A cancer immunotherapy (anti-PD-1)
Nivolumab
A cancer immunotherapy given as a drip that helps the immune system recognise and attack cancer cells.
What is Nivolumab?
Nivolumab (Opdivo) is a cancer immunotherapy given as a drip into a vein by an oncology team. It works by taking the 'brakes' off your immune system so your own immune cells can find and attack cancer. Because it boosts the immune system, it can sometimes cause the immune system to attack healthy parts of the body — most often the bowel, liver, lungs, skin or hormone glands. It is sometimes combined with ipilimumab, which tends to cause more frequent and stronger immune reactions. These reactions can be serious and can appear during or after treatment, so report new symptoms promptly. You will have blood tests before each cycle and should carry an alert card.
Education and reference only. This is a plain-language guide to Nivolumab — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Nivolumab is a type of cancer immunotherapy known as an immune checkpoint inhibitor. It is a man-made antibody that blocks a protein called PD-1 on immune cells, which some cancers use to evade the immune system. It is used by oncology specialists to treat several cancers, sometimes on its own and sometimes combined with another immunotherapy called ipilimumab. It is given slowly into a vein as an infusion (a drip), usually as a course of repeated cycles in a hospital or chemotherapy day unit.
How it works
Cancer cells can switch off the immune system by pressing on a 'brake' called PD-1, which stops immune cells attacking them. Nivolumab blocks this brake, freeing your immune cells (T-cells) to recognise and attack the cancer. Because these brakes also normally protect your healthy tissues, releasing them can sometimes let the immune system attack healthy organs too — which is why immune-related side effects are the main thing to watch for with this group of medicines. When nivolumab is combined with ipilimumab, the effect on the immune system is stronger, and immune reactions tend to be more frequent and more severe.
Company & origin
Originated / developed by: Bristol Myers Squibb.
A modern cancer immunotherapy given by specialist oncology teams in the UK as a drip to treat a range of cancers.
Practical use
How to take Nivolumab
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It is given by your oncology team as a drip into a vein; you do not take it yourself at home.
- You will usually have it as repeated cycles, with blood tests before each one to check your organs and hormone levels.
- If it is combined with ipilimumab, be especially watchful for new symptoms, as immune reactions are more common with the combination.
- Report any new or worsening symptoms promptly — diarrhoea, breathlessness, cough, severe tiredness, yellowing skin or unusual thirst — even between appointments or after treatment ends.
- Carry the alert card you are given at all times and show it to any healthcare professional you see.
Weighing it up
Advantages & disadvantages of Nivolumab
Advantages
- Can produce long-lasting responses in some cancers by harnessing the body's own immune system.
- Often better tolerated day to day than traditional chemotherapy, with no routine hair loss.
- Can be combined with ipilimumab when a stronger immune effect is needed, under close specialist care.
Disadvantages
- Can trigger immune-related side effects that affect healthy organs and may be serious.
- Immune reactions are more frequent and stronger when it is combined with ipilimumab.
- These reactions can appear weeks or months after treatment stops, and it does not work for everyone.
Practical use
Good to know
The most important thing to understand is that nivolumab can cause immune-related side effects, where the freed-up immune system attacks healthy organs. This can affect almost any part of the body: the bowel (diarrhoea or colitis), the liver (hepatitis), the lungs (pneumonitis, with cough or breathlessness), the skin (rash or itching) and the hormone glands such as the thyroid, pituitary and adrenal glands, and it can sometimes cause diabetes. These reactions can be serious and can begin during treatment or weeks to months after it finishes. If nivolumab is given together with ipilimumab, these reactions are more likely and can be stronger, so extra vigilance is needed. The key message is to report new symptoms promptly — new or worsening diarrhoea, breathlessness, a new cough, severe tiredness, yellowing of the skin or eyes, or unusual thirst — because early treatment, often with steroids, works well. You will have regular blood tests (including thyroid and liver checks) before each cycle, and you should carry the alert card you are given.
Who should not take it / use with caution
- People with certain active autoimmune conditions may not be suitable, as immunotherapy can worsen them; your team will weigh this up carefully.
- Those who have had a serious immune reaction to this type of medicine before may be advised against further treatment.
- It is used with great caution, and only after specialist assessment, in people who have had an organ transplant.
Monitoring
- Blood tests before each cycle, including liver function and thyroid and other hormone checks.
- Closer monitoring for immune-related reactions when combined with ipilimumab.
- Scans to assess how the cancer is responding to treatment.
Side effects
- Immune-related effects can affect the bowel (diarrhoea, colitis), liver (hepatitis), lungs (pneumonitis with cough or breathlessness), skin (rash, itching) and hormone glands (thyroid, pituitary, adrenal, and sometimes diabetes).
- More general effects include tiredness, reduced appetite, nausea, joint or muscle aches and a reaction around the time of the drip.
- Rarely, serious reactions affecting the heart, nervous system, kidneys or eyes can occur and need urgent medical attention; these are more likely with the ipilimumab combination.
Key interactions
- Tell your team about all medicines, as long-term steroids or medicines that dampen the immune system may affect how it works.
- It may be combined deliberately with ipilimumab or other cancer treatments, but only under specialist guidance.
- Some herbal remedies and supplements that affect the immune system should be discussed with your team before use.
Available as: Given as an infusion (a drip) into a vein by an oncology team.
Answers
Nivolumab: frequently asked questions
How does nivolumab work?
It blocks a 'brake' called PD-1 on your immune cells, freeing them to recognise and attack cancer. Because the same brakes protect healthy tissue, it can sometimes cause immune-related side effects.
Why is it sometimes given with ipilimumab?
Combining the two gives a stronger immune effect against some cancers, but immune-related side effects are more frequent and can be more severe, so you will be monitored especially closely.
What symptoms should I report straight away?
Tell your team promptly about new or worsening diarrhoea, breathlessness, a new cough, severe tiredness, yellowing of the skin or eyes, or unusual thirst — early treatment, often with steroids, is important.
Can side effects happen after treatment ends?
Yes. Immune-related reactions can appear weeks or even months after your last drip, so stay alert and report new symptoms even after treatment finishes.
Why do I need so many blood tests?
Blood tests before each cycle check your liver, thyroid and other hormone glands so any immune-related effect can be caught and treated early.
Authoritative sources
- BNF
- NICE CKS
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