Nivolumab (RCC / Urothelial)

How it works

It blocks the PD-1 receptor on T cells, preventing PD-L1/PD-L2 engagement and restoring T-cell-mediated anti-tumour immune responses.

Prescribing in practice

• It can cause immune-related adverse events affecting any organ (such as colitis, pneumonitis, hepatitis, nephritis and endocrinopathies) that may be severe and require prompt corticosteroid or immunosuppressive treatment.
• Immune toxicity is more frequent and severe when nivolumab is combined with ipilimumab than when it is given alone.
• Endocrinopathies may be irreversible and can present subtly; manage in line with the SPC and local immunotherapy pathways.

Monitoring

Monitor liver, renal, thyroid and other endocrine function, blood glucose and clinical symptoms before dosing and review for immune-related effects throughout treatment.

Counselling the patient

• Report new or worsening symptoms promptly, such as diarrhoea, breathlessness, rash, severe fatigue or excessive thirst.
• Carry an alert card stating you are receiving immunotherapy.
• Some side effects can develop after treatment has finished, so continue to report new symptoms.

Evidence & guidelines

Nivolumab is supported by randomised trial evidence in renal cell and urothelial carcinoma and is recommended within NICE guidance for defined indications.