Mechanism of Nivolumab


Journal of pharmacy practice and education is an open access, peer reviewed journal that focuses on the interdisciplinary research offering therapeutic solutions to various neurological, genetics, psychological, and respiratory issues affecting the human beings.

Nivolumab, marketed as Opdivo, is a medication used to treat a number of types of cancer. This includes melanoma, lung cancer, renal cell carcinoma, Hodgkin lymphoma, head and neck cancer, colon cancer, and liver cancer. It is used by slow injection into a vein.

Common side effects include tiredness, rash, liver problems, muscles pains, and cough. Severe side effects may include immune-related lung, intestinal, liver, kidney, skin, or endocrine problems. Use during pregnancy may harm the baby and use when breastfeeding is not recommended. Nivolumab is a human IgG4 monoclonal antibody that blocks PD-1. It is a type of Immunotherapy and works as a checkpoint inhibitor, blocking a signal that prevents activation of T cells from attacking the cancer.

Nivolumab was approved for medical use in the United States in 2014. It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system. In the United Kingdom it costs the NHS about £5266 a month as of 2018. In the United States this amount costs about US$13,556 as of 2019, while in China it is about US$7,000. It is made using Chinese hamster ovary cells.

Mechanism T cells protect the body from cancer by killing certain cancer cells. But cancer cells evolve proteins to protect themselves from T cells. Nivolumab blocks those protective proteins. Thus, the T cells can kill the cancer cells. This is an example of immune checkpoint blockade.

PD-1 is a protein on the surface of activated T cells. If another molecule, called programmed cell death 1 ligand 1 or programmed cell death 1 ligand 2 (PD-L1 or PD-L2), binds to PD-1, the T cell becomes inactive. This is one way that the body regulates the immune system, to avoid an overreaction. Many cancer cells make PD-L1, which inhibits T cells from attacking the tumor. Nivolumab blocks PD-L1 from binding to PD-1, allowing the T cell to work PD-L1 is expressed on 40–50% of melanomas and has limited expression otherwise in most visceral organs with the exception of respiratory epithelium and placental tissue.


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Journal of pharmacy Practice and Education