Nivolumab Therapy - Opdivo

Nivolumab was one of the first two drugs to block PD-1, the switch cancers use to silence the immune system. Twelve years on it treats more than a dozen cancers. The question for each patient is which of them, when, and with what.

Nivolumab, sold under the brand name Opdivo, is an antibody given by infusion that attaches to PD-1 on T cells and stops tumors from switching those cells off. It was first approved for advanced melanoma in 2014. Given alone to patients with advanced melanoma, it kept 44 percent alive at five years, against 26 percent with the drug that came before it (Larkin and colleagues, New England Journal of Medicine, 2019). Given with chemotherapy before surgery for lung cancer, it removed every trace of cancer from the operative specimen in 24.0 percent of patients, against 2.2 percent with chemotherapy alone (Forde and colleagues, New England Journal of Medicine, 2022). A version injected under the skin in a few minutes matched the infusion in a trial of 495 patients with kidney cancer (Albiges and colleagues, Annals of Oncology, 2025). This page explains what nivolumab is, which cancers it is used for and in which combinations, how it is given, how it differs from pembrolizumab, what the main trials found, the side effects and their monitoring, and how patients from abroad arrange treatment at Biruni Hospital in Istanbul.

What nivolumab is

Nivolumab and pembrolizumab reached patients within months of each other in 2014, first for melanoma that had spread, and between them they turned a cancer with a median survival under a year into one that a large minority of patients now survive. Since then nivolumab has gained approvals for lung, kidney, bladder, head and neck, stomach, esophageal, liver and bowel cancers, mesothelioma and Hodgkin lymphoma, alone or in combination, in advanced disease and increasingly around the time of surgery. The immunotherapy page on this site explains how the whole class works and how patients are selected. This page concerns the drug itself.

Cancers treated

Each approval covers a named cancer, a stage, a line of treatment and sometimes a marker. Outside those limits the evidence thins quickly.

Approvals differ between the United States, Europe and Turkey, and change every year. The file review checks the current approval and the evidence for the patient's exact cancer and stage before nivolumab is proposed.

Where another drug or approach has better data for a given cancer, the reply says so plainly, even when the patient wrote asking for nivolumab by name.

Markers that matter

PD-L1 decides the choice in stomach and esophageal cancer and shapes it in lung cancer. Microsatellite instability opens nivolumab with ipilimumab to bowel cancer that would otherwise not respond. In melanoma and kidney cancer no marker is required. A patient whose report does not state the relevant marker sends the tissue blocks, and the test is done here before the first dose.

Nivolumab with other drugs

Alone, nivolumab releases one brake. Its partners either release a second one or weaken the tumor so that the first counts for more.

How it is given

Into a vein over thirty minutes, or under the skin in a few minutes where the injectable form is available.

The two routes

1. Every two weeks. 240 milligrams by infusion, still used with some chemotherapy schedules.
2. Every three weeks. 360 milligrams, alongside three-weekly chemotherapy in stomach and lung cancer.
3. Every four weeks. 480 milligrams, the usual choice for nivolumab alone, since it halves the number of visits.

• A blood test before each dose checks liver, kidney and thyroid function and blood sugar, since the side effects show there first.
• A scan every eight to twelve weeks measures response against the baseline scan taken before the first dose.
• A card carried by the patient names the drug and the warning signs for any doctor who sees the patient between visits.

Nivolumab or pembrolizumab

Two antibodies against the same target, approved in overlapping cancers, compared in no head-to-head trial.

The practical differences

Schedules differ, with nivolumab every two, three or four weeks and pembrolizumab every three or six. Availability differs by country and by hospital. And the partner drug, ipilimumab, chemotherapy or a targeted tablet, often decides the choice more than the PD-1 antibody itself.

What the trials found

Three trials show nivolumab at three stages of cancer. Before surgery, when the goal is cure. In advanced disease, when the goal is time. And over the long term, where the question is whether a drug stopped after two years keeps working after it has gone, which for a fraction of patients with melanoma it plainly does, and which no chemotherapy for spread melanoma ever achieved.

Side effects and monitoring

Serious side effects on nivolumab alone affect a minority. They can strike any organ, at any time, including months after the last dose.

1. Before the first dose. Baseline thyroid, liver, kidney, sugar and cortisol tests, and an ECG for patients starting a combination.
2. Every visit. The same blood tests and a short review of symptoms, which is why each cycle begins with a consultation rather than going straight to the chair.
3. Between visits. A same-day call for diarrhea more than four times a day, a new cough or breathlessness, chest pain, severe headache, confusion or a blistering rash.

Adding nivolumab to chemotherapy

Grade 3 or 4 treatment-related adverse events occurred in 33.5 percent of patients receiving nivolumab plus chemotherapy before lung surgery and in 36.9 percent of those receiving chemotherapy alone (Forde and colleagues, 2022).

Treatment for patients from abroad

One coordinator from the international patients office handles arrangements from the first message through discharge and answers the same WhatsApp number once you are back home. The office works in English, Arabic, French, Russian, Serbian, Romanian and Spanish and books interpreters for other languages, and it arranges the visa invitation letter, airport transfers, daily transport and accommodation near the hospital. Halal, vegetarian and diabetic meals, a prayer room on site, and a female physician on request wherever the rota allows.

Deciding whether to start

Five things decide.

The cancer and its stage come first, because the approval and the trial data attach to them, and a patient with a cancer outside the approved list should hear on what evidence the drug is being offered before agreeing. The marker comes second, since in stomach and lung cancer the benefit rises with PD-L1 and a low score shifts the balance toward chemotherapy alone or a different drug. The patient comes third. An autoimmune disease that is active, a transplanted organ, or a need for steroids above a low daily dose each raise the risk, and some of them rule the drug out. The partner drug comes fourth, because the choice between nivolumab alone and nivolumab with ipilimumab is a choice between fewer side effects and a higher chance of response, and it belongs to the patient once the numbers are on the table. And the arrangement comes last, since a drug given every four weeks for up to two years needs a plan for where each dose will be given and who will answer the phone at night if the diarrhea starts.

A patient who reaches the end of that list with clear answers has made the decision well, whatever it is.

Cost

One figure per dose, after the file review.

The drug makes up most of it.