Nivolumab

Nivolumab (Opdivo, Bristol-Myers Squibb Pharma EEIG) has 28 EU-approved indications in 11 tumour types. 10 need a biomarker result: PD-L1 (8) and MMR/MSI (2).
Approved indications of Nivolumab
Biomarker requirementRegimenSettingConditions
Non-small cell lung cancer5
PD-L1 expression ≥ 1%
+ platinum-based chemotherapy
Neoadj.
early
High risk of recurrence
PD-L1 expression ≥ 1%
+ platinum-based chemotherapy
Neoadj.
early
Then adjuvant monotherapy after surgery; High risk of recurrence
PD-L1 expression ≥ 1%
Monotherapy
Adj.
early
After neoadjuvant nivolumab + platinum-based chemotherapy and surgical resection; High risk of recurrence
No sensitising EGFR mutation or ALK translocation
+ ipilimumab and 2 cycles of platinum-based chemotherapy
1L
metastatic
None
None
Monotherapy
2L
advanced
After prior chemotherapy
Mesothelioma1
None
+ ipilimumab
1L
advanced
Pleural mesothelioma only
Colorectal cancer2
Mismatch repair deficient or microsatellite instability-high
+ ipilimumab
1L
advanced
None
Mismatch repair deficient or microsatellite instability-high
+ ipilimumab
2L
metastatic
After prior fluoropyrimidine-based combination chemotherapy
Gastric and GEJ adenocarcinoma1
PD-L1 CPS ≥ 5, HER2-negative
+ fluoropyrimidine- and platinum-based combination chemotherapy
1L
advanced
None
Oesophageal cancer5
None
Monotherapy
Adj.
After prior neoadjuvant chemoradiotherapy; Residual pathologic disease
Tumour cell PD-L1 expression ≥ 1%
+ fluoropyrimidine- and platinum-based combination chemotherapy
1L
advanced
Squamous cell carcinoma only
PD-L1 CPS ≥ 5, HER2-negative
+ fluoropyrimidine- and platinum-based combination chemotherapy
1L
advanced
Adenocarcinoma only
Tumour cell PD-L1 expression ≥ 1%
+ ipilimumab
1L
advanced
Squamous cell carcinoma only
None
Monotherapy
2L
advanced
Squamous cell carcinoma only; After prior fluoropyrimidine- and platinum-based combination chemotherapy
Hepatocellular carcinoma1
None
+ ipilimumab
1L
advanced
None
Renal cell carcinoma3
None
+ cabozantinib
1L
advanced
None
None
+ ipilimumab
1L
advanced
Intermediate/poor-risk
None
Monotherapy
2L
advanced
After prior therapy
Urothelial carcinoma3
Tumour cell PD-L1 expression ≥ 1%
Monotherapy
Adj.
Muscle-invasive only; After radical resection of MIUC; High risk of recurrence
None
+ cisplatin and gemcitabine
1L
advanced
None
None
Monotherapy
2L
advanced
After failure of prior platinum-containing therapy
Melanoma3
None
Monotherapy
Adj.
After complete resection; Stage IIB or IIC melanoma, or melanoma with involvement of lymph nodes or metastatic disease
None
+ ipilimumab
Any line
advanced
None
None
Monotherapy
Any line
advanced
None
Head and neck squamous cell carcinoma1
None
Monotherapy
2L
advanced
Progressing on or after platinum-based therapy
Hodgkin lymphoma3
None
+ doxorubicin, vinblastine and dacarbazine (AVD)
1L
advanced
Classical Hodgkin lymphoma only; Stage III or IV
None
+ brentuximab vedotin
2L
Classical Hodgkin lymphoma only; After one prior line of therapy; Aged 5 up to 30 years
None
Monotherapy
3L+
Classical Hodgkin lymphoma only; After autologous stem cell transplant (ASCT) and treatment with brentuximab vedotin
Full text of section 4.1 (therapeutic indications)

