Our Therapies

OPDIVO® + YERVOY® Infusion Therapy

Next-generation infusion care - Violet Health Infusion Care

About OPDIVO® + YERVOY® Infusion Therapy

OPDIVO® (nivolumab) and YERVOY® (ipilimumab) are two biologic medications given together as intravenous (IV) infusions. OPDIVO® is a PD-1 blocking antibody and YERVOY® is a CTLA-4 blocking antibody. Each one releases a different brake on your immune system, so giving them together allows your own T cells to recognize and attack cancer cells through two separate pathways. This approach is often called dual checkpoint blockade.

The dosing schedule depends entirely on your diagnosis. For melanoma, the usual regimen is OPDIVO® 1 mg/kg with YERVOY® 3 mg/kg every three weeks for four doses, followed by single-agent OPDIVO® at 240 mg every two weeks or 480 mg every four weeks. For advanced renal cell carcinoma and MSI-H/dMMR colorectal cancer, the combination is OPDIVO® 3 mg/kg with YERVOY® 1 mg/kg every three weeks for four doses, again followed by single-agent OPDIVO®. For hepatocellular carcinoma, it is OPDIVO® 1 mg/kg with YERVOY® 3 mg/kg every three weeks for up to four doses. For non-small cell lung cancer, mesothelioma, and esophageal squamous cell carcinoma, the two drugs continue together on different schedules, with OPDIVO® every two or three weeks and YERVOY® every six weeks, for up to two years. Each drug is infused over about 30 minutes, with OPDIVO® given first.

Conditions treated by this therapy

The OPDIVO® and YERVOY® combination is FDA-approved for the treatment of several advanced solid tumors, used on its own or alongside chemotherapy. Your care team may consider this therapy if you have:

Unresectable or metastatic melanoma, in adults and children 12 years and older
Metastatic non-small cell lung cancer (NSCLC) with PD-L1-positive tumors and no EGFR or ALK abnormality, as a first treatment
Metastatic or recurrent NSCLC without an EGFR or ALK abnormality, given with two cycles of platinum-doublet chemotherapy as a first treatment
Unresectable malignant pleural mesothelioma, as a first treatment
Advanced renal cell carcinoma (kidney cancer), as a first treatment in adults with intermediate or poor risk disease
Microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) unresectable or metastatic colorectal cancer, in adults and children 12 years and older
Hepatocellular carcinoma (liver cancer) that cannot be removed by surgery or has spread, as a first treatment or after prior sorafenib
Unresectable advanced, recurrent, or metastatic esophageal squamous cell carcinoma with PD-L1-positive tumors, as a first treatment

Your oncologist will confirm which indication applies to your diagnosis, including any required biomarker testing such as PD-L1 expression or MSI-H/dMMR status, and will decide whether the combination or single-agent OPDIVO® is the better fit. Melanoma and MSI-H/dMMR colorectal cancer include patients 12 years and older; the remaining indications are approved for adults only.

OPDIVO® + YERVOY® Price

The cost of prescription medications can vary depending on your insurance coverage. If you're concerned about the price of your medication:

Contact your insurance provider to understand your coverage
Ask your doctor or pharmacist about lower-cost alternatives
Check with the drug manufacturer about financial assistance programs
Explore patient assistance options if you're uninsured or underinsured

Remember, many resources exist to help patients access necessary medications. Don't hesitate to ask for help if you're struggling with medication costs. No patient should go without necessary treatment due to financial limitations. If you have questions about financial assistance opportunities, contact a member of our Violet Health team.

What to Expect During OPDIVO® + YERVOY® Infusion Therapy

When you arrive at our Violet Health location, you'll settle into a private, welcoming space designed with your comfort and peace of mind in mind. Before and during your intravenous infusions, our experienced team will:

Review your current health status and any symptoms you've noticed
Check your vital signs and review recent lab work, including liver enzymes, kidney function, thyroid function, and blood glucose, before treatment begins
Place your IV using gentle, practiced technique
Administer your OPDIVO® infusion first, over about 30 minutes, through a line with an in-line filter
Flush the line, then administer your YERVOY® infusion over about 30 minutes on the same day
Sequence any chemotherapy that is part of your regimen after both immunotherapy infusions are complete
Monitor you closely for any infusion-related reactions
Protect your privacy and comfort throughout the visit

Plan for a longer visit on combination days than you would need for a single infusion, since two medications and the monitoring that follows both add time. For melanoma, kidney cancer, colorectal cancer, and liver cancer, the combination phase is usually four doses given every three weeks, after which you continue on OPDIVO® alone and your visits become shorter. For lung cancer, mesothelioma, and esophageal cancer, the two drugs continue on separate schedules, so some visits will include both medications and others will include only OPDIVO®. Because the combination places more demand on your immune system, we monitor you especially closely during the first several months.

