Opdivo® (Nivolumab) for Mesothelioma

What Is Opdivo (Nivolumab)?

Opdivo® (nivolumab) is an immunotherapy medication. It belongs to a class of drugs called immune checkpoint inhibitors. Opdivo interacts with certain proteins on immune system cells. This interaction allows immune cells to attack other cells they would normally ignore, such as cancer cells.

The U.S. Food and Drug Administration (FDA) has approved the use of Opdivo to treat several different types of cancer. When combined with Yervoy, Opdivo has FDA approval as a first-line treatment for malignant pleural mesothelioma. Doctors may recommend Opdivo and Yervoy for adults with unresectable pleural mesothelioma. Unresectable means it cannot be treated with surgery.

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How Does Opdivo (Nivolumab) Treat Mesothelioma?

Opdivo works by allowing the immune system to attack mesothelioma cancer cells. The drug blocks the PD-1 immune checkpoint. This checkpoint normally helps keep immune cells, called T cells, from attacking healthy cells. However, cancer cells can use these same checkpoints to hide from the immune system.

Once Opdivo blocks the checkpoints, T cells may recognize and attack cancer cells. Patients may experience side effects if the T cells also damage healthy cells.

Clinical trials and studies have tested Opdivo in mesothelioma cancer cases. In combination with Yervoy, it extended median survival compared to chemotherapy.

Opdivo (Nivolumab) and Yervoy for Malignant Pleural Mesothelioma

Opdivo and Yervoy have FDA approval to treat pleural mesothelioma when used together. Both are immune checkpoint inhibitors, but each targets different checkpoints. Opdivo targets the PD-1 checkpoint, and Yervoy targets the CTLA-4 checkpoint. Both mesothelioma drugs are given through intravenous (IV) infusions.

The CheckMate 743 clinical trial tested the combination on all mesothelioma cell types, including the more aggressive biphasic and sarcomatoid types. The trial reported several encouraging results with this combination, including:

• Effective across mesothelioma cell types: Biphasic and sarcomatoid mesothelioma, together called non-epithelioid mesothelioma, typically respond poorly to chemotherapy. In the CheckMate 743 trial, patients with non-epithelioid mesothelioma who received Opdivo and Yervoy had a median survival of 18.1 months, compared with 8.8 months for those who received chemotherapy, according to a 2021 report in The Lancet.
• Improved median overall survival: Patients treated with Opdivo and Yervoy had a median survival of 18.1 months, compared with 14.1 months for patients treated with chemotherapy, a 26% reduction in the risk of death, according to a 2021 report in The Lancet.
• Improved survival rates: Opdivo and Yervoy patients had survival rates of 68% and 41% at one- and two-year follow-up, respectively. Chemotherapy patients had survival rates of 58% and 27% at one- and two-year follow-ups, respectively.

Malignant pleural mesothelioma is a rare form of cancer that starts in the pleura, the lining around the lungs. It is caused by exposure to asbestos. In some cases, mesothelioma doctors do not recommend treating the cancer with surgery. Opdivo and Yervoy may be an option in such cases.

A 5-year follow-up of the CheckMate 743 trial, published in the Journal of Clinical Oncology in March 2026, found that 14% of patients treated with Opdivo and Yervoy were alive at 5 years, compared with 6% of patients treated with chemotherapy.

Opdivo (Nivolumab) and Yervoy for Asbestos-Related Lung Cancer

The Opdivo and Yervoy combination is FDA-approved to treat non-small cell lung cancer, which is a common form of lung cancer. It can be caused by asbestos exposure.

CheckMate 227 was a phase III clinical trial for patients with stage 4 non-small cell lung cancer. During the study, researchers compared the Opdivo and Yervoy combination to chemotherapy. Patients treated with the Opdivo and Yervoy combination had a median overall survival of 17.1 months. For chemotherapy patients, the median overall survival was 13.9 months.

Opdivo is FDA-approved to treat some other types of cancer, such as melanoma and colorectal cancer. Opdivo may also be used in an off-label capacity. It is both common and legal. Several types of mesothelioma have few, if any, approved treatments. Off-label usage allows doctors to use their judgment to treat mesothelioma and other rare conditions. This can expand treatment options for patients.

Did You Know? Some treatments for mesothelioma are not covered by insurance. Treatment for mesothelioma can become a financial burden. Learn More About Financial Assistance Available

What to Expect During Treatment

Opdivo in combination with Yervoy is approved for the treatment of inoperable pleural mesothelioma. Patient experiences with different cancer or infusion centers may vary. But patients can expect treatment that generally follows the manufacturer’s recommendations.

According to the drug label, Opdivo and Yervoy treatment for mesothelioma involves:

• Treatment with Opdivo every three weeks
• Treatment with Yervoy every six weeks

On days when the patient receives both, Opdivo is given first through an infusion. Then, Yervoy is given through a different infusion line.

