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What happens when you stop taking Opdivo (nivolumab) for melanoma?

Medically reviewed by N. France, BPharm. Last updated on Nov 23, 2020.

Official Answer

by Drugs.com

Opdivo (nivolumab) is an immunotherapy used to treat a variety of cancer types, including melanoma. It is designed to help turn on the immune system to help fight cancer.

It is not yet clear what the optimum duration of therapy with Opdivo is following a complete response to therapy, but it is not a type of medication that patients continue to take indefinitely.

Durable responses are observed in melanoma patients after they stop Opdivo, according to researchers at Memorial Sloan Kettering

Patients with melanoma who had been treated with Opdivo generally had a durable response after stopping treatment, according to the results of a retrospective analysis conducted by researchers at Memorial Sloan Kettering. Their analysis included 396 patients, 14.1% of which received treatment with Opdivo, while the rest received Keytruda (pembrolizumab).

The patients with melanoma were treated for a median duration of 7 months to achieve a complete response - which is defined as the disappearance of all signs of cancer in response to treatment. Treatment was Opdivo was then stopped shortly after a complete response was achieved, with little maintenance treatment being given.

The results of the analysis showed that the probability of being alive and not needing further treatment for melanoma was 72.1% at 3 years. Maintaining a complete response for 1 year was also a good sign, with the likelihood of the patient remaining in complete response for 2 or more years being reported as 83.3% should this occur.

However, among the group of patients who had a complete response before discontinuation of treatment, it was noted that a significant minority will eventually relapse. Results showed that among the 23 patients who relapsed, 87% did so within the first 2 years.

CheckMate 067 results show long term responses are even possible in patients who stop treatment early due to toxicity

Long-term data from the CheckMate 067 trial also revealed that long term responses to treatment were possible in patients who discontinued treatment with Opdivo + Yervoy (ipilimumab) in the early stages of the trial because of toxicity issues. Survival outcomes at 5 years were similar between the overall study population and the patients who had to stop treatment with Opdivo + Yervoy early because of adverse events.

Why might people stop treatment with Opdivo?

  • A complete response to treatment has been achieved
  • Financial reasons - Opdivo is an expensive therapy
  • To avoid adverse effects
  • To improve quality of life by avoiding the need for regular treatments
References
  • Betof Warner A, Palmer JS, Shoushtari AN, et al. Long-Term Outcomes and Responses to Retreatment in Patients With Melanoma Treated With PD-1 Blockade. J Clin Oncol. 2020;38(15):1655-1663. doi:10.1200/JCO.19.01464.
  • Larkin J, Chiarion-Sileni V, Gonzalez R, et al. Five-Year Survival with Combined Nivolumab and Ipilimumab in Advanced Melanoma. N Engl J Med. 2019;381(16):1535-1546. doi:10.1056/NEJMoa1910836.
  • Bristol Myers Squibb. Pricing Information. Opdivo. Available from: https://www.bmspricinginformation.com/opdivo. [Accessed November 23, 2020].

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