Malignant pleural mesothelioma - combination treatment with ipilimumab

Active Ingredient: Nivolumab

Indication for Nivolumab

Population group: only adults (18 years old or older)
Therapeutic intent: Curative procedure

Nivolumab in combination with ipilimumab is indicated for the first-line treatment of adult patients with unresectable malignant pleural mesothelioma.

For this indication, competent medicine agencies globally authorize below treatments:

360 mg once every 3 weeks

For:

Dosage regimens

Intravenous, 360 milligrams nivolumab, once every 3 weeks.

Detailed description

The recommended dose is 360 mg nivolumab every 3 weeks in combination with 1 mg/kg ipilimumab every 6 weeks. Treatment is continued for up to 24 months in patients without disease progression.

Duration of treatment

Treatment with nivolumab, either as a monotherapy or in combination with other therapeutic agents, should be continued as long as clinical benefit is observed or until treatment is no longer tolerated by the patient (and up to maximum duration of therapy if specified for an indication).

Atypical responses (i.e., an initial transient increase in tumour size or small new lesions within the first few months followed by tumour shrinkage) have been observed. It is recommended to continue treatment with nivolumab or nivolumab in combination with ipilimumab for clinically stable patients with initial evidence of disease progression until disease progression is confirmed.

Dose escalation or reduction is not recommended. Dosing delay or discontinuation may be required based on individual safety and tolerability.

Nivolumab as monotherapy or in combination with other therapeutic agents should be permanently discontinued for:

  • Grade 4 or recurrent Grade 3 adverse reactions;
  • Persistent Grade 2 or 3 adverse reactions despite management.

When nivolumab is administered intravenously in combination with ipilimumab, if either agent is withheld, the other agent should also be withheld. If dosing is resumed after a delay, either the intravenous combination treatment or nivolumab monotherapy administered intravenously or subcutaneously could be resumed based on the evaluation of the individual patient.

Dosage considerations

When administered in combination with ipilimumab, nivolumab should be given first followed by ipilimumab (if applicable) and then by chemotherapy on the same day. Use separate infusion bags and filters for each infusion.

Active ingredient

Nivolumab

Nivolumab is a human immunoglobulin G4 (IgG4) monoclonal antibody (HuMAb), which binds to the programmed death-1 (PD-1) receptor and blocks its interaction with PD-L1 and PD-L2. Nivolumab potentiates T-cell responses, including anti-tumour responses, through blockade of PD-1 binding to PD-L1 and PD-L2 ligands. In syngeneic mouse models, blocking PD-1 activity resulted in decreased tumour growth.

Read more about Nivolumab

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