Pharmapoet

Drug Class: PD-1 inhibitors

  • Pembrolizumab

    What is Pembrolizumab?

    Pembrolizumab (pronounced pem-broe-LIZ-oo-mab) is an anticancer medication that helps immune system to fight tumors.

    Unlike conventional chemotherapy, which directly destroys cancer, pembrolizumab helps immune T-cells to identify tumor cells and let immune system do the job of killing the malignancy. So it is more of an “enhancer” or “enabler” of the immune system, then traditional chemotherapeutic agent.

    Pemrolizumab
    Permbrolizumab works with immune cells raither than targting cancer cells directly

    Pembrolizumab belongs to the class of PD-1 inhibitors within a broader group called immunotherapy – medications that interact with your immune system to treat various diseases and disorders.

    What Pembrolizumab is Used For

    Whether pembrolizumab would be effective depends on a type of the cancers. Your cancer specialist (oncologist) will conduct necessary tests to ensure pembrolizumab is the right choice for your situation.

    Below are the cancer types for which pembrolizumab may be indicated.

    Melanoma (skin cancer)

    Doctors usually precribe it for melanoma that cannot be surgically removed or has spread to other parts of the body (metastatic melanoma).

    Oncologist might try it after surgery for certain stages of melanoma (Stage IIB, IIC, or III) to prevent relapse (when cancer returns).

    Non-Small Cell Lung Cancer

    Pertulizumab is usefull for the specific type of lung cancer called non-small cell lung cancer. Doctors might prescribe it as a standalone cancer treatment, but usually it goes along with other anti-cancer drugs.

    Head and Neck Squamous Cell Carcinoma

    Can be an initial treatment for head and neck cancer (HNC) at advanced stages and presents a significant challange for surgical removal. Doctor might also prescribe it for HNC that has relapsed (came back) or spread to the other organs.

    Classical Hodgkin Lymphoma

    Approved for adults and children with Hodgkin Lymphoma (HL), in following two scenarios:

    • Lymphoma has not responded to treatment (refractory);
    • HL Cancer came back(relapsed) after trying two or more different treatment regimens;
    • In children for the refractory Hodgkin Lymphoma after one or more prior lines of treatment has failed
    • For relalps og HC in children after first line of treatment has failed

    Primary Mediastinal Large B-cell Lymphoma

    If two or more prior lines of therapy fail, oncologists might try pertulizumab for cases of refractory B-cell lymphoma.

    Bladder and Urinary Tract Cancer

    Doctors prescribe pertulizumab for advanced or challenging cases of Urinary truct cancers:

    • For patients who do not tolerate specific anti-cancer agents, like cisplatin;
    • If cancer has spread to other organs;
    • For advaced cases, when the tumor poses a challange for surgical removal.

    Stomach (gastric) Cancer

    Used in combination with specific chemotherapy as a first-line treatment for specific cases of stomach cancer:

    • locally advanced gastric tumors that cannot be removed by surgery;
    • gastric or gastroesophageal junction (GEJ) cancers, that have spread to other organs and have specific HER-2 receptor on the surface of their cells.

    Esophageal Cancer

    Oncologist may try it to treat locally advanced or metastatic cancer of the esophagus or GEJ.

    Cervical Cancer

    Doctors prescribe it for cervical cancer that has returned or spread, expresses PD-L1, and has progressed during or after chemotherapy.

    Onclogists use it as a first line for persistent, recurrent, or metastatic cervical cancer when combined with chemotherapy (with or without bevacizumab);

    Liver Cancer

    Onclogist might prescribe it for patients who previously took sorafenib.

    Merkel Cell Skin Cancer

    Approved for adults and children with Merkel cell carcinoma (MCC) for challenging cases:

    • MMC has returned;
    • Cancer has spread to other organs.

    Kidney Cancer

    Oncologists would try it as first line for advanced kidney cancer in combination with either axitinib or lenvatinib. Some doctors would also use pertolizumab for replases of kidney cancer or metastatic cases.

