Opdivo (Nivolumab) for Mesothelioma Treatment

What Is Opdivo (Nivolumab)?

Opdivo (nivolumab) for mesothelioma is a type of immunotherapy. Known as a checkpoint inhibitor, Opdivo helps your immune system attack mesothelioma. Opdivo blocks proteins that act like checkpoints in the immune system. These proteins tell immune cells to ignore certain cells, which can include mesothelioma cells. 

Checkpoint inhibitors in immunotherapy can block a variety of proteins. Opdivo specifically blocks PD-1, a protein that can stop immune cells from attacking mesothelioma. As a PD-1 inhibitor,  Opdivo helps your immune system find and destroy mesothelioma cells.

Key Facts About Opdivo for Mesothelioma

1. Nivolumab is an immunotherapy drug marketed under the brand name Opdivo.
2. Opdivo is approved as a first-line treatment for pleural mesothelioma.
3. Studies show Opdivo can help people live longer and may cause fewer side effects than standard chemo.
4. Opdivo may take time to show results, but it can lead to longer-lasting control of the cancer.

Opdivo is made from a protein called a humanized antibody. It closely matches natural proteins already found in your body. This helps your immune system accept it more easily. 

Doctors combine Opdivo with Yervoy (ipilimumab) to improve outcomes. The U.S. Food and Drug Administration approved this combination specifically to treat advanced pleural mesothelioma.

Opdivo Information

Mesothelioma patients get Opdivo via IV injection. The recommended dosing schedule is 360 mg of Opdivo every 3 weeks and 1 mg/kg of Yervoy every 6 weeks. Dosage for each person with mesothelioma cancer may vary.

Each visit may take 30 to 90 minutes. Your doctor will check how your body is doing through blood tests and scans. Doctors will watch you closely to make sure your treatment is working. Some people see results in a few months, while others take longer.

Doctors will tailor treatment plans based on your needs and overall health. Your response and tolerance to the therapy will determine your treatment duration. You can still do many daily activities during treatment.

How Do Opdivo and Yervoy Work Together to Treat Mesothelioma?

Yervoy and Opdivo for mesothelioma work together, targeting different parts of your immune system. Opdivo helps your immune system see and attack cancer cells. Yervoy helps your T cells fight harder. 

The FDA approved this combo as a mesothelioma treatment because clinical trials proved it helps patients live longer. They work as a team to fight mesothelioma better than just one drug alone. 

Medical oncologist Dr. Bernardo Goulart at Seattle Cancer Care Alliance tells us these drugs harness the immune system to attack mesothelioma. He says, “This combination [Opdivo and Yervoy] is a game-changer, showing unquestionable survival benefits for mesothelioma. It confirms that the disease is subject to the harnessing of the immune system. This will open many doors.”

Who Is Eligible for Opdivo Treatment?

Opdivo with Yervoy is specifically FDA-approved as a first-line therapy for adults with inoperable pleural mesothelioma who haven’t had prior treatment. However, doctors are using Opdivo to help more of their mesothelioma patients and clinical trials are exploring its effectiveness for other types of the cancer like peritoneal mesothelioma.

In our exclusive 2025 mesothelioma patient survey, 22% of participants had tried immunotherapy. And of that group, 38% had received Opdivo.

Eligibility Criteria for Opdivo for Mesothelioma

• Diagnosed with mesothelioma (approved for pleura, experimental for peritoneal)
• Approved as a first-line treatment, but some patients are given it as a second line, meaning they’ve had prior treatment
• You’re healthy enough to handle treatment and don’t have certain autoimmune diseases like lupus or Crohn’s disease
• You’re not pregnant and are using birth control if needed

Patients should be in otherwise good health before starting the regimen because there are known side effects. Dr. Jeffrey Velotta, a thoracic surgeon at Oakland Medical Center in California, tells us, “I have seen a lot of toxicity with it and side effects, so it is not a benign treatment.” 

Dr. Velotta adds, “I personally feel that immunotherapy is going to be better in the adjuvant setting.” This means immunotherapy may work best after surgery, when it can help the immune system destroy any cancer cells left behind. Your mesothelioma specialist will assess if Opdivo is right for you.

Benefits of Opdivo and Yervoy for Mesothelioma

The benefits of Yervoy and Opdivo for mesothelioma include longer survival and reduced symptoms. These effects can improve patient quality of life. The combination showed a longer response duration regardless of mesothelioma cell type. Many patients maintain benefits for up to 3 years after treatment.

A key clinical trial, CheckMate 743, reported results that supported Opdivo’s FDA approval. The results demonstrated significant survival benefits for mesothelioma patients. 

Effectiveness of Opdivo for Mesothelioma

• In a major clinical trial, CheckMate 743, people lived a median of 18.1 months with Opdivo and Yervoy, compared to 14.1 months with chemo. 
• With Opdivo and Yervoy, 23% of people were alive 3 years after the trial. In contrast, only 15% of those who received chemo survived. 
• The 2-year survival rate was 41% with Opdivo and Yervoy, versus 27% with chemotherapy.
• Patients receiving this immunotherapy for mesothelioma had longer-lasting symptom control, including less chest pain and shortness of breath.
• Opdivo and Yervoy may delay disease progression longer than chemo in some patients.
• The combination helped many people avoid or delay the need for second-line treatments.

Peritoneal mesothelioma survivor Randy Derouen noticed the benefits of Opdivo and Yervoy quickly. He tells us, “Symptoms wise, I almost immediately felt the difference.” He also explained his side effects didn’t last as long as with chemo. “As far as side effects, you know, you’re always going to have fatigue and nausea, night sweats. And usually, the good thing about immunotherapy is it doesn’t last. It doesn’t linger past a few days.”

