Treatment Name: Nivolumab (Opdivo®)
Nivolumab (Opdivo®) is an Immunotherapy Regimen for Hodgkin's Lymphoma
How does nivolumab work?
Nivolumab is designed to enhance your immune system’s ability to target and kill cancer cells.
Goals of therapy:
Nivolumab is given to shrink tumors and help alleviate symptoms of Hodgkin’s lymphoma. It is not commonly given with the goal of cure, but may help patients live longer. In some cases, after therapy with nivolumab a bone marrow transplant may be able to be performed with the goal of cure.
- Nivolumab intravenous (I.V.) infusion over 30 minutes on Day 1 of each cycle
Estimated total infusion time for this treatment:
- Up to 30 minutes if there are no pre-medications or infusion reactions
- Up to one or more hours if there are pre-medications or infusion reactions
- Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time
Nivolumab is usually given in an outpatient infusion center, allowing the person to go home afterwards.
It is given every 14 or 28 days and this is known as one Cycle. Treatment is continued until nivolumab is no longer working, it is stopped because of intolerable side effects, or if a bone marrow transplant is given.
Click here for the common nivolumab starting doses for Hodgkin’s lymphoma.
In clinical studies, the most commonly reported nivolumab side effects are shown here.
- Skin rash (22%)
- Increased bleeding risk [low platelet count] (17%)
- Fatigue (13%)
- Fever (13%)
- Diarrhea (13%)
- Nausea (13%)
- Itching (13%)
- Cough (9%)
- Decreased thyroid function (9%)
- Low blood phosphate levels (9%)
- High blood calcium levels (9%)
- Mouth sores (9%)
- Development of myelodysplastic syndrome [MDS] (4%)
- Lymph node pain (4%)
- Inflammation of the pancreas (4%)
In this study, 9% of patients stopped therapy due to side effects.
Approximately 39% of patients had one or more doses delayed due to adverse effects. All of those patients were able to restart treatment.
How often is monitoring needed?
Labs (blood tests) are often checked before every treatment, and periodically if side effects are experienced. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), magnesium, amylase, lipase, AdrenoCorticoTropic Hormone (ACTH), serum cortisol, thyroid function using the TSH and/or free-T4 tests, hepatitis screening, plus any others your doctor may order.
How often is imaging needed?
Imaging may be checked before treatment, then approximately at 4, 8, 16 and 24 weeks after starting treatment, then every four months thereafter. Imaging may include: computerized tomography (CT) scans or positron emission tomography (PET) scans.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue nivolumab as planned, change the dose, or delay or switch therapy.
- A corticosteroid (e.g., prednisone, methylprednisolone) may be prescribed to decrease immune reactions if they occur
- If you experience gastrointestinal symptoms such as diarrhea that does not go away after delaying treatment or get significantly better with steroids after 3 to 5 days, an additional I.V. medication known as Infliximab (Remicade®) may be given
- If you experience liver toxicity from immune reactions that do not go away by delaying treatment or get significantly better with steroids after 3 to 5 days, an additional medication known as mycophenolate mofetil (CellCept®) may be prescribed
- If you experience fevers, they may be managed by taking anti-inflammatory medications (examples: ibuprofen or naproxen). Ask your doctor or pharmacist if these medicines are safe to take with nivolumab treatment
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for head and neck cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Nivolumab (Opdivo®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Nivolumab (Opdivo®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Nivolumab (Opdivo®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with Nivolumab (Opdivo®)