Standard Nivolumab Dosing
Nivolumab (Opdivo) is dosed at 240 mg every 2 weeks or 480 mg every 4 weeks for most approved indications, such as melanoma, non-small cell lung cancer, and renal cell carcinoma. These are fixed doses for adults, independent of body weight.[1]
When Weight-Based Dosing Applies
Weight-based dosing occurs in combination regimens:
- With ipilimumab: 1 mg/kg nivolumab + 3 mg/kg ipilimumab every 3 weeks for 4 doses, followed by 240 mg nivolumab every 2 weeks or 480 mg every 4 weeks.
- With ipilimumab or relatlimab: 240 mg every 2 weeks or 480 mg every 4 weeks (fixed), or 360 mg every 3 weeks with relatlimab.
Adjustments use actual body weight in kilograms at treatment start, without caps or floors unless specified.[1][2]
How to Calculate Weight-Based Dose
Multiply actual body weight (kg) by the mg/kg rate:
| Regimen | Rate | Example (70 kg patient) |
|---------|------|-------------------------|
| Nivolumab monotherapy (some trials) | 3 mg/kg every 2 weeks | 210 mg |
| Nivo + ipi (induction) | 1 mg/kg every 3 weeks | 70 mg |
| Historical flat-adjusted | ~3 mg/kg equivalent | 240 mg ≈ 3.4 mg/kg for 70 kg |
Round to nearest vial size (10 mg/mL, 40 mg/4 mL, 100 mg/10 mL, or 500 mg/50 mL). Recalculate if weight changes >10%.[1]
Adjustments for Special Populations
- Obesity: Use actual body weight; no ideal or adjusted body weight required. Studies show similar efficacy/safety vs. fixed dosing.[3]
- **Low weight (<40 kg)**: Limited data; consider pediatric dosing (0.3–3 mg/kg based on indication) or consult oncology guidelines.
- Renal/hepatic impairment: No dose adjustment needed.
- Elderly: No specific changes.[1][2]
Differences from Other PD-1 Inhibitors
Pembrolizumab uses 200 mg fixed or 2 mg/kg (capped at 200 mg); fixed doses reduced weight-based variability. Nivolumab shifted from 3 mg/kg to flat dosing in 2017 to simplify administration.[4]
[1]: Opdivo Prescribing Information (BMS, 2023)
[2]: FDA Label for Opdivo
[3]: ASCO Guidelines on Immunotherapy Dosing
[4]: DrugPatentWatch: Nivolumab Patents