опдиво

Overdose

There is no information on overdosage with Опдиво.

Contraindications

None.

Undesirable effects

The following adverse reactions are discussed in greater detail in other sections of the labeling.

• Immune-Mediated Pneumonitis
• Immune-Mediated Colitis
• Immune-Mediated Hepatitis
• Immune-Mediated Endocrinopathies
• Immune-Mediated Nephritis and Renal Dysfunction
• Immune-Mediated Skin Adverse Reactions
• Immune-Mediated Encephalitis
• Other Immune-Mediated Adverse Reactions
• Infusion Reactions
• Complications of Allogeneic HSCT after Опдиво

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

The data in the Warnings and Precautions section reflect exposure to Опдиво, as a single agent, for clinically significant adverse reactions in 1994 patients enrolled in the CHECKMATE-037, CHECKMATE-017, CHECKMATE-057, CHECKMATE-066, CHECKMATE-025, CHECKMATE-067, CHECKMATE-205, CHECKMATE-039 trials or a single-arm trial in NSCLC (n=117) administering Опдиво as a single agent. In addition, clinically significant adverse reactions of Опдиво administered with ipilimumab were evaluated in 407 patients with melanoma enrolled in CHECKMATE-067 (n=313) or a Phase 2 randomized study (n=94), administering Опдиво with ipilimumab, supplemented by immunemediated adverse reaction reports in ongoing clinical trials.

The data described below reflect exposure to Опдиво as a single agent in CHECKMATE-037, CHECKMATE-066, and CHECKMATE-067, and to Опдиво with ipilimumab in CHECKMATE-067, which are randomized, active-controlled trials conducted in patients with unresectable or metastatic melanoma. Also described below are single-agent Опдиво data from CHECKMATE-238, a randomized trial for the adjuvant treatment of patients with completely resected Stage IIIB/C and IV melanoma, CHECKMATE-017 and CHECKMATE-057, which are randomized trials in patients with metastatic NSCLC, CHECKMATE-025, which is a randomized trial in patients with advanced RCC, CHECKMATE-205 and CHECKMATE-039, which are open-label, multiple-cohort trials in patients with cHL, CHECKMATE-141, a randomized trial in patients with recurrent or metastatic SCCHN, CHECKMATE-275, which is a single-arm trial in patients with urothelial carcinoma, and CHECKMATE-040, which is an open-label, multiplecohort trial in patients with HCC.

Previously Treated Metastatic Melanoma

The safety of Опдиво as a single agent was evaluated in CHECKMATE-037, a randomized, open-label trial in which 370 patients with unresectable or metastatic melanoma received 3 mg/kg of Опдиво by intravenous infusion every 2 weeks (n=268) or investigator’s choice of chemotherapy (n=102), either dacarbazine 1000 mg/m2 every 3 weeks or the combination of carboplatin AUC 6 every 3 weeks plus paclitaxel 175 mg/m2 every 3 weeks. The median duration of exposure was 5.3 months (range: 1 day to 13.8+ months) in Опдиво-treated patients and was 2 months (range: 1 day to 9.6+ months) in chemotherapytreated patients. In this ongoing trial, 24% of patients received Опдиво for greater than 6 months and 3% of patients received Опдиво for greater than 1 year.

In CHECKMATE-037, patients had documented disease progression following treatment with ipilimumab and, if BRAF V600 mutation positive, a BRAF inhibitor. The trial excluded patients with autoimmune disease, prior ipilimumab-related Grade 4 adverse reactions (except for endocrinopathies) or Grade 3 ipilimumab-related adverse reactions that had not resolved or were inadequately controlled within 12 weeks of the initiating event, patients with a condition requiring chronic systemic treatment with corticosteroids (>10 mg daily prednisone equivalent) or other immunosuppressive medications, a positive test for hepatitis B or C, and a history of HIV.

The trial population characteristics in the Опдиво group and the chemotherapy group were similar: 66% male, median age 59.5 years, 98% white, baseline Eastern Cooperative Oncology Group (ECOG) performance status 0 (59%) or 1 (41%), 74% with M1c stage disease, 73% with cutaneous melanoma, 11% with mucosal melanoma, 73% received two or more prior therapies for advanced or metastatic disease, and 18% had brain metastasis. There were more patients in the Опдиво group with elevated LDH at baseline (51% vs. 38%).

Опдиво was discontinued for adverse reactions in 9% of patients. Twenty-six percent of patients receiving Опдиво had a drug delay for an adverse reaction. Serious adverse reactions occurred in 41% of patients receiving Опдиво. Grade 3 and 4 adverse reactions occurred in 42% of patients receiving Опдиво. The most frequent Grade 3 and 4 adverse reactions reported in 2% to less than 5% of patients receiving Опдиво were abdominal pain, hyponatremia, increased aspartate aminotransferase, and increased lipase.

Table 2 summarizes the adverse reactions that occurred in at least 10% of Опдиво-treated patients in CHECKMATE-037. The most common adverse reaction (reported in at least 20% of patients) was rash.

Table 2: Adverse Reactions Occurring in ≥10% of Опдиво-Treated Patients and at a Higher Incidence than in the Chemotherapy Arm (Between Arm Difference of ≥5% [All Grades] or ≥2% [Grades 3- 4]) (CHECKMATE-037)

Other clinically important adverse reactions in less than 10% of patients treated with Опдиво in CHECKMATE-037 were:

Cardiac Disorders: ventricular arrhythmia

Eye Disorders: iridocyclitis

General Disorders and Administration Site Conditions: infusion-related reactions

Investigations: increased amylase, increased lipase

Nervous System Disorders: dizziness, peripheral and sensory neuropathy

Skin and Subcutaneous Tissue Disorders: exfoliative dermatitis, erythema multiforme, vitiligo, psoriasis

Table 3: Laboratory Abnormalities Worsening from Baseline Occurring in ≥10% of Опдиво-Treated Patients and at a Higher Incidence than in the Chemotherapy Arm (Between Arm Difference of ≥5% [All Grades] or ≥2% [Grades 3-4]) (CHECKMATE-037)

CHECKMATE-066

The safety of Опдиво was also evaluated in CHECKMATE-066, a randomized, double-blind, active-controlled trial in which 411 previously untreated patients with BRAF V600 wild-type unresectable or metastatic melanoma received 3 mg/kg of Опдиво by intravenous infusion every 2 weeks (n=206) or dacarbazine 1000 mg/m2 every 3 weeks (n=205). The median duration of exposure was 6.5 months (range: 1 day to 16.6 months) in Опдивоtreated patients. In this trial, 47% of patients received Опдиво for greater than 6 months and 12% of patients received Опдиво for greater than 1 year.

