Nivolumab with relatlimab (Specialist drug)

How it works

It pairs dual immune checkpoint blockade, with nivolumab blocking PD-1 and relatlimab blocking the LAG-3 inhibitory receptor on T cells, together enhancing antitumour T-cell responses more than PD-1 blockade alone.

Prescribing in practice

• Dual checkpoint blockade increases the frequency and severity of immune-related adverse events affecting many organs, including colitis, hepatitis, pneumonitis, endocrinopathies, myocarditis and inflammatory arthritis, demanding early recognition and often corticosteroid or immunosuppressive treatment.
• Both components are given together as one infusion, and the combination should be managed by clinicians experienced in immunotherapy toxicity.
• Endocrine and other immune effects can be delayed, severe or permanent and may require specialist input including from rheumatology.

Monitoring

Monitor liver, thyroid and broader endocrine function and remain vigilant for gastrointestinal, respiratory, cardiac, skin or joint symptoms of immune toxicity.

Counselling the patient

• Report new diarrhoea, breathlessness, chest pain, rash or joint pain without delay.
• Be aware side effects may appear after treatment has finished.
• Tell any clinician you are receiving combined immunotherapy.

Evidence & guidelines

The fixed-dose nivolumab with relatlimab combination is approved for advanced melanoma based on improved progression-free survival over nivolumab alone, with immune-related toxicity well documented.