Opdivo (Nivolumab) vs Xalkori (crizotinib)

Opdivo (nivolumab) is an immune checkpoint inhibitor that works by blocking the PD-1 protein on T cells, enhancing the immune system's ability to attack cancer cells, and is typically used for a variety of cancers including melanoma, lung cancer, and kidney cancer. Xalkori (crizotinib) is a targeted therapy that specifically inhibits the anaplastic lymphoma kinase (ALK) and ROS1 receptors in non-small cell lung cancer (NSCLC) cells with these specific genetic alterations, leading to tumor shrinkage. The choice between Opdivo and Xalkori would largely depend on the specific genetic characteristics of the patient's cancer, as Xalkori is only effective in cancers with ALK or ROS1 mutations, while Opdivo has a broader range of indications but requires a functioning immune system to be effective.

Difference between Opdivo and Xalkori

Metric	Opdivo (Nivolumab)	Xalkori (crizotinib)
Generic name	Nivolumab	Crizotinib
Indications	Various types of cancers including melanoma, lung cancer, renal cell carcinoma, Hodgkin lymphoma, and others	Non-small cell lung cancer (NSCLC), ROS1-positive NSCLC, and ALK-positive metastatic NSCLC
Mechanism of action	Programmed death receptor-1 (PD-1) blocking antibody	Anaplastic lymphoma kinase (ALK) and ROS1 inhibitor
Brand names	Opdivo	Xalkori
Administrative route	Intravenous infusion	Oral
Side effects	Fatigue, rash, musculoskeletal pain, pruritus, diarrhea, nausea, and others	Visual disorders, gastrointestinal effects, edema, elevated transaminases, and others
Contraindications	Severe hypersensitivity to nivolumab or any of its excipients	Hepatic impairment, concomitant use with strong CYP3A inhibitors or inducers
Drug class	Immune checkpoint inhibitor	Tyrosine kinase inhibitor
Manufacturer	Bristol Myers Squibb	Pfizer

Efficacy

Overview of Opdivo (Nivolumab) in Lung Cancer Treatment

Opdivo, also known as Nivolumab, is an immunotherapy drug that has been approved for the treatment of certain types of lung cancer, including non-small cell lung cancer (NSCLC) after prior chemotherapy, and as a first-line treatment when combined with other therapies. It is a programmed death-1 (PD-1) inhibitor that works by enhancing the body's immune response against cancer cells. Clinical trials have demonstrated that Opdivo can significantly improve overall survival in patients with advanced NSCLC compared to chemotherapy alone. The efficacy of Opdivo has been observed in various subtypes of NSCLC, including those with high PD-L1 expression, where it has shown a greater benefit.

Xalkori (Crizotinib) and its Role in Lung Cancer

Xalkori, known generically as crizotinib, is a targeted therapy specifically indicated for the treatment of NSCLC patients whose tumors are anaplastic lymphoma kinase (ALK)-positive, as detected by an FDA-approved test. Crizotinib is a tyrosine kinase inhibitor that blocks the activity of the ALK protein, which can promote the growth of cancer cells. In clinical studies, Xalkori has been shown to be effective in shrinking tumors and prolonging progression-free survival in patients with ALK-positive NSCLC. The response rates to crizotinib in these patients are significantly higher compared to standard chemotherapy regimens.

Comparative Efficacy in Lung Cancer Management

When comparing the efficacy of Opdivo and Xalkori, it is important to consider the specific patient populations for which these drugs are indicated. Opdivo is used more broadly in NSCLC patients, including those with squamous and non-squamous histologies, and its efficacy is not dependent on the presence of specific genetic mutations. On the other hand, Xalkori is tailored for a subset of NSCLC patients with ALK rearrangements, a smaller but well-defined group. Both medications have altered the landscape of lung cancer treatment, offering improved outcomes for patients with advanced disease.

Considerations for Optimal Use in Clinical Practice

In clinical practice, the choice between Opdivo and Xalkori for lung cancer treatment is guided by tumor histology and genetic testing. For patients with ALK-positive NSCLC, Xalkori is a preferred first-line treatment option. For those without ALK rearrangements, Opdivo may be considered, especially after other treatments have failed. It is essential for healthcare providers to conduct appropriate biomarker testing to identify suitable candidates for each therapy, ensuring the most effective treatment plan is selected for each patient with lung 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)

Xalkori

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

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