The trial excluded patients with autoimmune disease and patients requiring chronic systemic treatment with corticosteroids (>10 mg daily prednisone equivalent) or other immunosuppressive medications.

The trial population characteristics in the Опдиво group and dacarbazine group: 59% male, median age 65 years, 99.5% white, 61% with M1c stage disease, 74% with cutaneous melanoma, 11% with mucosal melanoma, 4% with brain metastasis, and 37% with elevated LDH at baseline. There were more patients in the Опдиво group with ECOG performance status 0 (71% vs. 59%).

Adverse reactions led to permanent discontinuation of Опдиво in 7% of patients and dose interruption in 26% of patients; no single type of adverse reaction accounted for the majority of Опдиво discontinuations. Serious adverse reactions occurred in 36% of patients receiving Опдиво. Grade 3 and 4 adverse reactions occurred in 41% of patients receiving Опдиво. The most frequent Grade 3 and 4 adverse reactions reported in at least 2% of patients receiving Опдиво were gamma-glutamyltransferase increase (3.9%) and diarrhea (3.4%).

Table 4 summarizes selected adverse reactions that occurred in at least 10% of Опдиво-treated patients. The most common adverse reactions (reported in at least 20% of patients and at a higher incidence than in the dacarbazine arm) were fatigue, musculoskeletal pain, rash, and pruritus.

Table 4: Adverse Reactions Occurring in ≥10% of Опдиво-Treated Patients and at a Higher Incidence than in the Dacarbazine Arm (Between Arm Difference of ≥5% [All Grades] or ≥2% [Grades 3- 4]) (CHECKMATE-066)

Other clinically important adverse reactions in less than 10% of patients treated with Опдиво in CHECKMATE-066 were:

Nervous System Disorders: peripheral neuropathy

Table 5: Laboratory Abnormalities Worsening from Baseline Occurring in ≥10% of Опдиво-Treated Patients and at a Higher Incidence than in the Dacarbazine Arm (Between Arm Difference of ≥5% [All Grades] or ≥2% [Grades 3-4]) (CHECKMATE-066)

CHECKMATE-067

The safety of Опдиво, administered with ipilimumab or as a single agent, was evaluated in CHECKMATE-067 , a randomized (1:1:1), a double-blind trial in which 937 patients with previously untreated, unresectable or metastatic melanoma received:

• Опдиво 1 mg/kg with ipilimumab 3 mg/kg every 3 weeks for 4 doses followed by Опдиво 3 mg/kg as a single agent every 2 weeks (Опдиво plus ipilimumab arm; n=313),
• Опдиво 3 mg/kg every 2 weeks (Опдиво arm; n=313), or
• Ipilimumab 3 mg/kg every 3 weeks for up to 4 doses (ipilimumab arm; n=311).

The median duration of exposure to Опдиво was 2.8 months (range: 1 day to 18.8 months) for the Опдиво plus ipilimumab arm and 6.6 months (range: 1 day to 17.3 months) for the Опдиво arm. In the Опдиво plus ipilimumab arm, 39% were exposed to Опдиво for ≥6 months and 24% exposed for >1 year. In the Опдиво arm, 53% were exposed for ≥6 months and 32% for >1 year.

CHECKMATE-067 excluded patients with autoimmune disease, a medical condition requiring systemic treatment with corticosteroids (more than 10 mg daily prednisone equivalent) or other immunosuppressive medication within 14 days of the start of study therapy, a positive test result for hepatitis B or C, or a history of HIV.

The trial population characteristics were: 65% male, median age 61 years, 97% White, baseline ECOG performance status 0 (73%) or 1 (27%), 93% with AJCC Stage IV disease, 58% with M1c stage disease; 36% with elevated LDH at baseline, 4% with a history of brain metastasis, and 22% had received adjuvant therapy.

In CHECKMATE-067, serious adverse reactions (73% and 37%), adverse reactions leading to permanent discontinuation (43% and 14%) or to dosing delays (55% and 28%), and Grade 3 or 4 adverse reactions (72% and 44%) all occurred more frequently in the Опдиво plus ipilimumab arm relative to the Опдиво arm.

The most frequent (≥10%) serious adverse reactions in the Опдиво plus ipilimumab arm and the Опдиво arm, respectively, were diarrhea (13% and 2.6%), colitis (10% and 1.6%), and pyrexia (10% and 0.6%). The most frequent adverse reactions leading to discontinuation of both drugs in the Опдиво plus ipilimumab arm and of Опдиво in the Опдиво arm, respectively, were diarrhea (8% and 1.9%), colitis (8% and 0.6%), increased ALT (4.8% and 1.3%), increased AST (4.5% and 0.6%), and pneumonitis (1.9% and 0.3%). The most common (≥20%) adverse reactions in the Опдиво plus ipilimumab arm were fatigue, rash, diarrhea, nausea, pyrexia, vomiting, and dyspnea. The most common (≥20%) adverse reactions in the Опдиво arm were fatigue, rash, diarrhea, and nausea. Table 6 summarizes the incidence of adverse reactions occurring in at least 10% of patients in either Опдиво-containing arm in CHECKMATE-067.

Table 6: Adverse Reactions Occurring in ≥10% of Patients on the Опдиво plus Ipilimumab Arm or the Опдиво Arm and at a Higher Incidence than in the Ipilimumab Arm (Between Arm Difference of ≥5% [All Grades] or ≥2% [Grades 3-4]) (CHECKMATE-067)

Other clinically important adverse reactions in less than 10% of patients treated with either Опдиво with ipilimumab or single-agent Опдиво in CHECKMATE-067 were:

Gastrointestinal Disorders: stomatitis, intestinal perforation

Skin and Subcutaneous Tissue Disorders: vitiligo

Musculoskeletal and Connective Tissue Disorders: myopathy, Sjogren’s syndrome, spondyloarthropathy

Nervous System Disorders: neuritis, peroneal nerve palsy

Table 7: Laboratory Abnormalities Worsening from Baseline Occurring in ≥20% of Patients Treated with Опдиво with Ipilimumab or Single-Agent Опдиво and at a Higher Incidence than in the Ipilimumab Arm (Between Arm Difference of ≥5% [All Grades] or ≥2% [Grades 3-4]) (CHECKMATE-067)

The safety of Опдиво as a single agent was evaluated in CHECKMATE-238, a randomized (1:1), double-blind trial in which 905 patients with completely resected Stage IIIB/C or Stage IV melanoma received 3 mg/kg of Опдиво by intravenous infusion every 2 weeks (n=452) or 10 mg/kg ipilimumab (n=453), by intravenous infusion every 3 weeks for 4 doses then every 12 weeks beginning at Week 24 for up to a 1 year. The median duration of exposure was 11.5 months in Опдиво-treated patients and was 2.7 months in ipilimumab-treated patients. In this ongoing trial, 74% of patients received Опдиво for greater than 6 months.

