Nivolumab (Head and Neck SCC)

How it works

Nivolumab is a monoclonal antibody against the programmed death-1 (PD-1) receptor on T cells; by blocking PD-1 engagement with its ligands it restores T-cell-mediated antitumour immune responses.

Prescribing in practice

• Immune-related adverse events can affect almost any organ — including pneumonitis, colitis, hepatitis, endocrinopathies, nephritis and skin reactions — and may be severe, delayed or life-threatening, requiring prompt recognition and corticosteroid or immunosuppressive management.
• Infusion-related reactions can occur, and treatment should be initiated and supervised by oncologists experienced in immunotherapy.
• Endocrine effects such as thyroid dysfunction, hypophysitis and adrenal insufficiency may present insidiously and need replacement therapy rather than drug discontinuation alone.

Monitoring

Monitor liver and thyroid function, glucose, renal function and clinical status before each cycle, with a low threshold to investigate new respiratory, gastrointestinal, endocrine or dermatological symptoms as immune-related toxicity.

Counselling the patient

• Report any new or worsening symptoms promptly — breathlessness, persistent diarrhoea, jaundice, severe tiredness or rash — as the immune system can attack normal organs.
• Carry your immunotherapy alert card and show it to any healthcare professional you see.
• Side effects can appear weeks or months after treatment, so keep reporting them even after a dose.

Evidence & guidelines

Nivolumab is licensed in platinum-refractory recurrent/metastatic head and neck SCC on the basis of a randomised trial showing improved overall survival versus standard chemotherapy, and is positioned by NICE within those criteria.