Melanoma OPDIVO as monotherapy is indicated for the adjuvant treatment of adults and adolescents 12 years of age and older with Stage IIB or IIC melanoma, or melanoma with involvement of lymph nodes or metastatic disease who have undergone complete resection (see section 5.1). OPDIVO as monotherapy or in combination with ipilimumab is indicated for the treatment of advanced (unresectable or metastatic) melanoma in adults and adolescents 12 years of age and older. Relative to nivolumab monotherapy, an increase in progression-free survival (PFS) and overall survival (OS) for the combination of nivolumab with ipilimumab is established only in patients with low tumour PD-L1 expression (see sections 4.4 and 5.1). Non-small cell lung cancer (NSCLC) OPDIVO in combination with platinum-based chemotherapy is indicated for the neoadjuvant treatment of resectable non-small cell lung cancer at high risk of recurrence in adult patients whose tumours have PD-L1 expression ≥ 1% (see section 5.1 for selection criteria). OPDIVO in combination with platinum-based chemotherapy as neoadjuvant treatment, followed by OPDIVO as monotherapy as adjuvant treatment, is indicated for the treatment of resectable non-small cell lung cancer at high risk of recurrence in adult patients whose tumours have PD-L1 expression ≥ 1% (see section 5.1 for selection criteria). OPDIVO in combination with ipilimumab and 2 cycles of platinum-based chemotherapy is indicated for the first-line treatment of metastatic non-small cell lung cancer in adults whose tumours have no sensitising EGFR mutation or ALK translocation. OPDIVO as monotherapy is indicated for the treatment of locally advanced or metastatic non-small cell lung cancer after prior chemotherapy in adults. Malignant pleural mesothelioma (MPM) OPDIVO in combination with ipilimumab is indicated for the first-line treatment of adult patients with unresectable malignant pleural mesothelioma. Renal cell carcinoma (RCC) OPDIVO in combination with ipilimumab is indicated for the first-line treatment of adult patients with intermediate/poor-risk advanced renal cell carcinoma (see section 5.1). OPDIVO in combination with cabozantinib is indicated for the first-line treatment of adult patients with advanced renal cell carcinoma (see section 5.1). OPDIVO as monotherapy is indicated for the treatment of advanced renal cell carcinoma after prior therapy in adults. Classical Hodgkin lymphoma (cHL) OPDIVO in combination with doxorubicin, vinblastine and dacarbazine (AVD) is indicated for adults and adolescents 12 years of age and older with previously untreated Stage III or IV classical Hodgkin lymphoma. OPDIVO in combination with brentuximab vedotin is indicated for the treatment of children 5 years of age and older, adolescents and adults up to 30 years of age with relapsed or refractory classical Hodgkin lymphoma after one prior line of therapy (see section 5.1). OPDIVO as monotherapy is indicated for the treatment of adult patients with relapsed or refractory classical Hodgkin lymphoma after autologous stem cell transplant (ASCT) and treatment with brentuximab vedotin. Squamous cell cancer of the head and neck (SCCHN) OPDIVO as monotherapy is indicated for the treatment of recurrent or metastatic squamous cell cancer of the head and neck in adults progressing on or after platinum-based therapy (see section 5.1). Urothelial carcinoma (UC) OPDIVO as monotherapy is indicated for the adjuvant treatment of adults with muscle invasive urothelial carcinoma (MIUC) with tumour cell PD-L1 expression ≥ 1%, who are at high risk of recurrence after undergoing radical resection of MIUC (see section 5.1). OPDIVO in combination with cisplatin and gemcitabine is indicated for the first-line treatment of adult patients with unresectable or metastatic urothelial carcinoma. OPDIVO as monotherapy is indicated for the treatment of locally advanced unresectable or metastatic urothelial carcinoma in adults after failure of prior platinum-containing therapy. Mismatch repair deficient (dMMR) or microsatellite instability-high (MSI-H) colorectal cancer (CRC) OPDIVO in combination with ipilimumab is indicated for the treatment of adult patients with mismatch repair deficient or microsatellite instability-high colorectal cancer in the following settings: - first-line treatment of unresectable or metastatic colorectal cancer; - treatment of metastatic colorectal cancer after prior fluoropyrimidine-based combination chemotherapy (see section 5.1). Oesophageal squamous cell carcinoma (OSCC) OPDIVO in combination with ipilimumab is indicated for the first-line treatment of adult patients with unresectable advanced, recurrent or metastatic oesophageal squamous cell carcinoma with tumour cell PD-L1 expression ≥ 1%. OPDIVO in combination with fluoropyrimidine- and platinum-based combination chemotherapy is indicated for the first-line treatment of adult patients with unresectable advanced, recurrent or metastatic oesophageal squamous cell carcinoma with tumour cell PD-L1 expression ≥ 1%. OPDIVO as monotherapy is indicated for the treatment of adult patients with unresectable advanced, recurrent or metastatic oesophageal squamous cell carcinoma after prior fluoropyrimidine- and platinum-based combination chemotherapy. Adjuvant treatment of oesophageal or gastro-oesophageal junction cancer (OC or GEJC) OPDIVO as monotherapy is indicated for the adjuvant treatment of adult patients with oesophageal or gastro-oesophageal junction cancer who have residual pathologic disease following prior neoadjuvant chemoradiotherapy (see section 5.1). Gastric, gastro-oesophageal junction (GEJ) or oesophageal adenocarcinoma OPDIVO in combination with fluoropyrimidine- and platinum-based combination chemotherapy is indicated for the first-line treatment of adult patients with HER2-negative advanced or metastatic gastric, gastro-oesophageal junction or oesophageal adenocarcinoma whose tumours express PD-L1 with a combined positive score (CPS) ≥ 5. Hepatocellular carcinoma (HCC) OPDIVO in combination with ipilimumab is indicated for the first-line treatment of adult patients with unresectable or advanced hepatocellular carcinoma. OPDIVO as monotherapy is indicated for the adjuvant treatment of adults with Stage IIB or IIC melanoma, or melanoma with involvement of lymph nodes or metastatic disease who have undergone complete resection (see section 5.1). OPDIVO as monotherapy or in combination with ipilimumab is indicated for the treatment of advanced (unresectable or metastatic) melanoma in adults (see section 4.2). OPDIVO in combination with ipilimumab is indicated for the first-line treatment of adult patients with intermediate/poor-risk advanced renal cell carcinoma (see sections 4.2 and 5.1). OPDIVO in combination with cisplatin and gemcitabine is indicated for the first-line treatment of adult patients with unresectable or metastatic urothelial carcinoma (see sections 4.2 and 5.1). - first-line treatment of unresectable or metastatic colorectal cancer (see sections 4.2 and 5.1); - treatment of metastatic colorectal cancer after prior fluoropyrimidine-based combination chemotherapy (see sections 4.2 and 5.1).

Label history

101 changes to the Opdivo label since 2015, 28 of them to the indications. Newest first, in the words of EMA's record of each procedure.

Changes