Study therapy was discontinued for adverse reactions in 9% of Опдиво-treated patients and 42% of ipilimumab-treated patients. Twenty-eight percent of Опдиво-treated patients had at least one omitted dose for an adverse reaction. Grade 3 or 4 adverse reactions occurred in 25% of Опдивоtreated patients. The most frequent Grade 3 and 4 adverse reactions reported in at least 2% of Опдиво-treated patients were diarrhea and increased lipase and amylase. Serious adverse reactions occurred in 18% of Опдиво-treated patients.

The most common adverse reactions (reported in at least 20% of Опдиво-treated patients) were fatigue, diarrhea, rash, musculoskeletal pain, pruritus, headache, nausea, upper respiratory infection, and abdominal pain. The most common immune-mediated adverse reactions were rash (16%), diarrhea/colitis (6%), and hepatitis (3%).

Table 8 summarizes the adverse reactions that occurred in at least 10% of Опдиво-treated patients in CHECKMATE-238.

Adverse Reactions Occurring in ≥10% of Опдиво-Treated Patients (CHECKMATE-238)

Table 9: Laboratory Abnormalities Worsening from Baseline Occurring in ≥10% of Опдиво-Treated Patients (CHECKMATE-238)

Therapeutic indications

• Опдиво® as a single agent is indicated for the treatment of patients with BRAF V600 wildtype unresectable or metastatic melanoma.
• Опдиво as a single agent is indicated for the treatment of patients with BRAF V600 mutationpositive unresectable or metastatic melanoma.

This indication is approved under accelerated approval based on progression-free survival. Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials.

• Опдиво, in combination with ipilimumab, is indicated for the treatment of patients with unresectable or metastatic melanoma.

This indication is approved under accelerated approval based on progression-free survival. Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials.

Опдиво is indicated for the adjuvant treatment of patients with melanoma with involvement of lymph nodes or metastatic disease who have undergone complete resection.

Опдиво is indicated for the treatment of patients with metastatic non-small cell lung cancer (NSCLC) with progression on or after platinum-based chemotherapy. Patients with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for these aberrations prior to receiving Опдиво.

Опдиво is indicated for the treatment of patients with advanced renal cell carcinoma (RCC) who have received prior anti-angiogenic therapy.

Опдиво is indicated for the treatment of adult patients with classical Hodgkin lymphoma (cHL) that has relapsed or progressed after:

• autologous hematopoietic stem cell transplantation (HSCT) and brentuximab vedotin, or
• 3 or more lines of systemic therapy that includes autologous HSCT.

This indication is approved under accelerated approval based on overall response rate. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials.

Опдиво is indicated for the treatment of patients with recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN) with disease progression on or after platinum-based therapy.

Опдиво (nivolumab) is indicated for the treatment of patients with locally advanced or metastatic urothelial carcinoma who:

• have disease progression during or following platinum-containing chemotherapy
• have disease progression within 12 months of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy.

This indication is approved under accelerated approval based on tumor response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials.

Опдиво is indicated for the treatment of adult and pediatric patients 12 years and older with microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) metastatic colorectal cancer (CRC) that has progressed following treatment with a fluoropyrimidine, oxaliplatin, and irinotecan.

This indication is approved under accelerated approval based on overall response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials.

Опдиво is indicated for the treatment of patients with hepatocellular carcinoma (HCC) who have been previously treated with sorafenib. This indication is approved under accelerated approval based on tumor response rate and durability of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials.

Pharmacodynamic properties

Based on dose/exposure efficacy and safety relationships, there are no clinically significant differences in safety and efficacy between a nivolumab dose of 240 mg or 3 mg/kg every 2 weeks in patients with melanoma, NSCLC, RCC, urothelial carcinoma, MSI-H CRC, and HCC.

Pharmacokinetic properties

Nivolumab pharmacokinetics (PK) was assessed using a population PK approach for both single-agent Опдиво and Опдиво with ipilimumab.

The PK of single-agent nivolumab was studied in patients over a dose range of 0.1 to 20 mg/kg administered as a single dose or as multiple doses of Опдиво as a 60- minute intravenous infusion every 2 or 3 weeks. Nivolumab clearance decreases over time, with a mean maximal reduction (% coefficient of variation [CV%]) from baseline values of 24.5% (47.6%) resulting in a geometric mean steady state clearance (CLss) (CV%) of 8.2 mL/h (53.9%) in patients with metastatic tumors; the decrease in CLss is not considered clinically relevant. Nivolumab clearance does not decrease over time in patients with completely resected melanoma, as the geometric mean population clearance is 24% lower in this patient population compared with patients with metastatic melanoma at steady-state. The geometric mean volume of distribution at steady state (Vss) (CV%) is 6.8 L (27.3%), and geometric mean elimination half-life (t1/2) is 25 days (77.5%). Steady-state concentrations of nivolumab were reached by 12 weeks when administered at 3 mg/kg every 2 weeks, and systemic accumulation was 3.7-fold. The exposure to nivolumab increases dose proportionally over the dose range of 0.1 to 10 mg/kg administered every 2 weeks. The predicted exposure of nivolumab after a 30-minute infusion is comparable to that observed with a 60-minute infusion.

The geometric mean (CV%) CL, Vss, and terminal half-life of nivolumab were 10.0 mL/h (50.3%), 7.92 L (30.1%), and 24.8 days (94.3%), respectively. When administered in combination, the CL of nivolumab was increased by 24%, whereas there was no effect on the clearance of ipilimumab.

When administered in combination, the clearance of nivolumab increased by 42% in the presence of anti-nivolumab antibodies. There was no effect of anti-ipilimumab antibodies on the clearance of ipilimumab.

