Background Nivolumab is a human monoclonal antibody used in the pneumology unit to treat patients with metastatic non-small cell lung cancer (NSCLC) with progression on, or after, platinum-based chemotherapy. Nivolumab is administered intravenously at a dose of 3 mg/kg every 2 weeks or at a dose of 240 mg (dose based on the median body weight of 80 kg in patients in American clinical trials).
Purpose In order to meet the increasing demand for chemotherapy in our hospital we consider introducing a system of standardised dose-banding.
Material and methods In making an assessment of nivolumab prescriptions and of the patient characteristics who received nivolumab in 2016, we analysed the medical records on our chemotherapy software Asclepios®.
Results In 2016, our centralised reconstitution unit had prepared 472 nivolumab doses. Bodyweights of ours patients were clustered: 43 to 114 kg, with a median of 72 kg. The use of banded doses to give doses within 10% of the prescribed dose was considered acceptable practice by our prescribers. Therefore a standard dose of 240 mg could be administered to patients between 74 and 88 kg and a standard dose of 198 mg could be administered to patients between 60 and 73 kg. In view of our patients’ bodyweights in 2016, 40% of the prepared nivolumab could have been matched with the 240 mg standard dose and 36% with the 200 mg (rounded value of 198 mg) standard dose. Following this analysis, a meeting between the pneumology unit and the pharmacy allowed the creation of two nivolumab protocols: 200 mg (for weights≤73 kg) and 240 mg (for weights>73 kg).
Conclusion Dose-banding of nivolumab is effective since May 2017. Previous protocols were replaced by the two new protocols. This standardisation permits a reduction in waiting times for patients (nivolumab doses were prepared the day before) and reduces the waste when treatments are deferred (due to ability to re-asign the preparations).
References and/or Acknowledgements Vidal, Asclepios, medical records.
No conflict of interest
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