While many factors can affect infusion time, this immunotherapy treatment generally takes 30 to 60 minutes. Patients can receive Opdivo and Yervoy for up to two years. Doctors may shorten this time frame if the patient’s cancer grows or they experience unacceptable side effects. Patients should discuss specifics with their oncology care team.

Opdivo allows the immune system to attack cancer cells. It may also damage healthy cells. As a result, patients may experience some side effects that range from mild to severe. The care team will track the patient’s well-being and determine if they should pause or stop Opdivo treatment.

Preparing for Your Appointment

On the day of Opdivo treatment, patients may want to come prepared. How they prepare may depend on their specific treatment plan and the cancer center treating them. Patients can speak with their care team to find out what specific steps they should expect.

Some healthcare specialists recommend the following tips for immunotherapy patients:

• Diet: Some patients may benefit from a diet for mesothelioma patients. This may help give the immune system the nutrition it needs to fight cancer.
• Exercise: If safe for the patient, the healthcare team may recommend some mild exercise. This may also help activate the immune system.
• Sleep: Consistently getting a good night’s sleep can help support the immune system. Patients may be encouraged to maintain good sleep hygiene before and after starting treatment.

On the day of treatment, patients may want to have someone drive them to and from the appointment. Cancer centers may recommend this until they know how treatments will affect the patient.

Opdivo (Nivolumab) Benefits

Opdivo offers several potential benefits when used in combination with Yervoy. In pleural mesothelioma, Opdivo + Yervoy benefits include improved survival and quality of life. These benefits have been demonstrated in clinical trials.

In one study, researchers found the Opdivo and Yervoy combination improved survival rates over chemotherapy. Other benefits observed for Opdivo include:

• Lower rates of severe side effects versus another form of checkpoint inhibitor
• No mandatory pre-treatment preparation
• No need for a surgically implanted port

The healthcare team can provide additional information about the possible benefits for Opdivo.

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Opdivo (Nivolumab) Side Effects

Like many cancer treatments, Opdivo may cause a range of side effects. A patient’s healthcare team will watch for side effects during treatment. This can help ensure any adverse effects are managed promptly. Many side effects are short-term (called acute) and can be treated with medication. However, it is important to consider the potential for immune-related reactions, which may be serious and can develop during or after treatment.

Opdivo side effects can vary from person to person. During the CheckMate 743 trial, the most common side effects included:

• Abdominal pain
• Cough
• Decreased appetite
• Diarrhea
• Difficulty breathing
• Fatigue
• Itch
• Muscle and joint pain
• Nausea
• Rash

The side effects above were reported by mesothelioma patients receiving Opdivo and Yervoy. As such, side effects from Opdivo alone may differ.

Treatment with Opdivo and Yervoy can sometimes cause serious reactions. In the CheckMate 743 trial, 30% of patients treated with Opdivo and Yervoy had a grade 3 or 4 (severe) treatment-related side effect, a rate similar to chemotherapy. Most of these side effects were manageable and responded to standard treatment. Patients should discuss their concerns about side effects with their care team.

Managing Side Effects

Patients may experience side effects while receiving Opdivo and Yervoy. But doctors have established protocols for managing these reactions.

Side effects can range from mild to severe. For mild side effects, doctors may recommend pausing treatment until symptoms go away. Some can be effectively managed with corticosteroids, such as prednisone.

With more severe side effects, doctors may recommend stopping treatment completely. In studies, some patients who had to stop treatment did not lose the effects of the treatment.

Patients should speak to their doctor about side effects of Opdivo or any other medications they are prescribed.

Who Is Eligible for Opdivo (Nivolumab)?

Eligibility for Opdivo treatment depends on several factors including tumor location and stage at diagnosis. The Opdivo and Yervoy combination is the only FDA-approved mesothelioma treatment consisting solely of immunotherapy. This approval is for adults with confirmed pleural mesothelioma that cannot be treated with surgery.

Patients interested in a checkpoint inhibitor treatment should speak to their doctor. The healthcare team will be able to determine if the treatment can benefit the patient.

Doctors generally avoid prescribing Opdivo and Yervoy to patients with an active autoimmune disease since the drugs can worsen these conditions. They also generally avoid it for patients who have had an organ transplant since the treatment can affect how well the body tolerates the transplanted organ. Patients who are pregnant or breastfeeding should tell their doctor, since Opdivo can harm a developing fetus.

Clinical Trials and Studies on Opdivo (Nivolumab) for Mesothelioma

Researchers have tested Opdivo’s effectiveness in various mesothelioma clinical trials. It has shown promise as a first- and second-line treatment for mesothelioma.