Nivolumab (28 Day)
Nivolumab (28 Day) is used to treat many different types of cancer, including melanoma, classical Hodgkin Lymphoma, and lung, head and neck, esophageal, bladder, colorectal, liver, and kidney cancers.
Nivolumab (28 Day) is used to treat many different types of cancer, including melanoma, classical Hodgkin Lymphoma, and lung, head and neck, esophageal, bladder, colorectal, liver, and kidney cancers
Page 1 INTRAVENOUS CANCER TREATMENT EDUCATION NIVOLUMAB Name of the regimen and cancer drugs Nivolumab (nih VOL yoo mab): Opdivo Common uses Nivolumab is used to treat many different types of cancer, including melanoma, classical Hodgkin Lymphoma, and lung, head and neck, esophageal, bladder, colorectal, liver, and kidney cancers. Treatment schedule Your treatment will be given into your vein through an intravenous (IV) line. This may be into a short, flexible temporary catheter in your arm, or through a central venous catheter. A central venous catheter, or central line is a long, flexible IV tube that empties into a very large vein next to the heart. Talk with your care team to see which will be best for you and your treatment. Each nivolumab treatment is repeated every 14 days. This is known as one cycle. Your treatment may be given for a set number of cycles, or it will keep going until the drug stops working or you have side effects which stop you from continuing treatment. Nivolumab IV given on Day 1 Possible drug interactions Nivolumab may interact with other drugs you are taking. Please inform your care providers of all prescription medicine, over the counter medications, vitamins, and herbal products that you take. Talk with your care provider or pharmacist before taking new medications, supplements, or receiving any vaccines. Drug DAY 1 2 3 4 5 6 7 8 9 ... 14 Cycle 2 Day 1 Nivolumab X X NIVOLUMAB Page 2 INTRAVENOUS CANCER TREATMENT EDUCATION Common Side Effects Common side effects that have been known to happen in patients receiving nivolumab are listed in the left side of this table. In some instances, the side effects may be reported less often but are still important to discuss. This table does not list all the known side effects for this therapy, only the ones that are experienced most often. Not every patient experiences every known side effect of a drug; even if you are taking the same drug as another patient, you may experience different side effects. Options to help manage any side effects that do occur are included on the right side of this table. These should be discussed with your care provider. If you experience any side effect you cannot manage or that is not listed here, contact your care provider. Possible Side Effect Management Fatigue • You may be more tired than usual or have less energy. • Stay as active as possible, but know it is okay to rest as needed. • Try to do some type of moderate activity every day. • Conserve your energy. Plan your activities and do them at a time of day when you feel a bit more energetic. • Follow a healthy diet and stay hydrated. • Accept help from family and friends • Find healthy ways to manage stress, such as meditation, journaling, yoga, and guided imagery • Develop good sleeping habits, limit napping during the day to help you sleep better at night. • Avoid operating heavy machinery if you feel too tired. Contact your care team if you experience extreme fatigue that prevents you from doing your normal daily activities. Continued on the next page NIVOLUMAB Page 3 INTRAVENOUS CANCER TREATMENT EDUCATION Possible Side Effect Management Muscle or joint pain or weakness or muscle spasms • Keep a diary of your pain or spasms, including when and where the pain happens, what it feels like, and how long it lasts • Stay as active as possible, but know that it is okay to rest as needed, too • Tell your care team if pain or spasms limit what you can do If the pain, weakness, or spasms bothers you, ask your provider what you may use to help with this discomfort. Take only pain medication that has been prescribed or recommended by your care team Rash or itchy skin • Keep your skin moisturized with creams and moisturizing lotions to decrease the risk of rash or itchiness and wear loose fitting clothing. • Avoid using perfumes and cologne as these products may increase rash symptoms. • Avoid being in the heat for long periods of time. • Your provider may recommend an over the counter antihistamine or a topical cream. • Sunlight can make symptoms worse • Avoid sun exposure as much as possible to decrease the risk of sunburn. The highest exposure to UV (ultra violet) radiation occurs between the hours of 10am and 4pm. • Wear long sleeved clothing, with UV protection if possible. • Wear broad brimmed hats. • Apply broad spectrum sunscreen (UVA/UVB) with