Name of the medicinal product

Qualitative and quantitative composition

Special warnings and precautions for use

Included as part of the "PRECAUTIONS" Section

Опдиво can cause immune-mediated pneumonitis, defined as requiring use of corticosteroids and no clear alternate etiology. Fatal cases have been reported.

Monitor patients for signs with radiographic imaging and for symptoms of pneumonitis. Administer corticosteroids at a dose of 1 to 2 mg/kg/day prednisone equivalents for moderate (Grade 2) or more severe (Grade 3-4) pneumonitis, followed by corticosteroid taper. Permanently discontinue Опдиво for severe (Grade 3) or life-threatening (Grade 4) pneumonitis and withhold Опдиво until resolution for moderate (Grade 2) pneumonitis.

In patients receiving Опдиво as a single agent, immune-mediated pneumonitis occurred in 3.1% (61/1994) of patients. The median time to onset of immune-mediated pneumonitis was 3.5 months (range: 1 day to 22.3 months). Immune-mediated pneumonitis led to permanent discontinuation of Опдиво in 1.1%, and withholding of Опдиво in 1.3% of patients. Approximately 89% of patients with pneumonitis received high-dose corticosteroids (at least 40 mg prednisone equivalents per day) for a median duration of 26 days (range: 1 day to 6 months). Complete resolution of symptoms following corticosteroid taper occurred in 67% of patients. Approximately 8% of patients had recurrence of pneumonitis after re-initiation of Опдиво.

In patients receiving Опдиво with ipilimumab, immune-mediated pneumonitis occurred in 6% (25/407) of patients. The median time to onset of immune-mediated pneumonitis was 1.6 months (range: 24 days to 10.1 months). Immune-mediated pneumonitis led to permanent discontinuation or withholding of Опдиво with ipilimumab in 2.2% and 3.7% of patients, respectively. Approximately 84% of patients with pneumonitis received high-dose corticosteroids (at least 40 mg prednisone equivalents per day) for a median duration of 30 days (range: 5 days to 11.8 months). Complete resolution occurred in 68% of patients. Approximately 13% of patients had recurrence of pneumonitis after re-initiation of Опдиво with ipilimumab.

Опдиво can cause immune-mediated colitis, defined as requiring use of corticosteroids with no clear alternate etiology.

Monitor patients for signs and symptoms of colitis. Administer corticosteroids at a dose of 1 to 2 mg/kg/day prednisone equivalents followed by corticosteroid taper for severe (Grade 3) or lifethreatening (Grade 4) colitis. Administer corticosteroids at a dose of 0.5 to 1 mg/kg/day prednisone equivalents followed by corticosteroid taper for moderate (Grade 2) colitis of more than 5 days duration; if worsening or no improvement occurs despite initiation of corticosteroids, increase dose to 1 to 2 mg/kg/day prednisone equivalents.

Withhold Опдиво for moderate or severe (Grade 2 or 3) colitis. Permanently discontinue Опдиво for life-threatening (Grade 4) or for recurrent colitis upon re-initiation of Опдиво.

When administered in combination with ipilimumab, withhold Опдиво and ipilimumab for moderate colitis (Grade 2). Permanently discontinue Опдиво and ipilimumab for severe or lifethreatening (Grade 3 or 4) colitis or for recurrent colitis.

In patients receiving Опдиво as a single agent, immune-mediated colitis occurred in 2.9% (58/1994) of patients; the median time to onset was 5.3 months (range: 2 days to 20.9 months). Immune-mediated colitis led to permanent discontinuation of Опдиво in 0.7% and withholding of Опдиво in 1% of patients. Approximately 91% of patients with colitis received high-dose corticosteroids (at least 40 mg prednisone equivalents per day) for a median duration of 23 days (range: 1 day to 9.3 months). Four patients required addition of infliximab to high-dose corticosteroids. Complete resolution occurred in 74% of patients. Approximately 16% of patients had recurrence of colitis after re-initiation of Опдиво.

In patients receiving Опдиво with ipilimumab, immune-mediated colitis occurred in 26% (107/407) of patients including three fatal cases. The median time to onset of immune-mediated colitis was 1.6 months (range: 3 days to 15.2 months). Immune-mediated colitis led to permanent discontinuation or withholding of Опдиво with ipilimumab in 16% and 7% of patients, respectively. Approximately 96% of patients with colitis received high-dose corticosteroids (at least 40 mg prednisone equivalents per day) for a median duration of 1.1 month (range: 1 day to 12 months). Approximately 23% of patients required addition of infliximab to high-dose corticosteroids. Complete resolution occurred in 75% of patients. Approximately 28% of patients had recurrence of colitis after re-initiation of Опдиво with ipilimumab.

Опдиво can cause immune-mediated hepatitis, defined as requiring use of corticosteroids and no clear alternate etiology. Monitor patients for abnormal liver tests prior to and periodically during treatment. Administer corticosteroids at a dose of 1 to 2 mg/kg/day prednisone equivalents followed by corticosteroid taper for severe (Grade 3) or life-threatening (Grade 4) transaminase elevations, with or without concomitant elevation in total bilirubin. Administer corticosteroids at a dose of 0.5 to 1 mg/kg/day prednisone equivalents for moderate (Grade 2) transaminase elevations.

For patients without hepatocellular carcinoma (HCC): withhold Опдиво for moderate (Grade 2) immune-mediated hepatitis and permanently discontinue Опдиво for severe (Grade 3) or life-threatening (Grade 4) immune-mediated hepatitis. For patients with HCC, permanently discontinue, withhold, or continue Опдиво based on severity of immune-mediated hepatitis and baseline AST and ALT levels as described in Table 1. In addition, administer corticosteroids at a dose of 1 to 2 mg/kg/day prednisone equivalents followed by corticosteroid taper when Опдиво is withheld or discontinued due to immune-mediated hepatitis.

In patients receiving Опдиво as a single agent, immune-mediated hepatitis occurred in 1.8% (35/1994) of patients; the median time to onset was 3.3 months (range: 6 days to 9 months). Immune-mediated hepatitis led to permanent discontinuation of Опдиво in 0.7% and withholding of Опдиво in 1% of patients. All patients with hepatitis received high-dose corticosteroids (at least 40 mg prednisone equivalents) for a median duration of 23 days (range: 1 day to 2 months). Two patients required the addition of mycophenolic acid to high-dose corticosteroids. Complete resolution occurred in 74% of patients. Approximately 29% of patients had recurrence of hepatitis after re-initiation of Опдиво.

