Nivolumab
Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.
| ID | DRUG-NIVOLUMAB |
|---|---|
| Тип | Препарат |
| Синоніми | OpdivoOpdualag (with relatlimab)Ніволумаб |
| Статус | переглянуто 2026-04-26 | очікує клінічного підпису |
| Хвороби | DIS-CHL DIS-ESOPHAGEAL DIS-GASTRIC DIS-HCC DIS-HNSCC DIS-MELANOMA DIS-MESOTHELIOMA DIS-NSCLC DIS-RCC |
| Джерела | SRC-NCCN-ESOPHAGEAL-2025 SRC-NCCN-GASTRIC-2025 SRC-NCCN-HCC-2025 |
Дані про препарат
| Клас | Anti-PD-1 fully human IgG4 monoclonal antibody (immune checkpoint inhibitor) |
|---|---|
| Механізм дії | Fully human IgG4 monoclonal antibody binding programmed cell death protein 1 (PD-1) on activated T cells, blocking the inhibitory PD-1/PD-L1 and PD-1/PD-L2 interactions and restoring cytotoxic T-cell antitumor responses. IgG4 backbone with a stabilizing S228P hinge mutation minimizes ADCC. Mechanistically equivalent to pembrolizumab; combined with anti-CTLA-4 (ipilimumab) the dual blockade amplifies T-cell priming and effector activity at the cost of substantially increased irAE rates. Combined with relatlimab (anti-LAG-3) in Opdualag for melanoma. Approved as monotherapy or combination across many solid tumors and classical Hodgkin lymphoma. |
| Типове дозування | Standard adult monotherapy: 240 mg IV q2w OR 480 mg IV q4w (over 30 min). Pediatric melanoma adjuvant (≥12 yrs, ≥40 kg): 240 mg q2w; <40 kg: 3 mg/kg q2w. With ipilimumab (1L melanoma, RCC, MSI-H CRC): nivolumab 1 mg/kg + ipilimumab 3 mg/kg q3w × 4 doses, then nivolumab 240 mg q2w or 480 mg q4w maintenance. CheckMate-649 (gastric 1L + chemo): 360 mg q3w with chemo or 240 mg q2w. CheckMate-577 (adjuvant esophageal post-CROSS without pCR): 240 mg q2w × 16 wks, then 480 mg q4w to total 1 year. Treatment until progression, unacceptable toxicity, or specified duration (1 yr adjuvant; 2 yrs metastatic in some indications). |
| Зареєстровано в Україні | True |
| Відшкодовується НСЗУ | True |
| Остання перевірка для України | 2026-04-27 |
Застереження
- Severe and fatal immune-mediated adverse reactions (any organ; same spectrum as pembrolizumab)
- Complications of allogeneic HSCT post-nivolumab — hyperacute GVHD, hepatic VOD, severe sepsis (fatal cases)
Нотатки
CheckMate-577: adjuvant nivolumab × 1 yr in patients with residual ypT+ or ypN+ post-CROSS — DFS approximately doubled (median 22.4 vs 11.0 mo). CheckMate-649: 1L gastric / GEJ / esophageal adenocarcinoma with FOLFOX or CAPOX — OS benefit in CPS ≥5 (FDA + EMA approvals restrict to CPS ≥5 / CPS ≥1 respectively). Combination with ipi amplifies irAE rates substantially: melanoma combo Grade 3-4 irAE ~45-55% vs 15-20% mono. ICI-class management protocols apply uniformly (baseline TFTs/cortisol/LFTs, serial labs, prompt steroid intervention for Grade ≥2 irAE).
Де використовується
Contraindications
CI-PEMBROLIZUMAB-AUTOIMMUNE- CI-PEMBROLIZUMAB-AUTOIMMUNE
Regimens
REG-FOLFOX-NIVO- FOLFOX + NivolumabREG-IPI-NIVO-ESOPH-SCC- Nivolumab + ipilimumab (ESCC, 1L metastatic; CheckMate-648)REG-NIVO-ADJUVANT-ESOPH- Nivolumab adjuvant — post-CROSS without pCR (CheckMate-577)REG-NIVO-AVD- N+AVD (Nivolumab + Adriamycin + Vinblastine + Dacarbazine), 6 cycles — emerging 1L standa...REG-NIVO-CABO-RCC- Nivolumab + cabozantinib (RCC, 1L)REG-NIVO-CHEMO-ESCC- Nivolumab + platinum/fluoropyrimidine chemotherapy (ESCC)REG-NIVO-IPI-CHEMO-NSCLC-1L- Nivolumab + Ipilimumab + 2-Cycle Platinum-Doublet Chemotherapy (CheckMate-9LA)REG-NIVO-IPI-MELANOMA- Nivolumab + ipilimumab (melanoma, 1L metastatic)REG-NIVO-IPI-MESOTHELIOMA- Nivolumab + ipilimumab (mesothelioma, 1L)REG-NIVO-IPI-RCC- Nivolumab + ipilimumab (RCC, 1L IMDC intermediate/poor)REG-NIVO-MAINTENANCE-MELANOMA- Nivolumab maintenance (post-induction nivo+ipi, advanced melanoma)REG-NIVO-MONO-ESOPH-2L- Nivolumab monotherapy — 2L esophageal squamous (ATTRACTION-3)REG-NIVO-MONO-MESOTHELIOMA-2L- Nivolumab monotherapy (mesothelioma 2L, CONFIRM)REG-NIVOLUMAB-MONO- Nivolumab monotherapyREG-RELATLIMAB-NIVOLUMAB-MELANOMA- Relatlimab + nivolumab (Opdualag, melanoma)