Nivolumab

Immune checkpoint inhibitors
Immune checkpoint inhibitors
High alert
An error with this medicine can cause serious harm: double checks and protocols are used.

An anti-PD-1 antibody used in melanoma, lung, kidney, head and neck and liver cancer and Hodgkin lymphoma, alone or with ipilimumab.

Updated Nov 1, 2026

Also called: anti-PD-1 antibody

Quick facts

Group: Immune checkpoint inhibitors
Target: Programmed cell death protein 1 (PD-1) on T cells
Used for: Melanoma · Non-small cell lung cancer
Key effects: Fatigue · Rash and itching · Diarrhoea
Monitor: Thyroid function · Glucose · Stool frequency
ATC: L01FF01

No doses: the clinician sets them by the current guideline.

Mechanism of action

Programmed cell death protein 1 (PD-1) on T cellsNivolumab

The crystal shows human PD-1 bound by the nivolumab Fab.

Target in 3D: Programmed cell death protein 1 (PD-1) on T cells. PDB structure 5WT9 (RCSB PDB, public domain). View the structure at RCSB PDB

Nivolumab binds PD-1 on activated T cells and stops PD-L1 and PD-L2 from switching them off. T cells inside the tumour regain their ability to proliferate, release cytokines and kill tumour cells. Combined with the anti-CTLA-4 antibody ipilimumab it acts at two steps of T-cell activation, which raises both response rates and immune toxicity.

Binds PD-1 on activated T cells
PD-L1/PD-L2 can no longer switch them off
T cells attack the tumour
With ipilimumab: two checkpoints blocked, more effect and toxicity

Indications

Melanoma, advanced or after resection. Melanoma →
Non-small cell lung cancer. Lung cancer →
Renal cell carcinoma. Renal cell carcinoma →
Head and neck squamous cell carcinoma. Head and neck squamous cell carcinoma (oral cavity and oropharynx, HPV) →
Colorectal cancer with mismatch-repair deficiency or high microsatellite instability. Colorectal cancer →
Hepatocellular carcinoma. Hepatocellular carcinoma →
Relapsed or refractory classical Hodgkin lymphoma. Hodgkin lymphoma →

Adverse effects

Common

Fatigue
Rash and itching
Diarrhoea, nausea, decreased appetite
Cough and breathlessness
Muscle and joint pain
Thyroid dysfunction

Contraindications

Previous severe immune-mediated reaction to a checkpoint inhibitor (generally not re-exposed)
Caution: active autoimmune disease, organ or allogeneic stem-cell transplant

Key interactions

Systemic corticosteroids and other immunosuppressants: Used to treat moderate to severe immune-mediated reactions; they damp the immune response.
Ipilimumab: The combination is more effective in some cancers but causes more frequent immune toxicity, including rare fatal myocarditis.

What is monitored

Thyroid function (TSH) before starting and regularly
Liver tests and creatinine before each dose
Glucose; cortisol if fatigue or low blood pressure
Stool frequency, cough and breathlessness at each visit
Signs of myocarditis (chest pain, palpitations) and muscle weakness

Administration and safety

Intravenous infusion only, never as a push or bolus, through a line as the product instructions specify.
Look-alike names: the -mab checkpoint inhibitors (nivolumab, pembrolizumab, atezolizumab, cemiplimab, ipilimumab) are checked by full name; products combined with hyaluronidase for subcutaneous use are not interchangeable with the intravenous ones.
Watch for infusion reactions (chills, fever, rash, breathlessness) during the infusion.

Pregnancy and breastfeeding

Blocking PD-1/PD-L1 or CTLA-4 can harm the fetus (IgG antibodies cross the placenta); effective contraception is used during treatment and for months after, and breastfeeding is avoided.

Nursing care

Before each dose, ask about diarrhoea, cough, rash, headache, fatigue, dizziness, thirst or passing more urine, and review thyroid, liver, kidney and glucose results.
Teach the patient that side effects can start weeks or months after a dose, even after treatment ends, and must be reported early.
Teaching: report diarrhoea or blood in the stool, new cough or breathlessness, yellow skin, severe headache, extreme tiredness, chest pain or muscle weakness at once.
Make sure the patient carries information that they receive immunotherapy, for any emergency visit.

Pharmacokinetics

Absorption: Intravenous infusion.
Elimination: Broken down like natural IgG.
Half-life: About 27 days.

Test yourself

Think of the answer, then tap the question to see it.

Which two checkpoints are blocked by the nivolumab–ipilimumab combination?

PD-1 (nivolumab) and CTLA-4 (ipilimumab).

Which rare but often fatal immune toxicity is more frequent with the combination?

Myocarditis.

How is moderate immune-mediated pneumonitis on nivolumab managed?

The drug is withheld and systemic corticosteroids are given; it is stopped permanently if severe.

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Connections

← Back to the class: Immune checkpoint inhibitors

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Nivolumab Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2025); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.