Clinical Pearls for Nivolumab:

• Indications and Efficacy: Nivolumab is approved for various types of cancer, including melanoma, non-small cell lung cancer (NSCLC), renal cell carcinoma, Hodgkin lymphoma, and more. It works by blocking the PD-1 pathway, enhancing the immune response against cancer cells.

• Dosing and Administration: Administer Nivolumab IV over 60 minutes. Typical dosing schedules may vary based on cancer type, generally ranging from 240 mg every two weeks to 480 mg every four weeks. Always refer to specific guidelines for each cancer type regarding dosing adjustments.

• Management of Immune-Mediated Adverse Reactions: Monitor patients closely for symptoms of immune-mediated reactions. These may include dermatologic, gastrointestinal, hepatic, endocrinologic, and other inflammations. Early detection and management involving steroid administration and possible therapy discontinuation are critical.

• Pre-treatment Screening: Screen patients for hepatitis B, C, and tuberculosis due to the potential risk of reactivation under immunosuppression.

• Corticosteroid Preparation: Be prepared to administer corticosteroids for Grade 2 or higher immune-mediated reactions. Typically, prednisone or equivalent is used, with a tapering schedule following symptom control.

• Infusion-Related Reactions: Although less common than immune-mediated reactions, nivolumab can cause infusion-related reactions. Pre-medication isn't routinely recommended, but facilities should be equipped to manage acute reactions as per standard protocols.

• Patient Education and Communication: Educate patients thoroughly about potential side effects and the importance of immediately reporting symptoms indicative of immune-mediated reactions. Ongoing communication throughout the treatment course is crucial to manage side effects effectively.

• Follow-Up Care and Monitoring: Regular follow-up, including clinical evaluation and laboratory tests, is vital to monitor efficacy, manage side effects, and adjust therapy. Patient-specific follow-ups might be needed depending on their response and tolerability to the treatment.

• Interdisciplinary Collaboration: Coordination of care with oncology, dermatology, gastroenterology, endocrinology, and other specialties is essential for holistic management of patients, particularly those experiencing complex immune-mediated events.

• Documentation and Reporting: Due to the complexity and potential severity of immune-mediated adverse events, meticulous documentation and reporting of all adverse effects are required for ongoing pharmacovigilance and research.