    Uterine (endometrial) Cancer

    Indicated for advanced endometrial cancer that cannot be cured by surgery or radiation, where it may be given alone or in combination with lenvatinib.

    Cutaneous Squamous Cell Carcinoma

    Doctors might try it for this type of skin cancer for relapsing or metastatic cases.

    Triple-Negative Breast Cancer

    Some advanced cases of breats cancer might benefit from pembrolizumab treatment.

    How is Pembrolizumab Given?

    Pembrolizumab is administered exclusively by trained healthcare professionals in specialized clinic or hospital.

    Here some key features:

    • The drug is administrated via IV line (in the veins);
    • Infusion is around 30 minutes to complete;
    • Your doctor would probably offer you a schedule tailored to the your specific needs. The most common one is either once every 3 weeks or once every 6 weeks;
    • Your medical team would check up on you regularly during the drip to monitor for potential side effects.

    How Does Pembrolizumab Work?

    Structurally, pembrolizumab is a monoclonal antibody, large Y-shaped protein structure, that can bind another protein with high affinity and specificity.

    Pembrolizumab binds PD-1 receptors on the surface of immune cells called T-cells, preventing its interaction with PDL-1 of a cancer cell.

    Role of PD-1

    When the PD-1 protein on a T-cell connects with PD-L1 or PD-L2 on a cancer cell, it signals the T-cell to switch off or ignore the cancer cell. This interaction allows cancers to evade immune attack and survive.

    PD-1 and PD-L1 interaction

    Pembrolizumab prevents PDL-1 from linking to PD-1

    Pembrolizumab is specifically engineered to attach to and block the PD-1 protein located on the T-cells. By physically obstructing this connection point, it prevents PD-L1 and PD-L2 from linking to PD-1 and activate their escape mechanism.

    Without PD-1 – PD-L1 signal T-cell identifies tumor as a foreign structure and does the rest of the job destroying the cancer cell.

    Side Effects of Pembrolizumab

    Common Side Effects of Pembrolizumab

    Common side effects include:

    • fatigue or muscle weakness;
    • muscle or joint pain;
    • rash or blistering;
    • itchy skin;
    • decreased appetite;
    • nausea, and diarrhea.

    Less Common but More Serious Side Effects

    Because pembrolizumab boosts your immune system’s activity, it might also cause collateral damage to healthy organs and tissues, which might be mistakenly ttacked by immune system.

    These side affects are inlammatory in their nature, range from mild asymptomatic to severe (please, read “when to seek medical attention”) and usually limited to one organ (organ-specific).

    Scientists call them immune-related adverse events (irAEs) and they are a feature for a broader group of immunetherapeutic agents.

    When to Seek Immediate Medical Attention?

    Pembrolizumab and Organ-Specific Inflammation

    Your immune system could potentially target various organs. Watch for these signs:

    • Lungs (Pneumonitis). Symptoms include a new or worsening cough, chest pain, or shortness of breath, requiring prompt medical evaluation;
    • Large Intestines (Colitis). Signs are diarrhea (which might be severe, watery, or more frequent than usual), stools containing blood or mucus, black and tarry stools, or significant stomach pain or tenderness; Do not attempt to treat diarrhea yourself without consulting your doctor;
    • Liver (Hepatitis). Look for yellowing of the skin or the whites of your eyes (jaundice), dark urine resembling tea, nausea or vomiting, pain in the upper right part of your abdomen, or bruising or bleeding more easily than normal; Unusual fatigue can also be a sign;
    • Kidneys (Nephritis). Symptoms involve changes in urination frequency or amount, blood in the urine, swelling, particularly in the ankles, or loss of appetite;
    • Heart (Myocarditis). Be alert for chest pain, shortness of breath, irregular heartbeats or palpitations, significant fatigue, or swelling in your ankles or legs;
    • Brain or Nerves (Encephalitis, Meningitis, Neuropathies, Myasthenia Gravis). Watch for headache, fever, confusion, excessive sleepiness, memory issues, seizures, a stiff neck, severe muscle weakness (like drooping eyelids, difficulty swallowing), numbness or tingling sensations, vision changes (double vision), or hallucinations;
    • Eyes (Uveitis, Iritis). Report any changes in your vision, blurry vision, eye pain, or eye redness;
    • Myositis or Arthritis. Let your doctor know about severe or persistent muscle pain or weakness, or joint pain, stiffness, or swelling. It might be a signs of inflammation if joints (arthritis) or muscles (myositis).

