Opdualag® (nivolumab and relatlimab-rmbw)

The medication helps your body's immune system attack cancer cells. However, as your immune system attacks cancer cells, it can also affect normal organs and tissues. This can cause serious or life-threatening problems.  Tell your provider right away if you have any of the following symptoms:

• Autoimmune Complications: Tell your provider about all of your health conditions. They need to know if you have an autoimmune condition like Crohn’s disease, lupus, or rheumatoid arthritis. These conditions can get worse with immunotherapy.
• Gastrointestinal Problems: Gastrointestinal (GI) problems can include colitis (inflammation of the bowel) and diarrhea. Symptoms are abdominal (belly) pain, cramping, mucus or blood in the stool, dark or tar-like stools, and fever.  Diarrhea can be stools that are looser or more frequent than what you are used to.
• Bowel Obstruction or Perforation: Bowel obstruction is a blockage in your intestines. A perforation is a tear in your intestines. Symptoms of an obstruction or a tear are abdominal (belly) pain, fever, constipation, bloating, and cramping. Call your provider if you are not moving your bowels as often as you normally do.
• Skin Reactions: Skin reactions can include rash, with or without itching (pruritis), sores in your mouth, and blistering or peeling skin. Your provider will suggest ways to manage these issues.  
• Hormone Changes: Your pituitary, thyroid, pancreas, and adrenal glands can be affected by this medication. When these glands are inflamed or irritated, they can make too much or too little of a certain hormone. Some hormone levels can be monitored with blood work. Symptoms of hormonal changes may be: headaches, nausea, vomiting, constipation, rapid heart rate, increased sweating, extreme fatigue, weakness, changes in your voice, changes in memory and concentration, increased hunger or thirst, increased urination, weight gain, hair loss, dizziness, feeling cold all the time, and changes in mood or behavior (including irritability, forgetfulness and decreased sex drive).
• Brain and/or Nerve Problems: Symptoms include headaches, drooping of eyelids, double vision, trouble swallowing, weakness in the arms, legs, or face, or numbness or tingling in the hands or feet.
• Eye Problems: Changes in vision (eyesight), blurry or double vision, and eye pain or redness are symptoms of eye problems. 
• Kidney Problems: Kidney problems, like inflammation or not working as well as they should, can cause decreased urine output, blood in the urine, swelling in the ankles, or loss of appetite (not feeling as hungry). 
• Liver Problems: Hepatitis, or inflammation of the liver, can cause yellowing of the skin or eyes,  dark or brown urine, pain in your abdomen (belly), bleeding or bruising more easily than normal, or severe nausea and vomiting.
• Lung Problems: This medication can cause pneumonitis, which is inflammation of the lungs. Symptoms are a new or worsening cough, shortness of breath, trouble breathing, or chest pain.
• Pancreas Problems: Signs can be bloating, indigestion, fatty stools, loss of appetite, sweating, abdominal (belly) pain, and weight loss.

You may have joint or muscle pain:

• Arthralgia pain is like arthritis pain. It can cause morning stiffness, and you may feel it in your joints at different times during the day. It can also cause pain in your elbows, shoulders, wrists, knees, feet, pelvic and hip bones, or back.
• Myalgia is pain or aching in your muscles. 

Your providers can recommend medication and other ways to relieve pain.

Fatigue can cause exhaustion, feeling worn out and that your body is "heavy" and hard to move, or being unable to focus. It is common when you have cancer, and it is not the same as feeling tired. You may need to adjust your schedule to manage fatigue. Plan times to rest during the day and save your energy for more important activities. Exercise can help lessen fatigue. Talk to your providers about ways to deal with this side effect.

Anemia is when your red blood cell count is lower than normal. Red blood cells carry oxygen to the tissues in your body. When your red cell count is low, you may feel tired or weak. Tell your providers if you have shortness of breath, trouble breathing, or pain in your chest. If your count gets too low, you may receive a blood transfusion.

White blood cells (WBC) help your body fight infection. While you are having treatment for cancer, your WBC count can drop, putting you at a higher risk of an infection. Tell your provider right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips for preventing infection:

• Hand washing: both yours and your visitors is the best way to prevent the spread of infection.
• Avoid large crowds and people who are sick (those who have a cold, fever, or cough, or live with someone with these symptoms).
• When working outside, wear clothes that protect you, like long pants and gloves.
• Do not handle pet waste.
• Keep all cuts and scratches clean.
• Shower or bathe daily. 
• Brush your teeth at least twice a day.
• Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Ask your providers before scheduling dental appointments or procedures.
• Ask your providers before you or someone you live with has any vaccines. 

Some people may get a rash, scaly skin, or red, itchy bumps from this medication. Tell your provider if you notice any of these changes in your skin, since it could be a reaction. Your provider may suggest:

• Using an alcohol-free moisturizer on your skin and lips, and do not use moisturizers with perfumes or scents. 
• Keep the area clean to avoid infection, especially if it cracks or bleeds.
• Using a topical medication (applied to the skin) if the itching bothers you.

Be sure to talk with your provider about how to care for your skin.

There is a higher risk of health problems for your baby if you are pregnant, become pregnant, or get someone pregnant while on this medication. To lower the risk of birth defects, you should use birth control (contraception) to avoid pregnancy. Talk with your provider about what kind of birth control is safest for you and your partner.

Some people may have a reaction during infusion of this medication. These can be:

• Chills.
• Fever.
• Low blood pressure.
• Nausea.
• Vomiting.

Your provider will monitor you for symptoms of infusion-related reactions.