In patients receiving Опдиво with ipilimumab, immune-mediated hepatitis occurred in 13% (51/407) of patients; the median time to onset was 2.1 months (range: 15 days to 11 months). Immune-mediated hepatitis led to permanent discontinuation or withholding of Опдиво with ipilimumab in 6% and 5% of patients, respectively. Approximately 92% of patients with hepatitis received high-dose corticosteroids (at least 40 mg prednisone equivalents per day) for a median duration of 1.1 month (range: 1 day to 13.2 months). Complete resolution occurred in 75% of patients. Approximately 11% of patients had recurrence of hepatitis after re-initiation of Опдиво with ipilimumab.

Опдиво can cause immune-mediated hypophysitis. Monitor patients for signs and symptoms of hypophysitis. Administer hormone replacement as clinically indicated and corticosteroids at a dose of 1 mg/kg/day prednisone equivalents followed by corticosteroid taper for moderate (Grade 2) or greater hypophysitis. Withhold Опдиво for moderate (Grade 2) or severe (Grade 3). Permanently discontinue Опдиво for life-threatening (Grade 4) hypophysitis.

In patients receiving Опдиво as a single agent, hypophysitis occurred in 0.6% (12/1994) of patients; the median time to onset was 4.9 months (range: 1.4 to 11 months). Hypophysitis led to permanent discontinuation of Опдиво in 0.1% and withholding of Опдиво in 0.2% of patients. Approximately 67% of patients with hypophysitis received hormone replacement therapy and 33% received high-dose corticosteroids (at least 40 mg prednisone equivalents per day) for a median duration of 14 days (range: 5 to 26 days).

In patients receiving Опдиво with ipilimumab, hypophysitis occurred in 9% (36/407) of patients; the median time to onset was 2.7 months (range: 27 days to 5.5 months). Hypophysitis led to permanent discontinuation or withholding of Опдиво with ipilimumab in 1.0% and 3.9% of patients, respectively. Approximately 75% of patients with hypophysitis received hormone replacement therapy and 56% received high-dose corticosteroids (at least 40 mg prednisone equivalents per day) for a median duration of 19 days (range: 1 day to 2.0 months).

Опдиво can cause immune-mediated adrenal insufficiency. Monitor patients for signs and symptoms of adrenal insufficiency. Administer corticosteroids at a dose of 1 to 2 mg/kg/day prednisone equivalents followed by a corticosteroid taper for severe (Grade 3) or life-threatening (Grade 4) adrenal insufficiency. Withhold Опдиво for moderate (Grade 2) and permanently discontinue Опдиво for severe (Grade 3) or life-threatening (Grade 4) adrenal insufficiency.

In patients receiving Опдиво as a single agent, adrenal insufficiency occurred in 1% (20/1994) of patients and the median time to onset was 4.3 months (range: 15 days to 21 months). Adrenal insufficiency led to permanent discontinuation of Опдиво in 0.1% and withholding of Опдиво in 0.5% of patients. Approximately 85% of patients with adrenal insufficiency received hormone replacement therapy and 25% received high-dose corticosteroids (at least 40 mg prednisone equivalents per day) for a median duration of 11 days (range: 1 day to 1 month).

In patients receiving Опдиво with ipilimumab, adrenal insufficiency occurred in 5% (21/407) of patients and the median time to onset was 3.0 months (range: 21 days to 9.4 months). Adrenal insufficiency led to permanent discontinuation or withholding of Опдиво with ipilimumab in 0.5% and 1.7% of patients, respectively. Approximately 57% of patients with adrenal insufficiency received hormone replacement therapy and 33% received high-dose corticosteroids (at least 40 mg prednisone equivalents per day) for a median duration of 9 days (range: 1 day to 2.7 months).

Опдиво can cause autoimmune thyroid disorders. Monitor thyroid function prior to and periodically during Опдиво treatment. Administer hormone-replacement therapy for hypothyroidism. Initiate medical management for control of hyperthyroidism. There are no recommended dose adjustments of Опдиво for hypothyroidism or hyperthyroidism.

In patients receiving Опдиво as a single agent, hypothyroidism or thyroiditis resulting in hypothyroidism occurred in 9% (171/1994) of patients; the median time to onset was 2.9 months (range: 1 day to 16.6 months). Approximately 79% of patients with hypothyroidism received levothyroxine and 4% also required corticosteroids. Resolution occurred in 35% of patients.

Hyperthyroidism occurred in 2.7% (54/1994) of patients receiving Опдиво as a single agent; the median time to onset was 1.5 months (range: 1 day to 14.2 months). Approximately 26% of patients with hyperthyroidism received methimazole, 9% received carbimazole, 4% received propylthiouracil, and 9% received corticosteroids. Resolution occurred in 76% of patients.

In patients receiving Опдиво with ipilimumab, hypothyroidism or thyroiditis resulting in hypothyroidism occurred in 22% (89/407) of patients; the median time to onset was 2.1 months (range: 1 day to 10.1 months). Approximately 73% of patients with hypothyroidism or thyroiditis received levothyroxine. Resolution occurred in 45% of patients.

Hyperthyroidism occurred in 8% (34/407) of patients receiving Опдиво with ipilimumab: the median time to onset was 23 days (range: 3 days to 3.7 months). Approximately 29% of patients with hyperthyroidism received methimazole and 24% received carbimazole. Resolution occurred in 94% of patients.

Опдиво can cause Type 1 diabetes mellitus. Monitor for hyperglycemia. Withhold Опдиво in cases of severe (Grade 3) hyperglycemia until metabolic control is achieved. Permanently discontinue Опдиво for life-threatening (Grade 4) hyperglycemia.

In patients receiving Опдиво as a single agent, diabetes occurred in 0.9% (17/1994) of patients including two cases of diabetic ketoacidosis. The median time to onset was 4.4 months (range: 15 days to 22 months).

In patients receiving Опдиво with ipilimumab, diabetes occurred in 1.5% (6/407) of patients; the median time to onset was 2.5 months (range: 1.3 to 4.4 months). Опдиво with ipilimumab was withheld in a patient and permanently discontinued in a second patient who developed diabetes.