    Endocrine System Complications of Pembrolizumab

    Pembrolizumab can affect glands that produce hormones:

    • Thyroid gland. Unusual tiredness or lack of energy, changes in weight (gain or loss), feeling excessively cold or hot, rapid heartbeat, increased sweating are common signs of thyroid imbalance.
    • Pituitary gland. Pituitary is a small gland in your brain that controls how other gland work. The symptoms might vary from low sex drive and infertility to palpitation and heat intolerance.
    • Adrenal glands. Muscle wasting and weight loss, feeling dizzy or fainting, low blood pressure might indicate you have a deficiency of one of adrenal hormone. Please, contact your medical team if you expirience some of the symptoms.
    • Pancreas (diabetes). Muscle weakness, increased thirst or hunger, frequent urination are synmptoms to watch for.

    Skin Complications of Pembrolizumab

    Skin reactions like itchy skin or blistering are quite common.

    Check your skin regularly while taking pembrolizumab for the signs of more serious skin complications:

    • peeling skin;
    • painful sores or ulcers, especially if they occur in the mouth, nose, throat, or genital area;
    • Painful redness of teh skin and rapisly spreading blisters toghther with fever might indicate Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN).

    Both SJS and TEN are rare but life threatening complicatiosn and requre immidiate medical attention.

    Infusion Reactions

    Reactions can occur during or shortly after the infusion of pembrolizumab. Symptoms might include chills or shaking, itching, rash, flushing, shortness of breath or wheezing, dizziness, fever, or feeling faint; Your healthcare team will monitor you closely for these;

    Other Serious Complications

    Less common but potentially severe issues include:

    • Blood Disorders: Your immune system might attack blood cells, leading to conditions like hemolytic anemia (destruction of red blood cells) or aplastic anemia (body doesn’t produce enough new blood cells), or another rare condition called hemophagocytic lymphohistiocytosis (HLH), involving excessive immune activation; Symptoms can include fatigue, pale skin, shortness of breath, fever, bruising, or swollen lymph nodes;
    • Stem Cell Transplant Complications: If you have received, or plan to receive, an allogeneic stem cell transplant (using donor cells), pembrolizumab given before or after the transplant can increase the risk of serious complications like graft-versus-host disease (GVHD), where the donor cells attack your body, which can be life-threatening; Ensure your transplant team and oncologist are aware of all treatments received;

    Remember: This is not a complete list of all possible side effects; Always communicate openly with your healthcare team about any symptoms you experience, no matter how minor they seem;

    Before Taking Pembrolizumab

    To ensure pembrolizumab is administered safely and effectively, a thorough discussion of your medical background with your doctor is crucial before initiating treatment; It is vital to inform your doctor if you:

