Opdivo (Nivolumab) vs Xeloda ()

Opdivo (nivolumab) is an immunotherapy drug that works by blocking the PD-1 pathway, which enhances the body's immune response against cancer cells, and is commonly used for various types of cancers including melanoma, lung cancer, and kidney cancer. Xeloda (capecitabine) is a chemotherapy medication that is converted into 5-fluorouracil (5-FU) in the body, which interferes with DNA production and kills rapidly dividing cancer cells; it is often used for treating breast and colorectal cancers. The choice between Opdivo and Xeloda would depend on the specific type of cancer, its stage, the patient's overall health, and previous treatments, as these medications have different mechanisms of action and side effect profiles.

Difference between Opdivo and Xeloda

Metric	Opdivo (Nivolumab)	Xeloda ()
Generic name	Nivolumab	Capecitabine
Indications	Various types of cancers including melanoma, lung cancer, kidney cancer, bladder cancer, head and neck cancers, and others.	Metastatic colorectal cancer, metastatic breast cancer, and adjuvant treatment of colon cancer.
Mechanism of action	Programmed death receptor-1 (PD-1) blocking antibody, which helps the immune system attack cancer cells.	Prodrug that is enzymatically converted to 5-fluorouracil (5-FU) in the body, which is a cytotoxic agent that interferes with DNA synthesis.
Brand names	Opdivo	Xeloda
Administrative route	Intravenous infusion	Oral
Side effects	Fatigue, rash, musculoskeletal pain, pruritus, diarrhea, nausea, and others.	Hand-foot syndrome, diarrhea, nausea, vomiting, fatigue, and others.
Contraindications	Known hypersensitivity to nivolumab or any of its excipients.	Known hypersensitivity to capecitabine or any of its components, and in patients with severe renal impairment.
Drug class	Immune checkpoint inhibitor, monoclonal antibody	Antimetabolite, fluoropyrimidine
Manufacturer	Bristol-Myers Squibb	Roche

Efficacy

Overview of Opdivo (Nivolumab) in Colorectal Cancer Treatment

Opdivo, known generically as Nivolumab, is a type of immunotherapy that has shown efficacy in the treatment of certain types of colorectal cancer. It is a programmed death-1 (PD-1) immune checkpoint inhibitor that works by blocking the PD-1 pathway, thereby enhancing the immune system's ability to detect and fight cancer cells. Opdivo has been particularly effective in colorectal cancer patients with high microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR), conditions that affect the DNA repair process within cells and are present in a subset of colorectal cancers.

Efficacy of Opdivo in MSI-H/dMMR Colorectal Cancer

Studies have demonstrated that patients with MSI-H/dMMR metastatic colorectal cancer who have been treated with Opdivo show a significant improvement in overall response rate (ORR) and progression-free survival (PFS) compared to conventional chemotherapies. The efficacy of Opdivo in this patient population is noteworthy because these patients historically have a poor prognosis and limited treatment options. The use of Opdivo for MSI-H/dMMR colorectal cancer represents a shift towards personalized medicine, where the treatment is tailored based on specific genetic features of the cancer.

Xeloda (Capecitabine) in Colorectal Cancer Management

Xeloda, or Capecitabine, is an oral chemotherapy medication that is converted into 5-fluorouracil (5-FU) in the body, which then interferes with the DNA synthesis of cancer cells, leading to cell death. Xeloda is commonly used in the treatment of colorectal cancer, both in the adjuvant setting (after surgery to remove the primary tumor) and in metastatic cases. It has been shown to be effective as a single agent and in combination with other drugs, and its oral administration makes it a convenient option for patients.

Combination Therapy with Opdivo and Xeloda in Colorectal Cancer

There is growing interest in exploring the efficacy of combination therapies involving both immunotherapy agents like Opdivo and traditional chemotherapies like Xeloda. While the combination of these two drugs is not a standard treatment for colorectal cancer, clinical trials are underway to determine the potential benefits of such regimens. The rationale behind combining immunotherapy with chemotherapy is to potentially enhance the immune response against cancer cells while directly targeting them with cytotoxic agents. However, the efficacy and safety of such combinations need to be established through rigorous clinical trials before they can be recommended as a standard treatment approach for colorectal cancer.

Regulatory Agency Approvals

Opdivo

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA
Health Canada
Pharmaceuticals and Medical Devices Agency (PMDA), Japan
Therapeutic Goods Administration (TGA), Australia
Medsafe (NZ)

Xeloda

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA

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