Опдиво can cause immune-mediated nephritis, defined as renal dysfunction or ≥Grade 2 increased creatinine, requirement for corticosteroids, and no clear alternate etiology. Monitor patients for elevated serum creatinine prior to and periodically during treatment. Administer corticosteroids at a dose of 1 to 2 mg/kg/day prednisone equivalents followed by corticosteroid taper for life-threatening (Grade 4) increased serum creatinine. Administer corticosteroids at a dose of 0.5 to 1 mg/kg/day prednisone equivalents for moderate (Grade 2) or severe (Grade 3) increased serum creatinine, if worsening or no improvement occurs, increase dose of corticosteroids to 1 to 2 mg/kg/day prednisone equivalents.

Withhold Опдиво for moderate (Grade 2) or severe (Grade 3) increased serum creatinine. Permanently discontinue Опдиво for life-threatening (Grade 4) increased serum creatinine.

In patients receiving Опдиво as a single agent, immune-mediated nephritis and renal dysfunction occurred in 1.2% (23/1994) of patients; the median time to onset was 4.6 months (range: 23 days to 12.3 months). Immune-mediated nephritis and renal dysfunction led to permanent discontinuation of Опдиво in 0.3% and withholding of Опдиво in 0.8% of patients. All patients received high-dose corticosteroids (at least 40 mg prednisone equivalents per day) for a median duration of 21 days (range: 1 day to 15.4 months). Complete resolution occurred in 48% of patients. No patients had recurrence of nephritis or renal dysfunction after re-initiation of Опдиво.

In patients receiving Опдиво with ipilimumab, immune-mediated nephritis and renal dysfunction occurred in 2.2% (9/407) of patients; the median time to onset was 2.7 months (range: 9 days to 7.9 months). Immune-mediated nephritis and renal dysfunction led to permanent discontinuation or withholding of Опдиво with ipilimumab in 0.7% and 0.5% of patients, respectively. Approximately 67% of patients received high-dose corticosteroids (at least 40 mg prednisone equivalents per day) for a median duration of 13.5 days (range: 1 day to 1.1 months). Complete resolution occurred in all patients. Two patients resumed Опдиво with ipilimumab without recurrence of nephritis or renal dysfunction.

Опдиво can cause immune-mediated rash, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), some cases with fatal outcome. For symptoms or signs of SJS or TEN, withhold Опдиво and refer the patient for specialized care for assessment and treatment. If SJS or TEN is confirmed, permanently discontinue Опдиво.

For immune-mediated rash, administer corticosteroids at a dose of 1 to 2 mg/kg/day prednisone equivalents followed by a corticosteroid taper for severe (Grade 3) or life-threatening (Grade 4) rash. Withhold Опдиво for severe (Grade 3) rash and permanently discontinue Опдиво for lifethreatening (Grade 4) rash.

In patients receiving Опдиво as a single agent, immune-mediated rash occurred in 9% (171/1994) of patients; the median time to onset was 2.8 months (range: <1 day to 25.8 months). Immunemediated rash led to permanent discontinuation of Опдиво in 0.3% and withholding of Опдиво in 0.8% of patients. Approximately 16% of patients with rash received high-dose corticosteroids (at least 40 mg prednisone equivalents per day) for a median duration of 12 days (range: 1 days to 8.9 months) and 85% received topical corticosteroids. Complete resolution occurred in 48% of patients. Recurrence of rash occurred in 1.4% of patients who resumed Опдиво after resolution of rash.

In patients receiving Опдиво with ipilimumab, immune-mediated rash occurred in 22.6% (92/407) of patients; the median time to onset was 18 days (range: 1 day to 9.7 months). Immunemediated rash led to permanent discontinuation or withholding of Опдиво with ipilimumab in 0.5% and 3.9% of patients, respectively. Approximately 17% of patients with rash received highdose corticosteroids (at least 40 mg prednisone equivalents per day) for a median duration of 14 days (range: 2 days to 4.7 months). Complete resolution occurred in 47% of patients. Approximately 6% of patients who resumed Опдиво and ipilimumab after resolution had recurrence of rash.

Опдиво can cause immune-mediated encephalitis with no clear alternate etiology. Evaluation of patients with neurologic symptoms may include, but not be limited to, consultation with a neurologist, brain MRI, and lumbar puncture.

Withhold Опдиво in patients with new-onset moderate to severe neurologic signs or symptoms and evaluate to rule out infectious or other causes of moderate to severe neurologic deterioration. If other etiologies are ruled out, administer corticosteroids at a dose of 1 to 2 mg/kg/day prednisone equivalents for patients with immune-mediated encephalitis, followed by corticosteroid taper. Permanently discontinue Опдиво for immune-mediated encephalitis.

In patients receiving Опдиво as a single agent, encephalitis occurred in 0.2% (3/1994). Fatal limbic encephalitis occurred in one patient after 7.2 months of exposure despite discontinuation of Опдиво and administration of corticosteroids. In the other two patients, encephalitis occurred post-allogeneic HSCT.

Encephalitis occurred in one patient receiving Опдиво with ipilimumab (0.2%) after 1.7 months of exposure.

Опдиво can cause other clinically significant and potentially fatal immune-mediated adverse reactions. Immune-mediated adverse reactions may occur after discontinuation of Опдиво therapy. For any suspected immune-mediated adverse reactions, exclude other causes. Based on the severity of the adverse reaction, permanently discontinue or withhold Опдиво, administer high-dose corticosteroids, and if appropriate, initiate hormone-replacement therapy. Upon improvement to Grade 1 or less, initiate corticosteroid taper and continue to taper over at least 1 month. Consider restarting Опдиво after completion of corticosteroid taper based on the severity of the event.

Across clinical trials of Опдиво administered as a single agent or in combination with ipilimumab, the following clinically significant immune-mediated adverse reactions, some with fatal outcome, occurred in less than 1.0% of patients receiving Опдиво: myocarditis, rhabdomyolysis, myositis, uveitis, iritis, pancreatitis, facial and abducens nerve paresis, demyelination, polymyalgia rheumatica, autoimmune neuropathy, Guillain-Barré syndrome, hypopituitarism, systemic inflammatory response syndrome, gastritis, duodenitis, sarcoidosis, histiocytic necrotizing lymphadenitis (Kikuchi lymphadenitis), motor dysfunction, vasculitis, and myasthenic syndrome.

Опдиво can cause severe infusion reactions, which have been reported in less than 1.0% of patients in clinical trials. Discontinue Опдиво in patients with severe or life-threatening infusion reactions. Interrupt or slow the rate of infusion in patients with mild or moderate infusion reactions.

In patients receiving Опдиво as a 60-minute intravenous infusion, infusion-related reactions occurred in 6.4% (127/1994) of patients.

