What Nivolumab is and what it is used for?
- Nivolumab is a monoclonal antibody that binds to PD-1 (Programmed cell death protein 1) and blocks its interaction with PD-L1 (programmed cell death ligand 1). PD-1 is a checkpoint protein on T cells that prevents the immune system from attacking other cells in the body. PD-L1 is a protein expressed in both normal and tumor cells. When tumor PD-L1 binds to T cell PD-1, T cell activation is inhibited, thus blocking the normal immune response to tumor cells. This medicine blocks the PD-1/PD-L1 interaction and boosts the immune response against cancer cells.
- Nivolumab can be used either alone or with other medicines. This medicine usually is given after other cancer treatments did not work or is no longer working. Nivolumab is indicated for the treatment of patients with bladder cancer, colorectal cancer, head and neck cancer, kidney cancer, liver cancer, lung cancer, Hodgkin lymphoma, and melanoma. This drug also can be used in patients with colorectal cancers that present with high microsatellite instability.
- Nivolumab works in patients whose tumor tested positive for PD-L1. Your doctor will perform a PD-L1 testing to determine if this medicine is right for you.
How Nivolumab is given?
- Nivolumab is given as an infusion into a vein over 30 minutes.
What should I know while receiving Nivolumab?
- Infusion reactions may happen during or shortly after the infusion, causing fever, chills, itching or rash, flushing, breathing difficulties, feeling like passing out, or dizziness. Tell your nurse right away if you feel unwell during an infusion.
- Do not receive this drug when you are pregnant. Effective contraception should be used during treatment and for at least 5 months after the last dose.
- Do not breastfeed during treatment and for at least 5 months after the last dose.
- Do not receive any kind of vaccination without doctor's approval.
- You will have regular blood tests to check that you have enough blood cells and have adequate organ functions to receive this drug. The timing of your treatment may be changed based on the test results or other side effects.
- The existing health problems may affect the use of this drug. You should let your doctor know if you have any other medical problems, especially if you have had an organ transplant, have an autoimmune disease, lung or liver problems.
- There are many drugs may affect how nivolumab works, especially medicines which can weaken your immune system. Tell your doctor about all the medicines you are taking, including prescription and non-prescription medicines, vitamins, and herbal supplements.
Common side effects
- Weakness and fatigue
Try to pace yourself and rest as much as possible. Seek medical advice if fatigue does not go away when you rest and sleep.
Tell your doctor if this happens. Be sure to ask your doctor before taking any pain relievers.
- Loss of appetite
Try to eat in small quantities and have frequent meals. If your appetite does not get any better after a few days, tell your doctor.
- Diarrhea or constipation
Talk to your doctor and ask for advice. Drinking plenty of water and dietary changes can improve the symptoms.
A rash can be itchy, red, or painful. Tell your doctor about any skin changes that you have, they can give you medicines and advices that help you feel better.
- Nausea or vomiting
Medicines may be given before the treatment to prevent it happening. Eating and drinking often in small amounts may reduce the discomfort.
- Cough or trouble breathing
Tell your doctor if any existing breathing problems get worse. Contact your doctor right away if you suddenly feel breathless.
- Pain in muscles, bones, joints, or abdomen
Talk to the doctor if the pain is bothering you, they can give you medicine to relieve pain.
Uncommon but important side effects
Nivolumab can cause your immune system to attack healthy organs and can affect the way they work. These problems can occur at any time during or even after treatment is over and can range from mild to life-threatening. Not all side effects are listed below. Seek medical help right away if you have any new or worsening symptoms.
- Inflammation of the lungs
Contact your doctor right away if you notice a new or worsening cough, shortness of breath or chest pain.
- Inflammation of the bowel
Contact your doctor immediately if you have persistent watery or bloody diarrhea, or have severe abdominal pain.
- Inflammation of the liver
Seek medical help right away if you have yellowing of the skin or eyes, dark or brown urine, or pain in abdomen, as these can be signs that your liver is not working well.
- Hormone gland problems (especially thyroid, adrenal and pituitary glands)
The problems depend on which hormone glands are affected. Common signs and symptoms may include changes in mental status, nausea and vomiting, weakness, feeling cold, missed or no menstrual periods, passing urine more often than usual, weight loss or gain. Contact your doctor if you have any possible signs of an endocrine problem.
- Inflammation of kidney
Seek medical help at once if you have trouble urinating, decreased urination, swelling in limbs, or pain in lower back.
- Skin inflammation
Possible reactions include rash, itching, and blisters. Most are mild and can be treated with topical steroids. Rarely, a life-threatening blistering may develop on the skin and lining of the mouth, nose, eyes or genital area. Patients with severe or life-threatening blistering may need to be hospitalized for further treatments.
Nivolumab may cause inflammation of brain. Seek medical help at once if you notice you have headache, tiredness or weakness, confusion, memory loss, sleepiness, seeing or hearing things that are not really there, seizures, and stiff neck.
- Drink at least 6 to 8 glasses of water every day during treatment can help make your recovery a smoother process.
- Alcohol and cigarettes may interfere with certain medicines or worsen side effects from chemotherapy treatment. It is wise to avoid alcohol and cigarette smoking during cancer treatment. If you have any problem about drinking alcohol and smoking, you should check with your doctor.