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.

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.

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.

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.

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.

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!