In a study assessing the pharmacokinetics and safety of a more rapid infusion, in which patients received Опдиво as a 60-minute intravenous infusion or a 30-minute intravenous infusion, infusion-related reactions occurred in 2.2% (8/368) and 2.7% (10/369) patients, respectively. Additionally, 0.5% (2/368) and 1.4% (5/369) of patients, respectively, experienced adverse reactions within 48 hours of infusion that led to dose delay, permanent discontinuation or withholding of Опдиво.

In patients receiving Опдиво as a 60-minute intravenous infusion prior to the infusion of ipilimumab, infusion-related reactions occurred in 2.5% (10/407) of patients.

Complications, including fatal events, occurred in patients who received allogeneic HSCT after Опдиво. Outcomes were evaluated in 17 patients from the CHECKMATE-205 and CHECKMATE-039 trials who underwent allogeneic HSCT after discontinuing Опдиво (15 with reduced-intensity conditioning, two with myeloablative conditioning). The median age at HSCT was 33 (range: 18 to 56), and a median of 9 doses of Опдиво had been administered (range: 4 to 16). Six of 17 patients (35%) died from complications of allogeneic HSCT after Опдиво. Five deaths occurred in the setting of severe or refractory GVHD. Grade 3 or higher acute GVHD was reported in 5/17 patients (29%). Hyperacute GVHD, defined as GVHD occurring within 14 days after stem cell infusion, was reported in 2 patients (20%). A steroid-requiring febrile syndrome, without an identified infectious cause, was reported in six patients (35%) within the first 6 weeks post-transplantation, with five patients responding to steroids. Two cases of encephalitis were reported: one case of Grade 3 lymphocytic encephalitis without an identified infectious cause, which occurred and resolved on steroids, and one case of Grade 3 suspected viral encephalitis which was resolved with antiviral treatment. Hepatic veno-occlusive disease (VOD) occurred in one patient, who received reduced-intensity conditioned allogeneic HSCT and died of GVHD and multi-organ failure.

Other cases of hepatic VOD after reduced-intensity conditioned allogeneic HSCT have also been reported in patients with lymphoma who received a PD-1 receptor blocking antibody before transplantation. Cases of fatal hyperacute GVHD have also been reported.

These complications may occur despite intervening therapy between PD-1 blockade and allogeneic HSCT.

Follow patients closely for early evidence of transplant-related complications such as hyperacute GVHD, severe (Grade 3 to 4) acute GVHD, steroid-requiring febrile syndrome, hepatic VOD, and other immune-mediated adverse reactions, and intervene promptly.

Based on its mechanism of action and data from animal studies, Опдиво can cause fetal harm when administered to a pregnant woman. In animal reproduction studies, administration of nivolumab to cynomolgus monkeys from the onset of organogenesis through delivery resulted in increased abortion and premature infant death. Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with an Опдиво-containing regimen and for at least 5 months after the last dose of Опдиво.

Advise the patient to read the FDA-approved patient labeling (Medication Guide).

Inform patients of the risk of immune-mediated adverse reactions that may require corticosteroid treatment and withholding or discontinuation of Опдиво, including:

• Pneumonitis: Advise patients to contact their healthcare provider immediately for any new or worsening cough, chest pain, or shortness of breath.
• Colitis: Advise patients to contact their healthcare provider immediately for diarrhea or severe abdominal pain.
• Hepatitis: Advise patients to contact their healthcare provider immediately for jaundice, severe nausea or vomiting, pain on the right side of abdomen, lethargy, or easy bruising or bleeding.
• Endocrinopathies: Advise patients to contact their healthcare provider immediately for signs or symptoms of hypophysitis, adrenal insufficiency, hypothyroidism, hyperthyroidism, and diabetes mellitus.
• Nephritis and Renal Dysfunction: Advise patients to contact their healthcare provider immediately for signs or symptoms of nephritis including decreased urine output, blood in urine, swelling in ankles, loss of appetite, and any other symptoms of renal dysfunction.
• Skin Adverse Reactions: Advise patients to contact their healthcare provider immediately for rash.
• Encephalitis: Advise patients to contact their healthcare provider immediately for neurological signs or symptoms of encephalitis.
• Infusion Reactions: Advise patients of the potential risk of infusion reaction.
• Complications of allogeneic HSCT after Опдиво: Advise patients of potential risk of post-transplant complications.
• Females of Reproductive Potential: Advise females of reproductive potential of the potential risk to a fetus and to inform their healthcare provider of a known or suspected pregnancy. Advise females of reproductive potential to use effective contraception during treatment with Опдиво and for at least 5 months following the last dose of Опдиво.
• Lactation: Advise women not to breastfeed while taking Опдиво.

No studies have been performed to assess the potential of nivolumab for carcinogenicity or genotoxicity. Fertility studies have not been performed with nivolumab. In 1-month and 3-month repeat-dose toxicology studies in monkeys, there were no notable effects in the male and female reproductive organs; however, most animals in these studies were not sexually mature.

Based on its mechanism of action and data from animal studies, Опдиво can cause fetal harm when administered to a pregnant woman. In animal reproduction studies, administration of nivolumab to cynomolgus monkeys from the onset of organogenesis through delivery resulted in increased abortion and premature infant death. Human IgG4 is known to cross the placental barrier and nivolumab is an immunoglobulin G4 (IgG4); therefore, nivolumab has the potential to be transmitted from the mother to the developing fetus. The effects of Опдиво are likely to be greater during the second and third trimesters of pregnancy. There are no available human data informing the drug-associated risk. Advise pregnant women of the potential risk to a fetus.

The background risk of major birth defects and miscarriage for the indicated population is unknown; however, the background risk in the U.S. general population of major birth defects is 2% to 4% and of miscarriage is 15% to 20% of clinically recognized pregnancies.

Animal Data

A central function of the PD-1/PD-L1 pathway is to preserve pregnancy by maintaining maternal immune tolerance to the fetus. Blockade of PD-L1 signaling has been shown in murine models of pregnancy to disrupt tolerance to the fetus and to increase fetal loss. The effects of nivolumab on prenatal and postnatal development were evaluated in monkeys that received nivolumab twice weekly from the onset of organogenesis through delivery, at exposure levels of between 9 and 42 times higher than those observed at the clinical dose of 3 mg/kg of nivolumab (based on AUC). Nivolumab administration resulted in a non-dose-related increase in spontaneous abortion and increased neonatal death. Based on its mechanism of action, fetal exposure to nivolumab may increase the risk of developing immune-mediated disorders or altering the normal immune response and immune-mediated disorders have been reported in PD-1 knockout mice. In surviving infants (18 of 32 compared to 11 of 16 vehicle-exposed infants) of cynomolgus monkeys treated with nivolumab, there were no apparent malformations and no effects on neurobehavioral, immunological, or clinical pathology parameters throughout the 6-month postnatal period.

