Low-Dose Nivolumab in Various Cancers: A Real-World Exploratory Analysis in Resource-Constrained Settings.
- 1Department of Clinical Oncology, Kathmandu Cancer Center, Bhaktapur, Nepal.
- 2Department of Research and Academics, Kathmandu Cancer Center, Bhaktapur, Nepal.
- 3Department of Medical Oncology, Kathmandu Cancer Center, Bhaktapur, Nepal.
Abstract
Background
Immune checkpoint inhibitors (ICIs), including nivolumab, have significantly improved cancer care. However, due to high costs, there is a significant financial barrier to their widespread access. Emerging evidence shows biological plausibility as well as efficacy of low-dose nivolumab across different cancers.Aims
This exploratory study aims to investigate the clinical outcomes of low-dose nivolumab in cancer treatment to explore the potential to improve its access by reducing costs, especially in resource-limited settings.Methods and results
Data on patients with various malignancies treated with fixed 20 or 40 mg of nivolumab every 3 weeks were retrospectively analyzed. Response to the treatment, including the best objective response rate, best disease control rate, and adverse events, was reported. The Kaplan-Meier method was used to determine progression-free survival and overall survival. The patient cohort of 31 patients with various tumors received a median of 9 cycles (range, 2-20) of low-dose nivolumab therapy for 5.7 months (range, 0.7-17.1). Median follow-up was 8.6 months (95% CI, 7.1-12.9). Disease control was achieved in 21/31 (67.7%) patients, with the best objective response rate of 51.6%. The median progression-free survival was 8.8 months (95% CI, 6.6-not reached) and overall survival was 14.8 months (95% CI, 11.1-not reached). At the end of the study period, 3/31 patients had a radiologic complete response, 9/31 had a partial response, 4/31 had stable disease, and 6/31 had progressive disease, and 3/31 were not evaluable; 6 patients died during this period. The responses achieved were sustainable for a median of 4 months (range, 0.8-8.2). Only 5 patients developed adverse events of grade 2 or 3.Conclusions
Low-dose nivolumab shows preliminary efficacy in resource-constrained settings. Further research should explore optimal dosing and scheduling for low-dose immunotherapy and evaluate its efficacy and safety through larger, homogeneous studies.
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BibTeX
@article{pandit2026lowdose,
title = {{Low-Dose Nivolumab in Various Cancers: A Real-World Exploratory Analysis in Resource-Constrained Settings.}},
author = {Subhas Pandit and Simit Sapkota and Abish Adhikari and Jeebana Bhandari and Sunil Shrestha and Rajani Jha and Gerim Prasai and Anjani Kr Jha},
journal = {Cancer reports (Hoboken, N.J.)},
year = {2026},
month = oct,
doi = {10.1002/cnr2.70713},
url = {https://europepmc.org/article/MED/42897090},
note = {CC BY},
}
RIS
TY - JOUR
TI - Low-Dose Nivolumab in Various Cancers: A Real-World Exploratory Analysis in Resource-Constrained Settings.
AU - Subhas Pandit
AU - Simit Sapkota
AU - Abish Adhikari
AU - Jeebana Bhandari
AU - Sunil Shrestha
AU - Rajani Jha
AU - Gerim Prasai
AU - Anjani Kr Jha
PY - 2026
DA - 2026/10/01
JO - Cancer reports (Hoboken, N.J.)
DO - 10.1002/cnr2.70713
UR - https://europepmc.org/article/MED/42897090
AB - Background Immune checkpoint inhibitors (ICIs), including nivolumab, have significantly improved cancer care. However, due to high costs, there is a significant financial barrier to their widespread access. Emerging evidence shows biological plausibility as well as efficacy of low-dose nivolumab across different cancers.Aims This exploratory study aims to investigate the clinical outcomes of low-dose nivolumab in cancer treatment to explore the potential to improve its access by reducing costs, especially in resource-limited settings.Methods and results Data on patients with various malignancies treated with fixed 20 or 40 mg of nivolumab every 3 weeks were retrospectively analyzed. Response to the treatment, including the best objective response rate, best disease control rate, and adverse events, was reported. The Kaplan-Meier method was used to determine progression-free survival and overall survival. The patient cohort of 31 patients with various tumors received a median of 9 cycles (range, 2-20) of low-dose nivolumab therapy for 5.7 months (range, 0.7-17.1). Median follow-up was 8.6 months (95% CI, 7.1-12.9). Disease control was achieved in 21/31 (67.7%) patients, with the best objective response rate of 51.6%. The median progression-free survival was 8.8 months (95% CI, 6.6-not reached) and overall survival was 14.8 months (95% CI, 11.1-not reached). At the end of the study period, 3/31 patients had a radiologic complete response, 9/31 had a partial response, 4/31 had stable disease, and 6/31 had progressive disease, and 3/31 were not evaluable; 6 patients died during this period. The responses achieved were sustainable for a median of 4 months (range, 0.8-8.2). Only 5 patients developed adverse events of grade 2 or 3.Conclusions Low-dose nivolumab shows preliminary efficacy in resource-constrained settings. Further research should explore optimal dosing and scheduling for low-dose immunotherapy and evaluate its efficacy and safety through larger, homogeneous studies.
SN - 2573-8348
ER -