at least SPF 30 as often as directed on the bottle. • Use lip balm with at least SPF 30 If your rash or itching continues to worsen, contact your care team. Diarrhea (loose and/ or urgent bowel movements) Monitor how many bowel movements you have each day. • Drink 8 10 (8 ounce) glasses of water or fluid each day unless your care team has asked you to limit your fluid intake. • Eat small, frequent meals throughout the day rather than a few large meals. • Eat bland, low fiber foods (such as bananas, applesauce, potatoes, chicken, rice, and toast). • Avoid high fiber foods, such as raw vegetables and fruits and whole grains. • Avoid foods that cause gas, such as broccoli and beans. • Avoid foods with lactose, such as yogurt and milk. • Avoid spicy, fried, and greasy foods. Contact your care team if: • The number of bowel movements you have in a day increases by 4 or more • You feel dizzy or lightheaded Talk with your care team if you believe you have diarrhea. They may recommend an over thecounter medication or prescribe something to help keep it under control. Continued on the next page NIVOLUMAB Page 4 INTRAVENOUS CANCER TREATMENT EDUCATION Possible Side Effect Management Nausea or vomiting • Take all medications as prescribed to help prevent and lessen symptoms of nausea and vomiting • Eat and drink slowly • Drink 8 10 (8 ounce) glasses of water and/or fluid (soup or broth) each day unless your care team has instructed you to limit your fluid intake • Eat small, frequent meals throughout the day rather than a few large meals • Eat bland foods; avoid spicy, fried, and greasy foods • Avoid intense exercise immediately after eating • Don’t lay down right away after eating • Wear loose fitting clothing for comfort • Avoid strong odors. Consider getting fresh air and try deep breathing. Let your care team know if you have nausea or vomiting. Your care team may prescribe medication to help with the symptoms. Cough or shortness of breath A cough that does not produce any mucous or (dry cough) may occur while taking this medication. If you experience any breathing problems or shortness of breath, notify your care team right away. This may be a serious side effect of the medication. Lung (respiratory tract) infection • Wash your hands often, especially before eating and after using the bathroom • Avoid people with fevers, flu, or other infections • Bathe often to keep good personal hygiene. • Report symptoms of a lung infection like a cough, sneezing, runny nose, fever, and scratchy or sore throat to your provider Changes in liver function Your liver function will be checked every so often by a simple blood test. Contact your care team if you notice any of the following. • Yellowing of the skin or whites of your eyes • Dark or brown urine • Bleeding or bruising Changes in kidney function Your liver function will be checked every so often by a simple blood test. Contact your care team if you notice any of the following. • Decreased amount of urination • Unusual swelling in your legs and feet Continued on the next page NIVOLUMAB Page 5 INTRAVENOUS CANCER TREATMENT EDUCATION Possible Side Effect Management Changes in electrolyte levels and other laboratory values: High blood glucose Low sodium levels High lipase levels Changes in some lab values may occur and will be monitored by a simple blood test. • You may not feel any symptoms if the changes are mild and they usually are not a sign of a serious problem. • More severe changes may occur which can be a sign of a serious problem. Notify your care team if you have any of the following: • Shortness of breath • Chest discomfort • Weakness or fatigue • New aches and pains • Headaches • Dizziness or confusion • Stomach pain • Swelling of your legs or feet • Red or brown colored urine • Urinating more often than usual • Diarrhea Rare but serious side effects Tell your care provider if you experience any symptoms of these problems: Nivolumab can alter your hormone levels. Symptoms may include weight and mood changes, headaches, fatigue. Contact your doctor if you are experiencing any of these symptoms. Nivolumab may cause a severe skin reaction resulting in flu like symptoms and painful rashes that can spread and blister. Your healthcare professional may withhold or permanently discontinue medication depending on the severity. Your treatment may cause inflammation in your colon. If symptoms of diarrhea or severe abdominal pain are present, please contact your health care team right away. Your health care team may have to prescribe corticosteroids in order to decrease the inflammation. Nivolumab can cause lung and breathing problems. Tell your care team right away if you have new or worse cough, shortness of breath, chest pain, or difficulty breathing or wheezing. Nivolumab