What Are the Side Effects of Opdivo? 

Opdivo can cause side effects as it treats mesothelioma. These can include joint pain, pneumonitis and other immune-related side effects. These occur because of Opdivo’s impact on the immune system. 

Common Opdivo Side Effects

• Anemia
• Constipation
• Cough 
• Decreased appetite
• Diarrhea
• Fatigue
• Fever
• High potassium
• Low calcium
• Low sodium levels
• Low white blood cell count (lymphocytopenia)
• Nausea
• Pain in muscles, bones, and joints 
• Shortness of breath
• Weight loss

Certain side effects can mirror symptoms of lung cancer or pleural mesothelioma. Examples include shortness of breath and coughing. Most patients don’t experience all the common side effects. Most side effects are reversible or regress after complete treatment.

Similar to other checkpoint inhibitors, such as Keytruda (pembrolizumab), disruptions to the immune system cause the most severe side effects of Opdivo. While the immune system recognizes and attacks cancer cells, it may also target healthy cells. If damage occurs to healthy cells, it can lead to immune-related reactions.

Rare Side Effects of Opdivo

Rare side effects of Opdivo for mesothelioma, such as organ damage, result from inflammation. These reactions occur in less than 4% of patients but can become life-threatening. 

Rare But Serious Opdivo Side Effects

• Hormone gland issues (thyroid, pituitary, adrenal glands and pancreas)
• Inflammation of the brain (encephalitis)
• Intestinal problems (colitis)
• Kidney problems, including nephritis and kidney failure
• Liver problems (hepatitis)
• Lung problems (pneumonitis)
• Problems with other organs
• Skin problems

Patients who experience pneumonitis, inflammation of the lungs or joint inflammation may require immunosuppressive treatment with prednisone or other steroids. Prolonged use of corticosteroids may reduce the immune system’s effectiveness. This can lead to vision problems or changes in blood sugar levels.

Because doctors administer Opdivo via IV injection, in rare cases, this may cause severe infusion reactions. The reactions may include fever, dizziness, itching, rash, chills or shaking.

Opdivo and Yervoy Side Effects

When combined with Yervoy, Opdivo can introduce new or more severe side effects for people with mesothelioma. The combination may increase the risk of mild issues like hormone imbalances, which can become more pronounced. 

Side Effects of Opdivo With Yervoy

• Side effects more common with Opdivo: Fatigue, cough, shortness of breath, nausea, skin rash, joint pain and loss of appetite.
• Side effects more common with Yervoy: Diarrhea, belly pain, skin itching, rash, fever, headache and trouble sleeping.

Dr. Estelamari Rodriguez, a thoracic oncologist at the University of Miami Health System, tells us, “The most common side effects of the ipilimumab and nivolumab combination include fatigue, itching, diarrhea, rash, pain in muscles and joints, decreased thyroid hormone and, rarely, inflammation of the lungs, known as pneumonitis.” Many patients can tolerate the Opdivo-Yervoy combo treatment without any side effects. 

Things to Consider Before Taking Opdivo

Before starting Opdivo for mesothelioma, discuss your health and risks with your doctor. Opdivo is a powerful immunotherapy, and it may not suit everyone. Certain conditions could increase the risk of side effects.

Key Factors to Discuss With Your Mesothelioma Doctor

• Autoimmune conditions: Inform your mesothelioma doctor if you have a history of autoimmune disease. Opdivo stimulates the immune system, which may worsen these conditions.
• Existing health issues: If you have pre-existing conditions in addition to mesothelioma, your doctor may need to change your treatment plan. These include thyroid problems, kidney disease or respiratory issues.
• Immune-related side effects: Opdivo can inflame the lungs, liver and intestines. Look for shortness of breath, abdominal pain or yellowing of the skin.
• Organ transplants: If you’ve had an organ transplant, tell your doctor. Opdivo may affect your body’s ability to manage the transplanted organ.
• Other treatments: If you get radiation, other drugs or any other treatments, your doctor will check for interactions with Opdivo.
• Pregnancy: Opdivo can harm a developing fetus. Notify your doctor if you’re pregnant, planning to become pregnant or breastfeeding.

Openly discussing these factors with your doctor will help decide if Opdivo is the right mesothelioma treatment for you. It also helps to ensure you take any necessary precautions during your treatment.

Common Questions About Opdivo for Mesothelioma

How long does Opdivo treatment last for mesothelioma?

Doctors usually give Opdivo every few weeks for as long as it helps treat your mesothelioma and as side effects stay mild. Some people take it for several months or even over a year. Your mesothelioma specialist will check often to see if it’s working. People with mesothelioma who took Opdivo and Yervoy had an 8% higher 3-year survival rate than those treated with traditional chemo.

Can Opdivo be used for mesothelioma after chemotherapy?

Yes, doctors can use Opdivo after chemo. It may help the immune system keep fighting mesothelioma. Even if chemo didn’t work well, Opdivo can still give hope. Your doctor can help decide if it’s the right next step in your mesothelioma treatment.

How does Opdivo compare to other immunotherapy drugs for mesothelioma such as Keytruda?

Opdivo and Keytruda both help the immune system fight mesothelioma. Some people may respond better to one than the other. Doctors sometimes choose Opdivo with another drug called Yervoy for even better results. Your care team will recommend the best option for you.

Does insurance cover Opdivo for mesothelioma treatment?

Many insurance plans, including Medicare, cover Opdivo if a doctor says it’s needed to treat your mesothelioma. Coverage can depend on the plan and your medical records. Check with your insurance providers for coverage details. Financial assistance programs may also offset costs. Speak with a Patient Advocate who can help you navigate insurance and financial assistance options.

Recommended Reading