Opdualag is a fixed-dose combination medication consisting of nivolumab and relatlimab-rmbw. It is indicated for the treatment of patients aged 12 years and older with unresectable or metastatic melanoma. As an immune checkpoint inhibitor, it enhances the anti-tumor immune response by targeting the PD-1 and LAG-3 pathways.
What Are the Side Effects of Opdualag?
Systemic Reactions
Musculoskeletal pain: Incidence rate of 45%, with 4.2% being Grade 3–4.
Fatigue: Incidence rate of 39%, with 2% being Grade 3–4.
Skin-Related Reactions
Rash: Incidence rate of 28%, with 1.4% being Grade 3–4.
Pruritus (itching): Incidence rate of 25%.
Gastrointestinal Reactions
Diarrhea: Incidence rate of 24%, with 2% being Grade 3–4.
Nausea: Incidence rate of 17%, with 0.6% being Grade 3–4.
Abnormal Laboratory Findings (Incidence ≥ 20%)
Decreased hemoglobin: 37% (2.7% being Grade 3–4).
Lymphopenia (decreased lymphocytes): 32% (2.5% being Grade 3–4).
Increased AST: 30% (2.3% being Grade 3–4).
Increased ALT: 26% (3.2% being Grade 3–4).
Decreased serum sodium: 24% (1.2% being Grade 3–4).
Serious Side Effects of Opdualag That Require Vigilance
Immune-Mediated Pneumonitis
Incidence rate of 3.7%.
Symptoms: New or worsening cough, chest pain, shortness of breath.
Management: Temporarily hold or permanently discontinue the medication based on severity.
Immune-Mediated Colitis
Incidence rate of 7%.
Symptoms: Diarrhea, black/tarry stools/bloody stools, severe abdominal pain.
Management: Corticosteroid treatment may be required.
Immune-Mediated Hepatitis
Incidence rate of 6%.
Symptoms: Jaundice (yellowing of skin/eyes), severe nausea and vomiting, right upper abdominal pain.
Monitoring: Regular liver function tests.
Immune-Mediated Endocrine Disorders
Adrenal insufficiency: 4.2%.
Thyroid disorders: Thyroiditis (2.8%), hyperthyroidism (6%), hypothyroidism (17%).
Hypophysitis: 2.5% (9 out of 355 patients).
Type 1 diabetes mellitus: 0.3% (1 out of 355 patients).
Precautions for Opdualag Administration
Contraindicated Populations
Patients allergic to any component of this medication.
Pregnant women (may cause fetal harm).
Lactating women (breastfeeding should be avoided for at least 5 months after discontinuing the medication).
Important Monitoring Requirements
Liver function (AST/ALT).
Renal function (creatinine).
Thyroid function.
Blood glucose levels.
Electrolytes (especially serum sodium).
Key Patient Education Points
Recognize the early symptoms of serious side effects and report them promptly.
Maintain adequate fluid intake during treatment.
Pay attention to personal hygiene to prevent infections.
Women of childbearing age should use effective contraceptive measures (during treatment and for at least 5 months after discontinuing the medication).
