Opdivo vs Keytruda

Opdivo and Keytruda are both cancer immunotherapy drugs called PD-1 inhibitors. Opdivo is nivolumab, while Keytruda is pembrolizumab. Neither drug is automatically better. The better option depends on the cancer being treated, FDA-approved use, biomarker results such as PD-L1, MSI-H, or dMMR, prior treatments, combination therapy options, side effect risk, dosing schedule, and insurance coverage.

Medical review note: This article is for educational purposes only and does not replace medical advice from an oncologist. Opdivo and Keytruda are prescription cancer treatments. Treatment choice depends on cancer type, stage, biomarkers, prior treatments, overall health, side effect risks, and insurance coverage.

What are Opdivo and Keytruda?

Opdivo and Keytruda are prescription immunotherapy medicines used to treat several types of cancer. They are not chemotherapy. Chemotherapy directly attacks fast-growing cells. Opdivo and Keytruda work by helping the immune system recognize and attack cancer cells.

Opdivo is the brand name for nivolumab. It is made by Bristol Myers Squibb and is given by IV infusion. The FDA label lists uses across several cancers, including:

• • melanoma,
  • non-small cell lung cancer,
  • renal cell carcinoma,
  • urothelial carcinoma,
  • MSI-H or dMMR colorectal cancer,
  • hepatocellular carcinoma,
  • esophageal cancer,
  • gastric cancer,
  • gastroesophageal junction cancer,
  • and others, depending on stage, biomarkers, and treatment history.

Keytruda is the brand name for pembrolizumab. It is made by Merck and is also given by IV infusion. The FDA label lists uses across many cancers, including:

• • melanoma,
  • non-small cell lung cancer,
  • head and neck squamous cell carcinoma,
  • classical Hodgkin lymphoma,
  • urothelial carcinoma,
  • MSI-H or dMMR cancers,
  • colorectal cancer,
  • gastric and gastroesophageal junction cancer,
  • cervical cancer,
  • hepatocellular carcinoma,
  • biliary tract cancer,
  • Merkel cell carcinoma,
  • renal cell carcinoma,
  • endometrial carcinoma,
  • triple-negative breast cancer,
  • and other settings.

The simplest way to understand nivolumab vs pembrolizumab is this. They are different drugs in the same PD-1 inhibitor class. They share a similar immune target, but they do not have identical approvals, dosing schedules, clinical trial data, or combination regimens.

How Opdivo and Keytruda work

Opdivo and Keytruda are checkpoint inhibitors. More specifically, they are PD-1 inhibitors.

PD-1 is a checkpoint protein found on T cells, which are immune cells. Some cancer cells use checkpoint pathways to reduce the immune system’s ability to attack them. By blocking PD-1, Opdivo and Keytruda may help T cells detect and fight cancer cells.

The American Cancer Society explains that checkpoint inhibitors are monoclonal antibodies that block checkpoint proteins, which act like switches that turn immune responses on or off. These drugs do not kill cancer cells directly. Instead, they help the immune system better find and attack cancer cells.

Why PD-L1 and other biomarkers matter

Cancer treatment decisions often depend on biomarkers. Some people may need tumor testing before they are considered for Opdivo, Keytruda, or a combination regimen.

Important biomarker terms include:

This is one reason a simple “which is better, Opdivo or Keytruda” answer can be misleading. The better question is which option fits the person’s cancer type, biomarkers, stage, prior therapy, and goals.

Approved cancers treated with Opdivo vs Keytruda

Opdivo and Keytruda are both used across many cancer types, but their FDA-approved uses are not identical. Approvals also vary by line of therapy, whether the cancer is resectable or metastatic, biomarker status, and whether the drug is used alone or with another treatment.

Approved cancer types comparison

Note: Because oncology approvals change often, the article should be reviewed against the current FDA labels before publication. The current FDA labels remain the most reliable source for official indications, dosing, and safety language.

Is Keytruda better than Opdivo for lung cancer?

Not automatically. Keytruda is widely used in several non-small cell lung cancer (NSCLC) treatment settings, especially in PD-L1-positive and chemotherapy-combination settings.

