Opinion: Subcutaneous Nivolumab Offers an Effective Alternative to Intravenous Administration

Amanda Brink, DNP, APRN, FNP-BC, AOCNP

The landscape of cancer treatment is always evolving. While we often focus on the introduction of new drugs, changes in how existing, approved treatments are delivered can be equally noteworthy. For oncology nurses, shifts in drug administration methods present opportunities to enhance patient care but also bring challenges requiring careful consideration and adaptation. As subcutaneous delivery methods for cancer drugs become more widespread, it is essential for nurses to understand the implications of these changes and their potential to improve patient experiences and outcomes.

Subcutaneous drug delivery involves injecting medication into the tissue layer just beneath the skin, where it is gradually absorbed into the bloodstream. Unlike intravenous administration, which requires direct access to a vein, subcutaneous delivery is less invasive and often more convenient for patients and healthcare providers.

Subcutaneous Delivery of Nivolumab Compared to Intravenous

Albiges et al. recently published results from the CheckMate 67T trial in the Annals of Oncology, demonstrating the effectiveness of subcutaneous administration of nivolumab (Opdivo) compared to the traditional intravenous route in patients with advanced or metastatic clear-cell renal cell carcinoma (ccRCC). This phase 3 trial enrolled 495 patients, randomly assigning them to receive either subcutaneous nivolumab, delivered at a fixed dose of 1200 mg every 4 weeks, or intravenous nivolumab at 3 mg/kg every 2 weeks. The study aimed to determine whether subcutaneous administration could match intravenous delivery in terms of pharmacokinetics, efficacy, and safety, while potentially improving healthcare efficiency and patient convenience.

The trial's findings confirmed that subcutaneous nivolumab achieves noninferior pharmacokinetics compared to intravenous administration. This was evidenced by therapeutic drug levels delivered effectively with subcutaneous dosing.

Furthermore, the objective response rate was 24.2% for subcutaneous nivolumab vs 18.2% for intravenous at 8 months, establishing therapeutic equivalence. Additional measures, including progression-free survival, disease control rate, and overall survival, were comparable between the 2 groups. These findings highlight that subcutaneous administration maintains the effectiveness of nivolumab in treating ccRCC.

Safety outcomes were also favorable. The subcutaneous formulation had fewer grade 3/4 adverse events (40.1% vs 46.5% in the intravenous group), and injection-site reactions were mild and resolved quickly without intervention. Importantly, subcutaneous administration reduced the need for central venous port access, which is associated with risks such as infection, thrombosis, and complications from long-term use.

Perhaps the most practical advantage was the significantly reduced administration time. Subcutaneous delivery took less than 5 minutes, compared to the 30 minutes typically required for intravenous infusions.

Nursing Considerations

The introduction of subcutaneous nivolumab creates opportunities for oncology nurses to improve patient care and streamline workflows. By educating patients about the differences between subcutaneous and intravenous administration, including potential side effects and reduced time in the infusion center, nurses can help patients make informed decisions. Proper injection techniques and monitoring for local site reactions are essential for safe administration. Shorter treatment times also allow for more personalized care and may support home-based treatment, reducing the overall burden on patients.

The CheckMate 67T trial demonstrates that subcutaneous nivolumab is a safe, effective, and efficient alternative to intravenous administration. For oncology nurses, this innovation offers the chance to enhance patient outcomes, reduce port-related complications, and adapt care delivery to better meet the needs of more patients.

Reference

Albiges L, Bourlon MT, Chacón M, et al. Subcutaneous versus intravenous nivolumab for renal cell carcinoma. Ann Oncol. 2025;36(1):99-107. doi:10.1016/j.annonc.2024.09.002