Nivolumab (Specialist drug)

How it works

It is a monoclonal antibody that blocks the programmed death-1 (PD-1) receptor on T cells, releasing a key immune checkpoint to enhance T-cell-mediated antitumour activity.

Prescribing in practice

• By disinhibiting the immune system it can trigger immune-related adverse events affecting almost any organ, including colitis, hepatitis, pneumonitis, endocrinopathies and inflammatory arthritis, which may require corticosteroids or other immunosuppression and prompt recognition.
• Endocrine effects such as thyroid dysfunction, hypophysitis and adrenal insufficiency can present non-specifically and may be permanent.
• Infusion reactions can occur and rheumatologists may be involved in managing checkpoint-induced musculoskeletal and inflammatory complications.

Monitoring

Monitor liver, thyroid and other endocrine function, and remain alert for new gastrointestinal, respiratory, skin or joint symptoms suggesting immune-related toxicity.

Counselling the patient

• Report new diarrhoea, breathlessness, rash, joint pain or unusual fatigue promptly.
• Do not stop investigating new symptoms, as immune side effects can appear during or after treatment.
• Carry information that you are on immunotherapy for any clinician you see.

Evidence & guidelines

Nivolumab is widely NICE-approved across multiple tumour types, and its immune-related adverse events are well characterised in oncology and rheumatology guidance.