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Nivolumab (Opdivo)

Nivolumab is a type of cancer treatment drug called an immunotherapy. It is a treatment for a number of different types of cancer. You might have it as part of a clinical trial for other types of cancer.

How nivolumab works

Nivolumab works by blocking a protein that stops the immune system from working properly and attacking cancer cells. It helps to make your immune system find and kill cancer cells. 

How you have nivolumab

You have nivolumab through a drip into your bloodstream.

You have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • Portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

When you have nivolumab

You have nivolumab every 2 to 4 weeks, over 30 or 60 minutes depending on your cancer type. 

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatment you are having. For example, your side effects could be worse if you are also having other drugs or radiotherapy.

This treatment affects the immune system. This may cause inflammation in different parts of the body which can cause serious side effects. They could happen during treatment, or some months after treatment has finished. In some people, these side effects could be life threatening.

When to contact your team

Your doctor or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Skin problems

Symptoms of skin problems can include rash and itching.

Less commonly your skin might develop reddening of the skin, dryness, pale white patches of the skin (vitiligo), raised red crusty ring like patches, it may get flaky, your face might get red or you might develop spots.                    

Your doctor will check your skin regularly throughout your treatment.

Diarrhoea

Contact your advice line if you have 4 loose watery poos (diarrhoea) or more in 24 hours. Or if you have diarrhoea for more than 3 days. Or if you can't drink to replace the lost fluid.

Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty of liquid to replace the fluid lost.

Let your doctor or nurse know if you get any skin rash or a rash that gets worse, or you’re worried about any other changes to your skin.

Tiredness and weakness (fatigue)

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Changes in blood sugar levels

You might get changes to your blood sugar levels. Some of the symptoms for high blood sugar levels (hyperglycaemia) are feeling very thirsty, a dry mouth, passing urine very often, feeling tired, blurred vision, weight loss, feeling or being sick, and fruity smelling breath.

Less commonly you might get a low blood sugar (hypoglycaemia). These symptoms include: sweating, feeling hungry, shaky, trembling, fast heartbeat, dizziness, changes to your mood, and feeling tired.

Rarely you may develop diabetes.

Contact your team or advice line if you have any of these symptoms.

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Kidney changes

You might have some changes in the way your kidneys work. You'll have regular blood tests to check how well they are working.

High levels of pancreatic enzymes in your blood

You might have high levels of substances (enzymes) called amylase and lipase in your blood. It doesn’t usually cause symptoms. You have regular blood tests to check this and they return to normal when you stop treatment. 

Feeling sick

Feeling sick is usually well controlled with anti sickness medicine. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques, can all help.

Tell your doctor or nurse if you feel sick. 

Changes in the levels of minerals in your body

Your blood contains different minerals and electrolytes. This treatment can change the levels of calcium, phosphate, magnesium, sodium, and potassium in your blood.

You have regular blood tests during treatment to check this.

Changes to your blood counts

Your blood might show a low number of red blood cells (anaemia) or platelets that helps your blood to clot. You will have regular blood tests to check your blood count levels.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

  • a reaction during the infusion – you might get a rash, shortness of breath, redness or swelling of the face and dizziness – tell your team straight away
  • inflammation of the bowel (colitis) – this can cause diarrhoea with or without blood or pus, tummy (abdomen) pain or cramps, tiredness and problems passing stools
  • high temperature (fever)
  • headaches and dizziness - tell your doctor or nurse straight away if you have these symptoms
  • inflammation of the lungs - this can cause breathlessness or cough
  • cold symptoms - a sore throat, runny or blocked nose, sneezing, or coughing
  • thyroid problems - you might feel tired, gain or lose weight, sweat more than usual or have a fast pounding heart beat
  • loss of appetite and weight loss
  • numbness or tingling in the hands and feet
  • high blood pressure (hypertension)
  • mouth ulcers and sores
  • being sick (vomiting)
  • abdominal pain
  • difficulty passing stool (constipation)
  • dry mouth
  • hair thinning
  • pain in your muscles, bones and joints
  • swelling in the body due to fluid build up

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • lung problems - such as infection (pneumonia) and fluid around the lungs (pleural effusion)
  • pituitary gland problems that can cause fatigue, vision problems, and headaches
  • chest pain – contact your advice line or call 999 immediately
  • high levels of a type of white blood cell called eosinophils in your blood
  • changes to hormone levels – symptoms might include fatigue, loss of appetite and weight loss, low blood pressure, feeling or being sick and darkening of your skin
  • lack of fluid in your body (dehydration)
  • imbalance of substances in your blood (metabolic acidosis) – it can cause confusion, tiredness, shortness of breath and headaches
  • eye problems – the eye may swell, feel dry and cause blurred vision
  • heart problems – your heart beat might get faster or you might have a build up of fluid around the heart
  • inflammation of the blood vessels (vasculitis), pancreas, heart, stomach, liver, muscles or joints
  • kidney problems – you might get high blood pressure, feeling or being sick, dark urine, blood in your urine, and high temperature

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant while you are having treatment and for 5 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)
  • be in contact with other people who have had live vaccines as injections

Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened. 

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help

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