IntravenousAdvanced renal cell carcinoma, Locally advanced non-small cell lung carcinoma, Locally advanced squamous cell carcinoma of the head and neck, Locally advanced urothelial carcinoma, Metastatic melanoma, Metastatic non-small cell lung carcinoma, Metastatic squamous cell carcinoma of the head and neck, Metastatic urothelial carcinoma, Refractory classical Hodgkin lymphoma, Relapsed classical Hodgkin lymphomaAdult: 3 mg/kg, given via infusion over 60 minutes, every 2 weeks. Continued until disease progression or unacceptable toxicity.
IntravenousMetastatic colorectal cancerAdult: 240 mg, given via infusion over 60 minutes, every 2 weeks. Continued until disease progression or unacceptable toxicity.
Child: ≥12 years Same as adult dose.
IntravenousHepatocellular carcinomaAdult: 240 mg, given via infusion over 60 minutes, every 2 weeks. Continued until disease progression or unacceptable toxicity.
IntravenousMetastatic melanomaAdult: In combination with ipilimumab: 1 mg/kg, given via infusion over 60 minutes, every 3 weeks for 4 doses, followed by ipilimumab. Thereafter, 3 mg/kg over 60 minutes, every 2 weeks, as monotherapy. Continued until disease progression or unacceptable toxicity.
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Dilute vials labelled as containing 10 mg/mL with NaCl 0.9% solution or glucose 5% solution to provide a solution containing approx 1-10 mg/mL. Do not shake.
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Patient with history or concurrent active brain metastases or active auto-immune disease, ocular/uveal melanoma, symptomatic interstitial lung disease, poor prognosis or aggressive disease, and medical conditions requiring systemic immunosuppression. Patient with carcinoma of the nasopharynx or salivary gland when used for the treatment of head and neck cancer. Patient who received hematopoietic stem cell transplant. Moderate to severe hepatic impairment. Children. Pregnancy and lactation.
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Significant: Adrenal insufficiency, type 1 diabetes mellitus, diabetic ketoacidosis; elevation of ALT, AST, alkaline phosphatase, bilirubin; hypophysitis, immune-mediated nephritis, and other immune-related adverse reactions (e.g. auto-immune neuropathy, demyelination, uveitis). Rarely, severe infusion-related reactions.
Blood and lymphatic system disorders: Lymphocytopenia, anaemia, leucopenia, thrombocytopenia.
Gastrointestinal disorders: Nausea, constipation, vomiting, abdominal pain, intestinal perforation, stomatitis.
General disorders and administration site conditions: Fatigue, malaise, weakness, febrile reaction.
Investigations: Increased serum amylase, lipase, triglycerides, cholesterol.
Metabolism and nutrition disorders: Peripheral oedema, decreased appetite, hyponatraemia, hyperkalaemia, hypocalcaemia, hypomagnesaemia.
Musculoskeletal and connective tissue disorders: Musculoskeletal pain, back pain, arthralgia, myopathy.
Nervous system disorders: Headache, peripheral neuropathy, neuritis, peripheral nerve palsy.
Renal and urinary disorders: UTI.
Respiratory thoracic and mediastinal disorders: Upper respiratory tract infection.
Skin and subcutaneous tissue disorders: Rash, pruritus, vitiligo, erythema.
Vascular disorders: Hypertension.
Potentially Fatal: Stevens-Johnson syndrome, toxic epidermal necrolysis, neutropaenia, dyspnoea, renal failure; immune-mediated encephalitis, diarrhea/colitis, hepatitis, hypophysitis, thyroid dysfunction, pneumonia, pneumonitis or interstitial lung disease, pulmonary embolism. Rarely, myotoxicity (e.g. myositis, myocarditis, rhabdomyolysis).
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This drug may cause fatigue, if affected, do not drive or operate machinery.
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Monitor LFT, serum creatinine, thyroid function at baseline and periodically thereafter; blood glucose. Monitor for signs and symptoms of electrolyte disturbance, dehydration, immune-mediated colitis, hypophysitis, pneumonitis, hepatitis, thyroid disorder, rash, encephalitis, adrenal insufficiency and other immune-related adverse reactions; cardiac and pulmonary adverse reactions, myotoxicity, and infusion reactions during and at least 5 months after discontinuation of therapy.
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Potentially Fatal: Decreased therapeutic effect with immunosuppressants.
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Description: Nivolumab is a human immunoglobulin G4 (IgG4) monoclonal antibody which binds to negative immunoregulatory protein programmed death-1 (PD-1) receptor. This results in the activation of immune response to tumour cells.
Pharmacokinetics:
Distribution: Crosses the placenta.
Metabolism: Catabolised into small peptides and amino acids.
Excretion: Terminal elimination half-life: Approx 25 days.
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Store between 2-8°C. Protect from light. Do not freeze. Reconstituted solution: Stable for 8 hours when stored between 20-25°C and 24 hours between 2-8°C.
Any unused portions should be disposed of in accordance with local requirements.
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L01FF01 - nivolumab ; Belongs to the class of PD-1/PDL-1 (Programmed cell death protein 1/death ligand 1) inhibitors. Used in the treatment of cancer.
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Anon. Nivolumab. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 11/12/2017. Buckingham R (ed). Nivolumab. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 11/12/2017. Joint Formulary Committee. Nivolumab. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 11/12/2017. McEvoy GK, Snow EK, Miller J et al (eds). Nivolumab. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 11/12/2017. Opdivo Injection (E.R. Squibb & Sons, L.L.C). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 11/12/2017.
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