    • Suffer from any immune system disorders, such as Crohn’s disease, ulcerative colitis, lupus, or rheumatoid arthritis;
    • Have undergone an organ transplant, particularly an allogeneic stem cell transplant (using cells from a donor);
    • Are scheduled to receive, or have previously received, an allogeneic stem cell transplant;
    • Have received radiation therapy to your chest area in the past;
    • Experience any lung or breathing difficulties;
    • Have pre-existing liver or kidney conditions;
    • Have issues with your thyroid, pituitary gland, adrenal glands, or pancreas, including diabetes;
    • Possess any other significant medical conditions;
    • Are pregnant, suspect you might be pregnant, or are planning pregnancy; Pembrolizumab poses risks to an unborn baby, so females capable of becoming pregnant must utilize effective contraception throughout the treatment period and for a minimum of 4 months following the final dose;
    • Are breastfeeding or intend to breastfeed; It remains unknown whether pembrolizumab passes into breast milk, therefore breastfeeding should be avoided during treatment and for 4 months after the last dose due to potential risks to the infant;
    • Have any known allergies, especially to pembrolizumab or its components;
    • Are currently taking any other medications, encompassing prescription drugs, over-the-counter medicines, vitamins, herbal remedies, or supplements;

    What Should I Avoid While Receiving Pembrolizumab?

    Based on safety guidelines for pembrolizumab and similar immunotherapy agents:

    • Avoid Becoming Pregnant. Due to the potential harm to a developing fetus, females who are able to conceive must use reliable birth control during the entire course of treatment and continue for at least 4 months after the final infusion.
    • Avoid Breastfeeding. Breastfeeding is not recommended during treatment and for 4 months following the last dose, owing to the potential risk for adverse effects in the nursing child.
    • Avoid Self-Managing Side Effects. Do not attempt to treat potential side effects like diarrhea, rash, or cough independently without first consulting your healthcare provider; It’s essential they evaluate the cause, particularly to rule out serious immune-related reactions requiring specific medical management.

    Always adhere to the specific instructions and precautions provided by your healthcare team regarding activities and lifestyle during your treatment period.

    Brand Name

    Pembrolizumab is marketed globally under the brand name Keytruda®;

    Similar Medications to Pembrolizumab

    Pembrolizumab is part of a class of cancer drugs known as immune checkpoint inhibitors, specifically targeting the PD-1/PD-L1 pathway; Other medications function through similar mechanisms, targeting PD-1, PD-L1, or the related CTLA-4 pathway, to enhance the immune response against cancer; These include:

    • Other PD-1 Inhibitors: 
    • PD-L1 Inhibitors: 
      • Atezolizumab (Tecentriq®);
      • Durvalumab (Imfinzi®);
      • Avelumab (Bavencio®);
    • CTLA-4 Inhibitors: 
      • Ipilimumab (Yervoy®);
      • Tremelimumab (Imjudo®);

    Although these drugs operate similarly, their approved uses (indications), dosing schedules, and specific side effect profiles can differ; Your oncologist will determine the most suitable immunotherapy agent based on your unique cancer type and overall health situation;

  • Nivolumab

    Nivolumab (OPDIVO®) is an anti-cancer medication, which doesn’t allow tumor cells to escape from the survelience of immune system

    What is Nivolumab?

    Nivolumab (pronounced ni-VOH-loo-mab) is a type of cancer treatment known as immunotherapy. It belongs to the group of “immune checkpoint inhibitor,” and even more specifically, a “PD-1 inhibitor“.

    Unlike traditional chemotherapy that directly attacks cancer cells, nivolumab works with your own immune system, essentially empowering it to recognize and fight the cancer more effectively.

    Think of it as taking the brakes off your immune cells so they can do their job better against the cancer.

    Nivolumab is a prescription medication given intravenously (as an infusion into a vein). Its most common brand name is OPDIVO®.

    What is Nivolumab Used For?

    Nivolumab is approved to treat several different types of cancer, often in advanced stages or when other treatments haven’t worked or are no longer working.

    All of these cancers express ligand PDL-1 to connect to PD-1 and evade immune attack:

    Skin Cancer (Melanoma)

    • To treat advanced melanoma (that has spread or cannot be removed by surgery), sometimes with ipilimumab, especially if not previously treated.
    • After surgery to completely remove melanoma and its metastases, to help prevent or delay the cancer from coming back (this is called adjuvant therapy).

