Opdivo (Nivolumab) vs Enhertu (fam-trastuzumab deruxtecan-nxki)

Opdivo (nivolumab) is an immune checkpoint inhibitor that works by blocking the PD-1 protein on immune cells, thereby enhancing the body's immune response against cancer cells. Enhertu (fam-trastuzumab deruxtecan-nxki) is an antibody-drug conjugate that combines an antibody targeting HER2, a protein overexpressed in some cancers, with a cytotoxic agent, delivering targeted chemotherapy to cancer cells. The choice between Opdivo and Enhertu would depend on the type and characteristics of the cancer; for instance, Opdivo is commonly used in melanoma, non-small cell lung cancer, and kidney cancer, while Enhertu is approved for use in HER2-positive breast cancer and could be considered in other HER2-expressing tumors.

Difference between Opdivo and Enhertu

Metric	Opdivo (Nivolumab)	Enhertu (fam-trastuzumab deruxtecan-nxki)
Generic name	Nivolumab	Fam-trastuzumab deruxtecan-nxki
Indications	Various types of cancers including melanoma, lung cancer, kidney cancer, bladder cancer, head and neck cancer, and others	HER2-positive breast cancer, HER2-positive gastric or gastroesophageal junction adenocarcinoma
Mechanism of action	PD-1 immune checkpoint inhibitor that promotes T-cell response against cancer cells	Antibody-drug conjugate targeting HER2 receptors on cancer cells and delivering cytotoxic chemotherapy
Brand names	Opdivo	Enhertu
Administrative route	Intravenous infusion	Intravenous infusion
Side effects	Fatigue, rash, musculoskeletal pain, pruritus, diarrhea, nausea, and others	Nausea, fatigue, vomiting, alopecia, constipation, decreased appetite, anemia, and others
Contraindications	Known hypersensitivity to nivolumab or any of its excipients	Known hypersensitivity to trastuzumab, deruxtecan, or any of its excipients
Drug class	Monoclonal antibody, Immune checkpoint inhibitor	Antibody-drug conjugate
Manufacturer	Bristol Myers Squibb	Daiichi Sankyo and AstraZeneca

Efficacy

Efficacy of Opdivo (Nivolumab) in Lung Cancer

Opdivo (Nivolumab) is a programmed death-1 (PD-1) immune checkpoint inhibitor that has shown significant efficacy in the treatment of lung cancer, specifically non-small cell lung cancer (NSCLC). Clinical trials have demonstrated that Opdivo can improve overall survival in patients with advanced NSCLC compared to traditional chemotherapy. In particular, the CheckMate-057 trial showed that Opdivo improved the median overall survival for patients with advanced, non-squamous NSCLC who had progressed during or after platinum-based chemotherapy. Furthermore, Opdivo has been associated with a durable response rate, meaning that some patients experience long-term control of their disease.

Opdivo's efficacy varies based on several factors, including the expression of the PD-L1 protein on tumor cells and prior treatments received by the patient. For instance, patients with higher PD-L1 expression may experience better outcomes with Opdivo. Additionally, Opdivo has been approved for use as a first-line treatment in combination with other agents, providing an option for patients with metastatic NSCLC without EGFR or ALK genomic tumor aberrations.

Efficacy of Enhertu (fam-trastuzumab deruxtecan-nxki) in Lung Cancer

Enhertu (fam-trastuzumab deruxtecan-nxki) is an antibody-drug conjugate that targets HER2, a protein overexpressed in a subset of NSCLC tumors. The efficacy of Enhertu in lung cancer has been evaluated in patients with HER2-mutant unresectable and/or metastatic NSCLC who have received prior systemic therapy. Clinical trials, such as the DESTINY-Lung01 trial, have shown promising results, with a notable objective response rate and median progression-free survival in this patient population. The responses observed with Enhertu have been both deep and durable, indicating a significant clinical benefit for patients with HER2-mutant NSCLC.

Enhertu's efficacy in lung cancer highlights the importance of molecular profiling in NSCLC to identify patients who may benefit from targeted therapies. As HER2 mutations are present in a small percentage of NSCLC cases, Enhertu provides a tailored treatment option for this group of patients. The development and approval of Enhertu for HER2-mutant NSCLC represent a step forward in personalized medicine, offering a new line of therapy for patients who have historically had limited treatment options.

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)

Enhertu

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA
Pharmaceuticals and Medical Devices Agency (PMDA), Japan

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