OPDIVO® + YERVOY® Side Effects

As with any medication, OPDIVO® and YERVOY® may cause side effects. Side effects are more frequent and often more severe with the combination than with either medication on its own, so being informed helps you know what to watch for and when to contact your healthcare team. Common Side Effects:

Fatigue or weakness
Diarrhea
Rash and itching
Fever (pyrexia)
Nausea and vomiting
Muscle, joint, and bone pain
Decreased appetite and weight loss
Cough and shortness of breath
Abdominal pain and constipation
Underactive or overactive thyroid (hypothyroidism or hyperthyroidism)
Headache and dizziness
Upper respiratory tract infection
Changes in blood test results, including liver enzymes, kidney function, blood counts, blood sugar, and electrolytes

In clinical trials, fatigue, diarrhea, rash, nausea, and fever were the standouts for patients receiving both medications, and side effects led to treatment being paused or stopped more often than with either drug alone. Your care team may hold one or both medications while a reaction is treated, and when OPDIVO® is withheld or discontinued, YERVOY® is withheld or discontinued as well.

OPDIVO® and YERVOY® can cause your immune system to attack healthy organs and tissues. These immune-mediated reactions can become severe or life-threatening, can affect more than one organ at a time, and may occur during treatment or after it has ended. They occur more often and tend to appear earlier with the combination than with either medication alone. Please alert our clinical staff or seek medical attention immediately if you experience any of the following:

Intestinal inflammation (colitis), including diarrhea, stool changes, severe abdominal pain, or blood or mucus in the stool
Lung inflammation (pneumonitis), including new or worsening cough, chest pain, or shortness of breath
Liver problems (hepatitis), including yellowing of the skin or eyes, dark urine, severe nausea, bruising or bleeding more easily, or pain on the right side of the abdomen
Hormone gland problems affecting the thyroid, adrenal glands, or pituitary, including headaches, extreme tiredness, weight changes, increased hunger or thirst, dizziness or fainting, constipation, hair loss, mood changes, or feeling cold
New-onset type 1 diabetes, including increased thirst, frequent urination, or diabetic ketoacidosis
Kidney problems (nephritis), including changes in the amount or color of your urine, blood in the urine, or swelling in the ankles
Serious skin reactions, including rash, blistering or peeling skin, painful sores or ulcers in the mouth, nose, throat, or genital area, fever or flu-like symptoms, and swollen lymph nodes
Nervous system problems, including brain inflammation (encephalitis), confusion, severe muscle weakness, or numbness and tingling
Heart problems (myocarditis), including irregular or rapid heartbeat, chest pain, or unusual shortness of breath
Eye problems, including eye redness, pain, or vision changes
Infusion reactions, including chills or shaking, itching or rash, flushing, wheezing, shortness of breath, dizziness, feeling faint, fever, and back or neck pain

Before treatment, tell your care team if you have an immune system condition such as Crohn's disease, ulcerative colitis, or lupus, if you have had or plan to have an organ or donor stem cell transplant, if you have received radiation to your chest, or if you take medicines that suppress your immune system. Fatal and other serious complications have occurred in patients who received an allogeneic stem cell transplant before or after PD-1 blocking therapy, and organ transplant rejection has been reported.

Multiple myeloma warning: This combination is not approved for multiple myeloma. In clinical trials, adding a PD-1 blocking antibody to a thalidomide analogue and dexamethasone increased the risk of death.

Pregnancy warning: OPDIVO® and YERVOY® may harm an unborn baby. Tell your care team if you are pregnant or plan to become pregnant. Use effective birth control during treatment and for five months after your last dose, and do not breastfeed during treatment or for five months after your last dose.

Patient Forms

Before you attend your first appointment at Violet Health, please make sure to review the documents below. Please contact us if you have any questions!