How long does Opdivo take to work and how do you know if it's working?
Opdivo (nivolumab) is a monoclonal antibody or type of immunotherapy used to treat various types of cancer. It is a programmed death-1 (PD-1) inhibitor that helps the T cells of your immune system identify and attack cancer cells. It does this by helping to block the cancer cell’s ability to disguise itself and evade detection by the immune system.
Opdivo is administered via a 30-60 minute intravenous infusion every 2-4 or 6 weeks. It is also available as a subcutaneous (under the skin) injection under the brand name Opdivo Qvantig.
How long does Opdivo take to work?
Unlike traditional chemotherapy, immunotherapy like Opdivo takes time to activate the immune response against cancer. The body must first recognize cancer cells as threats before attacking them, which can delay visible results.
In clinical trials, researchers measure the "time to response"—the period from treatment initiation to the first signs of tumor shrinkage. The median time to response observed in key Opdivo trials is listed below:
Time to response following treatment with Opdivo
|
Cancer Type (Trial name) |
Median Time to Response |
|
Melanoma (CheckMate-066) |
Opdivo: 2.1 months (range 1.2-7.6) vs Dacarbazine 2.1 months (range 1.8-3.6) |
|
Renal-cell carcinoma (CheckMate-214) |
Opdivo + Yervoy: 2.8 months (range 0.9-11.3) vs Sutent (sunitinib): 3.0 months (range 0.6-15.0) |
|
Renal-cell carcinoma (CheckMate-9ER) |
Opdivo + Cabometyx (cabozantinib): 2.8 months vs Sutent: 4.2 months |
|
Classic Hodgkin Lymphoma (CheckMate-205) |
Opdivo: 2.1 months (range 1.9-2.7) |
|
Squamous cell carcinoma of the head and neck (CheckMate-141) |
Opdivo: 2.1 months (range 1.8-7.4) vs Investigator’s choice (methotrexate, docetaxel or cetuximab) : 2.0 (range 1.9-4.6) |
|
Hepatocellular carcinoma (CheckMate-040) |
Opdivo + Yervoy every 3 weeks (4 doses) then Opdivo every 2 weeks (Arm A): 32% (95% CI 20-47): 2.0 months (range 1.3 to 2.7 months) |
|
Urothelial carcinoma (CheckMate-275) |
Opdivo: 2.0 months (range 1.6-13.8) |
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How do you know if Opdivo is working?
Your healthcare provider will monitor your response to Opdivo through imaging tests, such as:
- CT scans (Computed Tomography)
- MRI scans (Magnetic Resonance Imaging)
- PET scans (Positron Emission Tomography)
These scans assess changes in tumor size and detect new tumor growth.
Understanding "Pseudoprogression"
Sometimes, cancer may initially appear to grow on scans before shrinking—a phenomenon known as pseudoprogression. This happens when immune cells flood the tumor site, temporarily increasing its size before the tumor ultimately shrinks. Your doctor will interpret scan results carefully to distinguish between actual progression and pseudoprogression.
If you have concerns about your treatment response, consult your healthcare provider for further evaluation.
References
- Opdivo. How Does Opdivo Work With My Immune System? Available from: https://www.opdivo.com/about-opdivo/how-opdivo-works-monotherapy. [Accessed November 24, 2020].
- OncoLink. All About Immunotherapy. Available from: https://www.oncolink.org/cancer-treatment/immunotherapy/all-about-immunotherapy. [Accessed November 24, 2020].
- Food and Drug Administration (FDA). Opdivo. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/125554s092lbl.pdf. [Accessed June 2, 2021].
- Robert C, Long GV, Brady B, et al. Nivolumab in previously untreated melanoma without BRAF mutation. N Engl J Med. 2015;372(4):320-330. doi:10.1056/NEJMoa1412082.
- Motzer RJ, Tannir NM, McDermott DF, et al. Nivolumab plus Ipilimumab versus Sunitinib in Advanced Renal-Cell Carcinoma. N Engl J Med. 2018;378(14):1277-1290. doi:10.1056/NEJMoa1712126.
- Armand P, Engert A, Younes A, et al. Nivolumab for Relapsed/Refractory Classic Hodgkin Lymphoma After Failure of Autologous Hematopoietic Cell Transplantation: Extended Follow-Up of the Multicohort Single-Arm Phase II CheckMate 205 Trial [published correction appears in J Clin Oncol. 2018 Sep 10;36(26):2748]. J Clin Oncol. 2018;36(14):1428-1439. doi:10.1200/JCO.2017.76.0793.
- Ferris RL, Blumenschein G Jr, Fayette J, et al. Nivolumab vs investigator's choice in recurrent or metastatic squamous cell carcinoma of the head and neck: 2-year long-term survival update of CheckMate 141 with analyses by tumor PD-L1 expression. Oral Oncol. 2018;81:45-51. doi:10.1016/j.oraloncology.2018.04.008.
- Yau T, Kang YK, Kim TY, et al. Efficacy and Safety of Nivolumab Plus Ipilimumab in Patients With Advanced Hepatocellular Carcinoma Previously Treated With Sorafenib: The CheckMate 040 Randomized Clinical Trial [published online ahead of print, 2020 Oct 1]. JAMA Oncol. 2020;6(11):e204564. doi:10.1001/jamaoncol.2020.4564.
- Ma Y, Wang Q, Dong Q, Zhan L, Zhang J. How to differentiate pseudoprogression from true progression in cancer patients treated with immunotherapy. Am J Cancer Res. 2019;9(8):1546-1553. Published 2019 Aug 1.
- Opdivo. Questions Patients May Have. Available from: https://www.opdivo.com/patient-caregiver-support/faqs. [Accessed November 24, 2020].
- Choueiri TK, Powles T, Burotto M, et al. Nivolumab plus Cabozantinib versus Sunitinib for Advanced Renal-Cell Carcinoma. N Engl J Med. 2021;384(9):829-841. doi:10.1056/NEJMoa2026982.
- Galsky MD, Saci A, Szabo PM, et al. Nivolumab in Patients with Advanced Platinum-resistant Urothelial Carcinoma: Efficacy, Safety, and Biomarker Analyses with Extended Follow-up from CheckMate 275. Clin Cancer Res. 2020;26(19):5120-5128. doi:10.1158/1078-0432.CCR-19-4162.
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Pembrolizumab and nivolumab are both prescription medications used to treat various types of cancers, including solid tumors and blood cancers. They may be used alone or in combination with other medicines for cancers that are more advanced, have spread in the body, or are no longer responding to previous treatments. Continue reading
How long does Opdivo stay in your system?
Opdivo stays in your system for a very long time, up to 3 to 4 months (100 to 125 days). This is based on the half-life of Opdivo, which is 25 days. The half-life is the time it takes for half of a drug to be removed from the body, and experts have agreed it takes 4 to 5 half-lives for a drug to be completely removed from the body. This calculates out to 100 to 125 days for Opdivo. This means that side effects can still occur because of Opdivo a few months after you stop taking the drug. Continue reading
What happens when you stop taking Opdivo for melanoma?
Opdivo (nivolumab) is an immunotherapy used to treat a variety of cancer types, including melanoma. Durable responses to treatment have been observed following discontinuation of Opdivo therapy. Continue reading
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Drug information
- Opdivo Information for Consumers
- Opdivo prescribing info & package insert (for Health Professionals)
- Side Effects of Opdivo (detailed)
- Opdivo user reviews (94)
Related support groups
- Opdivo (18 questions, 53 members)