    Lung Cancer (Non-Small Cell Lung Cancer – NSCLC)

    • To treat advanced NSCLC that has spread or grown after treatment with platinum-based chemotherapy. (If you have specific mutations like EGFR or ALK, you usually need to have tried targeted therapies first).
    • As a first treatment for advanced NSCLC, often combined with ipilimumab (sometimes depending on PD-L1 test results).
    • As a first treatment for metastatic NSCLC, combined with ipilimumab and platinum-based chemotherapy.
    • Before surgery for NSCLC (neoadjuvant therapy), combined with chemotherapy.

    Malignant Pleural Mesothelioma.

    • For untreated mesothelioma (cancer affecting the lining of the lungs/chest wall) that cannot be removed by surgery, given in combination with ipilimumab.

    Kidney Cancer (Renal Cell Carcinoma – RCC)

    • To treat advanced RCC that has spread or grown after treatment with therapies that block blood vessel growth (anti-angiogenic therapies).
    • As a first treatment for advanced RCC, combined with ipilimumab.
    • As a first treatment for advanced RCC (that cannot be treated with radiation/surgery or is metastatic), combined with cabozantinib.

    Head and Neck Cancer (Squamous Cell Carcinoma)

    • To treat advanced head and neck cancer when it grows or spreads during or after treatment with platinum-based chemotherapy.

    Hodgkin Lymphoma.

    • For cancer that has come back or spread after an autologous stem cell transplant (using your own stem cells) and treatment with brentuximab vedotin, OR after at least 3 kinds of treatment including an autologous stem cell transplant. (Note: This use was approved under Health Canada’s NOC/c policy, meaning ongoing studies are confirming its benefit).

    Colon or Rectal Cancer

    • For cancer shown by tests to be microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR), given in combination with ipilimumab, IF you have already tried treatment with specific chemotherapy combinations (fluoropyrimidine with oxaliplatin, or irinotecan) and the cancer has spread/grown or you can no longer tolerate that treatment.

    Esophageal Cancer.

    • After chemoradiation and surgery to remove the cancer (adjuvant therapy).
    • For advanced esophageal squamous cell carcinoma that tests positive for PD-L1, cannot be removed surgically, and has come back or spread. Sometimes given with chemotherapy or ipilimumab as a first treatment in the metastatic setting.

    Stomach Cancer (Adenocarcinoma type).

    • As a first treatment when the cancer cannot be removed by surgery, given in combination with chemotherapy (fluoropyrimidine and platinum).

    Bladder and Urinary Tract Cancer (Urothelial Carcinoma).

    • To help prevent cancer from returning after it was removed by surgery (adjuvant therapy), particularly if you are at high risk and may have had prior platinum chemotherapy. (Note: This use was approved under Health Canada’s NOC/c policy).
    • As a first treatment when the cancer has spread (metastatic) or cannot be removed by surgery, given in combination with cisplatin and gemcitabine chemotherapy.

    Important Note: Nivolumab is not currently known to be safe or effective for children under 18 years of age.

    How is Nivolumab Given?

    Nivolumab is administered via intravenous (IV) infusion. Patient receive the drip in the specilized clinic under supervision of health professional.

    Here some key

    • Duration. A standard infusion typically takes about 30 minutes.
    • Frequency. Depending on your specific cancer, the dose being used, and whether you’re receiving it alone or with other treatments, you’ll likely receive nivolumab every 2, 3, or 4 weeks. Your doctor will determine the exact schedule for you.
    • Combination Therapy Order. If you receive nivolumab with chemotherapy or ipilimumab, nivolumab is usually given first, followed by the other medication(s). If combined with cabozantinib (a pill), you’ll receive the nivolumab infusion first.
    • Appointments are Key: It’s very important to keep all your scheduled appointments for treatment. If you have to miss an appointment, contact your healthcare team immediately to reschedule.

    How Does Nivolumab Work?