can rarely cause an infusion reaction. During your treatment, let the nurse know right away if any of these symptoms happen: chills or shaking, dizziness, fever, itchiness or rash, flushing, difficulty breathing, wheezing, sudden back pain, or feeling faint. Nivolumab can cause severe reactions in people who receive a stem cell transplant before or after treatment. If you have received a stem cell transplant, talk with your care team about these risks before starting treatment. If you experience ANY new, worsening, or uncontrolled side effects, call your care team immediately. (INSTITUTIONAL CONTACT INFO) NIVOLUMAB Page 6 INTRAVENOUS CANCER TREATMENT EDUCATION Handling body fluids and waste Some of the drugs you receive may be present in urine, stool, sweat, or vomit for many days after treatment. Many cancer drugs are toxic, your bodily waste may also be toxic and can be dangerous to come into contact with. Once you have started nivolumab, follow the instructions below for at least two days after your treatment. This is to keep you, your loved ones, and the environment as safe as possible. Pregnant women should avoid touching anything that may be soiled with body fluids from the patient. Toilet and septic systems • You may use the same toilet, septic tank, and/or sewer that you usually use. If you have a low flow toilet, close the lid and flush twice to ensure that all waste has been discarded. If the toilet or toilet seat becomes soiled with urine, stool, or vomit, clean the surface after every use before other people use the toliet. Wash hands with soap and water after using the toilet for at least 20 seconds. If you need a bedpan, be sure your caregiver knows to wear gloves to assist with cleanup and to wash the bedpan with soap and water every day. If you do not have good control of bladder or bowels, use a disposable pad with a plastic back, a diaper, or a sheet to absorb body waste. Wash any skin that has been exposed to body waste with soap and water. Linens or clothing that are soiled with body fluids or body waste should be washed separately from other linens and clothing. If you do not have a washer, place the soiled linens in a plastic bag until they can be washed. Wash hands with soap and water after touching linens or clothing that may be soiled with body fluids. Intimacy, sexual activity, contraception, and fertility This treatment may cause changes that can affect intimacy and sexuality, including desire and body image. Maintaining physical closeness and/or intimacy with loved ones can be continued during treatment. Holding hands, hugging, and kissing can be done safely. It is recommended that you talk to your care team about any restrictions or questions you may have. Some treatments can influence the ability to have children, also known as fertility. If you’re interested in preserving fertility, talk to your care team before treatment. Ask your healthcare provider to determine when it is safe to become pregnant after your treatment. Patients of reproductive ability should not become pregnant or get their partners pregnant while receiving nivolumab. Some of the drugs you receive may be present in semen and vaginal secretion for many days after treatment. You should use barrier devices, such as condoms, during sexual activity to limit exposure to body fluids. Talk to your care team about birth control. Not all options may be right for your treatment or cancer. Effective contraception could include one or more of the following: barrier methods (e.g. condoms), hormone methods (e.g. birth control pills), or surgery. Tell your care team if you become pregnant or plan to breastfeed. NIVOLUMAB Page 7 INTRAVENOUS CANCER TREATMENT EDUCATION Additional resources Product website: www.opdivo.com Prescribing information link: https://packageinserts.bms.com/pi/pi opdivo.pdf Product resources: https://www.opdivo.com/patient caregiver support/patient resources Updated – July 20, 2021 Additional instructions Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient education guide. This guide represents a brief summary of the therapy derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related to the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this therapy and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this therapy by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual receiving therapy. All decisions related to receiving this therapy should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Intravenous Cancer Treatment Education (IVE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about intravenous cancer therapy. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to
Published: 01 August 2021
Last Updated: 28 September 2021
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