It is not known whether Опдиво is present in human milk. Because many drugs, including antibodies, are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from Опдиво, advise women to discontinue breastfeeding during treatment with Опдиво.

Based on its mechanism of action, Опдиво can cause fetal harm when administered to a pregnant woman. Advise females of reproductive potential to use effective contraception during treatment with Опдиво and for at least 5 months following the last dose of Опдиво.

The safety and effectiveness of Опдиво have been established in pediatric patients age 12 years and older with microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) metastatic colorectal cancer (mCRC) that has progressed following treatment with a fluoropyrimidine, oxaliplatin, and irinotecan. Use of Опдиво for this indication is supported by evidence from adequate and well-controlled studies of Опдиво in adults with MSI-H or dMMR mCRC with additional population pharmacokinetic data demonstrating that age and body weight had no clinically meaningful effect on the steady state exposure of nivolumab, that drug exposure is generally similar between adults and pediatric patients age 12 years and older for monoclonal antibodies, and that the course of MSI-H or dMMR mCRC is sufficiently similar in adults and pediatric patients to allow extrapolation of data in adults to pediatric patients. The recommended dose in pediatric patients 12 years of age or greater for this indication is the same as that in adults. The safety and effectiveness of Опдиво have not been established (1) in pediatric patients less than 12 years old with MSI-H or dMMR mCRC or (2) in pediatric patients less than 18 years old for the other approved indications.

Of the 1359 patients randomized to single-agent Опдиво in CHECKMATE-017, CHECKMATE-057, CHECKMATE-066, CHECKMATE-025, and CHECKMATE-067, 39% were 65 years or older and 9% were 75 years or older. No overall differences in safety or effectiveness were reported between elderly patients and younger patients.

In CHECKMATE-275 (Urothelial Cancer), 55% of patients were 65 years or older and 14% were 75 years or older. No overall differences in safety or effectiveness were reported between elderly patients and younger patients.

In CHECKMATE-238 (Adjuvant Treatment of Melanoma), 26% of patients were 65 years or older and 3% were 75 years or older. No overall differences in safety or effectiveness were reported between elderly patients and younger patients.

CHECKMATE-037, CHECKMATE-205, CHECKMATE-039, CHECKMATE-141, and CHECKMATE-142, a

Dosage (Posology) and method of administration

The recommended dose of Опдиво as a single agent is 240 mg administered as an intravenous infusion over 30 minutes every 2 weeks until disease progression or unacceptable toxicity.

The recommended dose of Опдиво is 1 mg/kg administered as an intravenous infusion over 30 minutes, followed by ipilimumab on the same day, every 3 weeks for 4 doses. The recommended subsequent dose of Опдиво, as a single agent, is 240 mg administered as an intravenous infusion over 30 minutes every 2 weeks until disease progression or unacceptable toxicity. Review the Full Prescribing Information for ipilimumab prior to initiation.

The recommended dose of Опдиво is 240 mg administered as an intravenous infusion over 60 minutes every 2 weeks until disease recurrence or unacceptable toxicity for up to 1 year.

The recommended dose of Опдиво is 240 mg administered as an intravenous infusion over 30 minutes every 2 weeks until disease progression or unacceptable toxicity.

The recommended dose of Опдиво is 240 mg administered as an intravenous infusion over 30 minutes every 2 weeks until disease progression or unacceptable toxicity.

The recommended dose of Опдиво is 3 mg/kg administered as an intravenous infusion over 30 minutes every 2 weeks until disease progression or unacceptable toxicity.

The recommended dose of Опдиво is 3 mg/kg administered as an intravenous infusion over 30 minutes every 2 weeks until disease progression or unacceptable toxicity.

The recommended dose of Опдиво is 240 mg administered as an intravenous infusion over 30 minutes every 2 weeks until disease progression or unacceptable toxicity.

The recommended dose of Опдиво is 240 mg administered as an intravenous infusion over 60 minutes every 2 weeks until disease progression or unacceptable toxicity.

The recommended dose of Опдиво is 240 mg administered as an intravenous infusion over 60 minutes every 2 weeks until disease progression or unacceptable toxicity.

Recommendations for Опдиво modifications are provided in Table 1. When Опдиво is administered in combination with ipilimumab, if Опдиво is withheld, ipilimumab should also be withheld.

There are no recommended dose modifications for hypothyroidism or hyperthyroidism.

Interrupt or slow the rate of infusion in patients with mild or moderate infusion reactions. Discontinue Опдиво in patients with severe or life-threatening infusion reactions.

Table 1: Recommended Dose Modifications for Опдиво

Visually inspect drug product solution for particulate matter and discoloration prior to administration. Опдиво is a clear to opalescent, colorless to pale-yellow solution. Discard the vial if the solution is cloudy, discolored, or contains extraneous particulate matter other than a few translucent-to-white, proteinaceous particles. Do not shake the vial.

• Withdraw the required volume of Опдиво and transfer into an intravenous container.
• Dilute Опдиво with either 0.9% Sodium Chloride Injection, USP or 5% Dextrose Injection, USP to prepare an infusion with a final concentration ranging from 1 mg/mL to 10 mg/mL.
• Mix diluted solution by gentle inversion. Do not shake.
• Discard partially used vials or empty vials of Опдиво.

The product does not contain a preservative.

After preparation, store the Опдиво infusion either:

• at room temperature for no more than 8 hours from the time of preparation. This includes room temperature storage of the infusion in the IV container and time for administration of the infusion or
• under refrigeration at 2°C to 8°C (36°F to 46°F) for no more than 24 hours from the time of infusion preparation.

Do not freeze.

Administer the infusion through an intravenous line containing a sterile, non-pyrogenic, low protein binding in-line filter (pore size of 0.2 micrometer to 1.2 micrometer).

Do not coadminister other drugs through the same intravenous line.

Flush the intravenous line at end of infusion.

When administered in combination with ipilimumab, infuse Опдиво first followed by ipilimumab on the same day. Use separate infusion bags and filters for each infusion.