Infusion times

[Anonymous]

Hi all,

I’m curious what everyone is using for infusion times for Ipi and/or Nivo these days. There is some controversy surrounding this at my institution at this time and I know the shorter infusion times are not approved across all tumor types either.
Thanks in advance!
Lisa

[Anonymous]

This is a very timely question. As a consequence of the release of the practice changing adjuvant therapy data surrounding nivolumab, the volume in our practice has dramatically increased in the past few months. This in turn leads to a busier infusion/treatment center.

We have been administering ipi over 30 minutes (the 3mg/kg dose) for over a year. We have not seen any increase in infusion reactions.

We have NOT yet switched to nivo over 30 minutes, however, we are hoping to do so very soon. This is based on a fair amount of published literature demonstrating safety for both ipi + nivo over 30 minutes. I do believe 30 minutes will soon be the “standard” for both ipi + nivo very very soon.

Would love to hear what others are doing in their practices.

[Anonymous]

I agree with Krista that we have seen a big increase in volume with nivolumab now being used in the adjuvant setting. We still give ipilimumab over 90 minutes, nivolumab over 60 minutes and pembrolizumab over 30 minutes. It sounds like we are behind with adjusting infusion times, but I will talk with our pharmacy about adjusting them. Thanks for the tip!

[Anonymous]

We are still administering ipilimumab over 90 min and nivolumab over 60 min. However, I believe that we are in the process of changing the infusion time for nivolumab to 30 minutes across the institution.

[Mandi Murph]

Ipi 3mg/kg is still approved for 90 min infusion, however, the FDA just recently approved the nivo in the metastatic setting to be admin over 30 min.

Is anyone using flip dose ipi/nivo?

[Anonymous]

Hi Kathy,

Currently we are not using flip dose Ipi/Nivo (“ipi lite” as we like to refer to it) off clinical trial. Thank you all for the responses, we are still working on infusion times here and this is very helpful.

[Samantha Guild]

The flipped dose clinical trials allow for the Ipillimumab 1mg/kg to be given over 60 min. We have started to do more flipped dozing of Nivolumab 3mg/kg and Ipi 1mg/kg which we are seeing less toxicity with but what appears to be the same response rates to the FDA approved dosing.

[Anonymous]

We have not incorporated the ipi/nivo flipped doses outside of a clinical trial. We are infusion nivo over 30 min as a single agent. There is some controversy and back and forth continuing with our pharmacy and the approved indications for the 30 min infusion time.

[Anonymous]

Can you please comment the study that led to the label change for nivolumab monotherapy for metastatic/unresectable from 60 to 30 minutes infusion time? Do you think the label will also change for the adjuvant setting (Which is currently still 60 minutes)?

[Samantha Guild]

Currently Nivolumab is approved for 30 min infusion for all melanoma metastic indications as single agent or in combination with Ipilimumab. However, the adjuvant Nivolumab was approved after the 30 min Nivolumab had been submitted to the FDA. Therefore for adjuvant Nivolumab the label states that it should be given over 60 min. There should be an update to the label soon, and adjuvant Nivolumab will be approved for 30 min infusion. There are several studies to support it’s safety in infusing it over 30 min.

[Anonymous]

Update: We just got an email here yesterday that all non-investigational infusion times for nivolumab will be going to the 30 minute infusions.

[Anonymous]

As of this week, we will be doing what Lisa is doing as well: all nivo over 30 minutes.
We have been administering ipi over 30 minutes for the past couple of years and will continue to do so with ipi + nivo combinations.

[Anonymous]

We are finally making this change in infusion time for nivo. How do you think the new 4-week nivolumab dosing will impact treatment choice for anti-PD-1 inhibitors? This will certainly help decrease the high volume somewhat in our infusion center.

[Anonymous]

I think it will certainly decrease volumes in the clinic. I also think that it could impact which treatment providers choose – pembrolizumab vs. nivolumab. I know that certain providers chose pembro based on the fact that dosing is less frequent while others who like to see patients more frequently chose nivo. I do know that my nivo patients will be thrilled with the once monthly dosing!

[Mandi Murph]

NEW DOSING OF OPDIVO APPROVED 3/6/18
Opdivo (nivolumab) PI was updated for melanoma to reflect

UNRESECTABLE OR METASTATIC:

-Opdivo 240mg q 2 weeks or 480mg q 4 weeks
– Yervoy+ Opdivo 1mg/kg q 3 weeks x 4 infusions, followed by either 240mg q 2w or 480mg q 4w- maintenance

ADJUVANT:

-240mg q 2 w or 480mg q 4

INFUSION TIMES:
all are approved for Opdivo over 30min

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