On December 27, 2024, the United States Food and Drug Administration approved nivolumab and hyaluronidase-nvhy (Opdivo Qvantig, Bristol Myers Squibb Company) for subcutaneous injection across approved adult, solid tumour nivolumab (Opdivo, Bristol Myers Squibb Company) indications as monotherapy, monotherapy maintenance following completion of Opdivo plus Yervoy (ipilimumab) combination therapy, or in combination with chemotherapy or cabozantinib.
The approval includes indications for renal cell carcinoma, melanoma, non-small cell lung cancer, head and neck squamous cell carcinoma, urothelial carcinoma, colorectal cancer, hepatocellular carcinoma, oesophagal carcinoma, gastric cancer, gastroesophageal junction cancer, and oesophagal adenocarcinoma. Opdivo Qvantig is not indicated in combination with intravenous ipilimumab.
Efficacy and Safety
The subcutaneous injection of nivolumab and hyaluronidase-nvhy was evaluated in CHECKMATE-67T (NCT04810078), a multicenter, randomised, open-label trial in patients with advanced or metastatic clear cell renal cell carcinoma who received no more than 2 prior systemic treatment regimens. A total of 495 patients were randomised to receive either subcutaneous nivolumab and hyaluronidase-nvhy or intravenous nivolumab.
The primary objective was to assess the nivolumab exposure of subcutaneous administration of OPDIVO QVANTIG compared to intravenous nivolumab. The key secondary objective was to evaluate overall response rate (ORR), assessed by blinded independent central review. The trial met the predefined acceptance margin for pharmacokinetic endpoints, with the lower boundary of 90 per cent confidence interval of geometric mean ratios of not less than 0.8 for both serum nivolumab Cavg over 28 days and Cmin at steady state. ORR was 24 per cent (95 per cent CI: 19,30) in the subcutaneous nivolumab and hyaluronidase-nvhy arm and 18 per cent (95 per cent CI: 14, 24) in the intravenous nivolumab arm.
In general, CHECKMATE-67T showed a similar safety profile between OPDIVO QVANTIG and intravenous nivolumab. The most common adverse reactions (≥10 per cent) were fatigue, musculoskeletal pain, pruritus, rash, and cough.
Recommended Dosage
The recommended dosage depends on the specific indication and is either 600 mg nivolumab and 10,000 units hyaluronidase every 2 weeks; 900 mg nivolumab and 15,000 units of hyaluronidase every 3 weeks; or 1,200 mg nivolumab and 20,000 units hyaluronidase every 4 weeks until disease progression, unacceptable toxicity, or as indicated in the prescribing information.