Patient Handout: Nivolumab and Hyaluronidase-nvhy (Opdivo + Hyaluronidase)
What are Nivolumab and Hyaluronidase-nvhy?
Nivolumab (brand name Opdivo) is an immunotherapy medication that helps the immune system fight certain types of cancer, including melanoma, non-small cell lung cancer, renal cell carcinoma, and more. It works by blocking a protein called PD-1 on immune cells, allowing your immune system to better recognize and attack cancer cells.
Hyaluronidase-nvhy (brand name Hylenex or Hyaluronidase-nvhy) is an enzyme that is used to help deliver nivolumab more effectively under the skin. It temporarily breaks down hyaluronan, a substance found in tissues that can prevent the drug from being absorbed quickly. By doing this, hyaluronidase-nvhy helps the body absorb nivolumab when it is injected under the skin.
When combined, nivolumab and hyaluronidase-nvhy are used to treat cancers and allow for the subcutaneous administration of nivolumab (a type of injection into the fatty tissue just under the skin), rather than through an intravenous (IV) infusion. This method can offer more convenience for patients compared to traditional IV administration.
How Does Nivolumab + Hyaluronidase-nvhy Work?
Nivolumab works by blocking the PD-1 protein, which can otherwise prevent T-cells (immune cells) from attacking cancer cells. By blocking PD-1, nivolumab allows the immune system to better recognize and fight cancer cells.
Hyaluronidase-nvhy helps increase the absorption of nivolumab when given as an injection under the skin. It breaks down hyaluronan in the tissue, allowing nivolumab to be absorbed more easily and quickly, reducing the need for an IV infusion.
How is Nivolumab and Hyaluronidase-nvhy Given?
Nivolumab + hyaluronidase-nvhy is given as a subcutaneous injection (under the skin).
- Dosage: Your doctor will determine the appropriate dose based on your type of cancer, overall health, and treatment goals.
- Injection Frequency: The medication is usually given once every 2 to 4 weeks.
- Administration: A healthcare professional will give the injection in a clinic or medical setting. They will carefully monitor you during and after the injection.
- Injection Sites: Nivolumab with hyaluronidase-nvhy is typically injected into the fatty tissue of the abdomen or thigh. Your doctor will determine the best injection site for you.
Possible Side Effects
Nivolumab + hyaluronidase-nvhy may cause side effects, which can vary from mild to severe. Some side effects may be immune-related, meaning they happen when your immune system attacks healthy tissue. Common side effects include:
Common Side Effects:
- Fatigue: Many people feel tired or weak during treatment. Rest as needed and talk to your doctor if it affects your daily activities.
- Skin reactions: You may experience mild redness, swelling, or irritation at the injection site. These are usually temporary.
- Nausea or decreased appetite: Some patients may experience nausea, or a loss of appetite. Eating smaller, more frequent meals may help.
- Diarrhea: Nivolumab can cause diarrhea, which should be reported to your healthcare provider if severe.
- Rash: Skin rashes may develop, often appearing as red spots or bumps.
Serious Side Effects:
- Immune-related side effects: Nivolumab can cause the immune system to attack healthy organs, leading to:
- Colitis (inflammation of the colon): Severe diarrhea, abdominal pain, or blood in the stool.
- Pneumonitis (lung inflammation): Symptoms like cough, difficulty breathing, or chest pain.
- Hepatitis (liver inflammation): Yellowing of the skin or eyes, dark urine, or pain in the upper right abdomen.
- Nephritis (kidney inflammation): Symptoms like swelling in the legs, decreased urine output, or changes in urination.
- Endocrine problems: These can cause symptoms like weight changes, fatigue, dizziness, or mood swings.
Injection Site Reactions:
- While usually mild, the injection site may become red, swollen, or tender. If the pain or swelling becomes severe, inform your healthcare provider.
Precautions Before Taking Nivolumab + Hyaluronidase-nvhy
Before starting treatment, it’s important to inform your doctor if you have:
- Any autoimmune disease (e.g., rheumatoid arthritis, lupus), as nivolumab may worsen autoimmune conditions.
- Lung, liver, kidney, or heart issues, as nivolumab may affect these organs.
- A history of organ transplant or if you are on immunosuppressive medications.
- Are pregnant or planning to become pregnant, as nivolumab can harm an unborn baby. Effective contraception should be used during treatment and for at least 5 months after treatment.
- Are breastfeeding, as nivolumab can pass into breast milk, so breastfeeding is not recommended during treatment.
What to Avoid While Taking Nivolumab + Hyaluronidase-nvhy
- Infections: Since nivolumab may lower your immune system’s ability to fight infections, try to avoid contact with sick people and practice good hygiene.
- Live vaccines: Talk to your doctor before receiving any vaccines during treatment, as live vaccines may not be safe.
- Pregnancy: As mentioned, nivolumab can cause harm to an unborn baby, so effective birth control is essential.
Regular Monitoring
Your healthcare provider will regularly monitor your health during treatment, including:
- Blood tests: To check your liver, kidney, and immune system functions, and to monitor for any changes.
- Imaging tests: Your doctor may use imaging (e.g., CT scans or MRIs) to monitor how your cancer is responding to treatment.
- Vital signs: Your doctor will also check your temperature, heart rate, and blood pressure during treatment.
When to Contact Your Doctor
Call your healthcare provider right away if you experience any of the following:
- Signs of infection (fever, chills, cough, painful urination)
- Severe diarrhea or blood in your stool
- Shortness of breath, chest pain, or cough (potential lung and heart problems)
- Yellowing of your skin or eyes, dark urine, or right-sided abdominal pain (possible liver issues)
- Severe rash or blistering of the skin
- Unusual fatigue, dizziness, or mood changes
Disclaimer:
This handout is for educational purposes only and should not be considered medical advice. Always follow the instructions provided by your healthcare provider regarding treatment and care. For personalized advice, consult your healthcare provider or pharmacist.