    Nivolumab mechanism of action

    Your immune system has cells called T-cells that are designed to find and destroy threats like infections and cancer cells. However, cancer cells can be sneaky. They sometimes develop ways to “hide” from the immune system. One way they do this is by displaying a protein called PD-L1 on their surface.

    When PD-L1 on a cancer cell connects with a protein called PD-1 on your T-cells, it acts like a switch, telling the T-cell to turn off or leave the cancer cell alone. This is called an “immune checkpoint.”

    Nivolumab is designed to block the PD-1 protein on your T-cells. By blocking PD-1, nivolumab prevents the cancer cell’s PD-L1 from delivering that “off” signal. This action “releases the brakes” on the T-cells, allowing them to recognize the cancer cells as harmful and attack them.

    Read more about how does it work in our article “nivolumab mechanism of action“.

    Side Effects of Nivolumab

    Because nivolumab works by stimulating your immune system, its side effects are often related to inflammation caused by the immune system becoming overactive and potentially affecting healthy organs. These are sometimes called immune-related adverse events (irAEs).

    It’s crucial to remember that these side effects can occur during treatment and sometimes weeks or even months after your last dose.

    When to Call your Medical Team Immediately ?

    While many side effects are manageable, some can be serious or even life-threatening if not addressed promptly. Contact your healthcare team right away if you experience any of the following symptoms.

    Nivolumab and serious inflammation of other organs

    • Pneumonia.  New or worsening cough, chest pain, shortness of breath, difficulty breathing might be signs of inflamation developing inside your lungs.
    • Inflammation of the large intestine (Colitis). Diarrhea (watery, loose, or more frequent than usual), blood or mucus in your stool, black/tarry stools, severe stomach pain or tenderness. Do not self-meidicate, tell your doctor about problems with the loose or watery stool.
    • Liver inflammation (Hepatitis). Yellowing of the skin or whites of the eyes (jaundice), severe nausea or vomiting, pain on the right side of your stomach area, dark urine (tea-colored), unusual tiredness, bruising or bleeding easily.
    • Kidney Problems (Nephritis). When urine saddenly changes the color, becoming much darker, your face and hands are swollen, and you have a dull pain in your lower back, it might be signs of nephritis. Call your medical team immediately.
    • Brain and problems with nervous symptoms. Headache that doesn’t go away, coupled with fever, or a neural deficit (confusion, palsy, memory loss or coordination problems) are signs you have some neural side effects.
    • Heart Problems. Most common side efefct is an inflammation of heart muscles, called myocarditis. Common signs are chest pain, irregular heartbeat, shortness of breath, fatigue, swelling in the legs.

    Nivolumab and serious endocrine events

    • Hormone imbalances. 
      • Thyroid problems. Whe the thyroid is affected and stop profucing suffcient levels of hormones, you might expirience extreme tiredness or sleepiness, weight gain or loss, changes in mood or behavior (irritability, forgetfulness, depression, low sex drive).
      • Diabetes. Frequent urination, feeling thirsty, and muscle wasting are common symptoms of diabetes.
      • Pituitary gland. A small gland in your brain, that produces bunch of important hormones controlling how other glands in your body are working. A person might expirirence symptoms ranging from low sex drive (decreased libido) and infertility to weight gain, frequent urination or headaches.

    Skin, eye problem and infusion reactions

    • Skin Problems. Itchy skin is quite common in immunotherapy. Sometimes you might experience more disturbing skin side effects like blistering or peeling skin, painful sores or ulcers in the mouth, nose, throat, or genital area.
    • Severe Infusion Reactions. Some people might react on a drip. Chills or shaking, itching or rash, flushing, difficulty breathing, dizziness, fever, feeling like you might pass out during or shortly after the infusion.
    • Eye Problems. Blurry vision, sadden changes in clarity of your vision are two serius, but rare side effects. More benign changes, like “red eyes” or an itchy eye

    It is vital to report ANY new or worsening symptoms to your healthcare team promptly. Early detection and management are key to preventing serious complications.

