune diseases or those requiring immunosuppressive medications, as nivolumab can worsen these conditions.

Patients who have had severe immune-mediated side effects from prior immunotherapy should discuss risks with their doctor. Nivolumab is not recommended for use in pregnancy or breastfeeding due to potential harm to the fetus or infant. It is not approved for use in children under 12 years old for most indications.

Commonly used with

Nivolumab may be used alone (monotherapy) or in combination with other cancer treatments. In some cancers, it is combined with ipilimumab (another checkpoint inhibitor), cabozantinib (a targeted therapy), or chemotherapy. The combination depends on the type of cancer and treatment plan.

For classical Hodgkin lymphoma, it is usually used as a single agent after other treatments have failed. In solid tumors, combinations are more common.

Commonly tested with

Nivolumab has been tested in combination with:

• Ipilimumab (CTLA-4 inhibitor)
• Cabozantinib (tyrosine kinase inhibitor)
• Platinum-based chemotherapies
• Brentuximab vedotin (for Hodgkin lymphoma)

Research is ongoing to test nivolumab with other immunotherapies, targeted therapies, and chemotherapy agents in various blood cancers and solid tumors.