    Common Side Effects

    These side effects are seen more frequently but are often less severe. They can vary depending on whether you receive nivolumab alone or in combination.

    • You take only Nivolumab: 
      • Fatigue (feeling tired or weak);
      • skin rash or itchy skin;
      • decreased appetite;
      • nausea, diarrhea;
      • joint pain.
    • Nivolumab with other medicines.:
      • fatigue;
      • skin rash or itching;
      • diarrhea, nausea or a vomiting, decreased appetite,
      • thyroid problems,
      • headache;
      • shortness of breath;
      • fever;
      • low white blood count;
      • muscle/bone/joint pain.

    Less Common or Rare Side Effects

    Besides the serious conditions listed under “When to Seek Medical Attention,” other less common but potentially serious side effects include:

    • Inflammation of muscles (myositis) or muscle breakdown (rhabdomyolysis).
    • Inflammation of the pancreas (pancreatitis).
    • Blood sugar problems (diabetes or ketoacidosis).
    • Changes in blood levels of calcium, potassium, magnesium, or sodium.
    • Rare blood conditions where the immune system attacks blood cells (autoimmune hemolytic anemia, aplastic anemia) or causes widespread inflammation (haemophagocytic lymphohistiocytosis).
    • Complications if you have an allogeneic stem cell transplant (using donor cells) after receiving nivolumab – these can be severe or fatal. Inform your transplant team if you’ve had nivolumab.

    This is not an exhaustive list of potential side effect, so you feel something is wrong, do not hesitate to talk with your medical team.

    Before Taking Nivolumab

    To ensure nivolumab is as safe and effective as possible for you, it’s crucial to have an open discussion with your healthcare team about your health history before you start treatment. Be sure to tell them if you:

    • Have any allergies, especially if you’ve ever had a reaction to nivolumab or any of its ingredients.
    • Tall about all medications you are taking
    • Have any autoimmune diseases (like Crohn’s disease, ulcerative colitis, lupus, rheumatoid arthritis, etc.), where the body’s immune system attacks itself.
    • If you expirience any problems with your lungs, liver, kidneys, or hormone glands (thyroid, pituitary, adrenals, pancreas).
    • Have melanoma of the eye.
    • If you have had an organ transplant, including a stem cell transplant using donor cells (allogeneic).
    • Have cancer that has spread to your brain.
    • Are taking any medications that suppress your immune system, such as steroids (like prednisone).
    • Have experienced serious side effects from other immunotherapies (like ipilimumab).

    Nivolumab and pregnancy

    Nivolumab can harm your unborn baby. Women who could become pregnant must use effective birth control during treatment and for at least 5 months after the last dose.
    Do not become pregnant while taking nivolumab.

    Nivolumab and breast-feeding

    Breast-feeding: It’s not known if nivolumab passes into breast milk, but due to the potential for serious side effects in the baby, you should not breast-feed during treatment.

    What Should I Avoid While Receiving Nivolumab?

    • Pregnancy and breast-feeding;
    • Self-treating side effects;
    • Stopping treatment abruptly or not missing a drip;
    • Driving/Operating machinery.

    Brand Names for Nivolumab

    The brand name for nivolumab is OPDIVO®.

    Similar Medications

    Nivolumab belongs to a class of drugs called immune checkpoint inhibitors. Other medications work in similar ways by targeting PD-1, PD-L1, or CTLA-4 to help the immune system fight cancer. These include:

    • Other PD-1 Inhibitors: Pembrolizumab (Keytruda®), Cemiplimab (Libtayo®)
    • PD-L1 Inhibitors: Atezolizumab (Tecentriq®), Durvalumab (Imfinzi®), Avelumab (Bavencio®)
    • CTLA-4 Inhibitors: Ipilimumab (Yervoy®) – often used in combination with nivolumab.

    While these drugs have similar mechanisms, they may be used for different types of cancer or have slightly different side effect profiles.