Opdivo also has FDA-labeled NSCLC uses, including first-line use with ipilimumab (Yervoy) for metastatic NSCLC with PD-L1 expression of at least 1% and no EGFR or ALK genomic tumor aberrations. It also includes use with ipilimumab and two cycles of platinum-doublet chemotherapy for metastatic or recurrent NSCLC without EGFR or ALK genomic tumor aberrations.

The best option depends on details such as cancer stage, histology, PD-L1 level, EGFR and ALK status, prior treatment, and whether chemotherapy is part of the plan.

In the KEYNOTE-024 trial, pembrolizumab (Keytruda) was compared with platinum-based chemotherapy in previously untreated metastatic NSCLC with PD-L1 tumor proportion score of at least 50% and no EGFR or ALK alterations. Five-year data showed better overall survival with pembrolizumab than chemotherapy in that specific group.

In the CheckMate 227 trial, nivolumab (Opdivo) plus ipilimumab showed long-term benefit compared with chemotherapy in metastatic NSCLC. Six-year reporting showed higher overall survival rates for nivolumab plus ipilimumab than chemotherapy in patients with PD-L1 expression of at least 1% and in patients with PD-L1 expression below 1%.

Opdivo vs Keytruda success rate

There is no single Opdivo vs Keytruda success rate. Success rates are cancer-specific and trial-specific. A result from advanced melanoma cannot be applied to lung cancer, kidney cancer, bladder cancer, or colorectal cancer.

Success rate can mean different things:

• • Overall survival – How long patients live after starting treatment
  • Progression-free survival – How long cancer stays from growing or spreading
  • Objective response rate – Percentage of patients whose tumors shrink by a defined amount
  • Complete response – No detectable cancer by trial criteria
  • Partial response – Tumor shrinkage without complete disappearance
  • Duration of response – How long a response lasts
  • Disease-free survival – Time after treatment without cancer returning
  • Event-free survival – Time without a defined event such as progression, recurrence, or death

Opdivo survival rates

In advanced melanoma, a 10-year follow-up from the CheckMate 067 trial showed overall survival of 71.9 months with nivolumab (Opdivo) plus ipilimumab, 36.9 months with nivolumab, and 19.9 months with ipilimumab.

For metastatic NSCLC, a 6-year follow-up reported survival rates of 22% vs 13% in patients with PD-L1 expression of at least 1%, and 16% vs 5% in patients with PD-L1 expression below 1%, comparing nivolumab plus ipilimumab with chemotherapy.

Keytruda survival rates

Patients with untreated metastatic NSCLC, PD-L1 TPS of at least 50%, and no EGFR or ALK alterations had 5-year overall survival rates of 31.9% with pembrolizumab (Keytruda) and 16.3% with chemotherapy.

In early-stage triple-negative breast cancer, the estimated 5-year overall survival was 86.6% in the pembrolizumab plus chemotherapy group, compared with 81.7% in the placebo plus chemotherapy group.

Opdivo side effects vs Keytruda side effects

Opdivo and Keytruda’s side effects can overlap because both drugs affect immune checkpoints. Some side effects are mild. Others can be serious or life-threatening if the immune system attacks healthy organs.

The American Cancer Society notes that checkpoint inhibitors can cause side effects related to increased immune activity, including inflammation in organs such as the lungs, intestines, liver, hormone glands, kidneys, skin, and other tissues.

Common side effects may include:

• • fatigue
  • rash
  • itching
  • diarrhea
  • nausea
  • cough
  • muscle or joint pain
  • decreased appetite
  • shortness of breath
  • constipation
  • fever
  • abnormal lab results

Serious immune-related side effects

Both drugs can cause immune-related adverse reactions, including:

• • pneumonitis
  • colitis
  • hepatitis
  • thyroiditis, hypophysitis, adrenal insufficiency
  • nephritis
  • severe rash or blistering
  • Type 1 diabetes
  • myocarditis
  • neurologic immune reactions
  • infusion reactions

The FDA labels for both drugs include warnings about immune-mediated adverse reactions, infusion reactions, and the need to withhold or permanently discontinue treatment in certain severe reactions.

When to call your doctor

Call your oncology team right away if you develop:

• • new or worsening shortness of breath
  • chest pain
  • severe cough
  • severe diarrhea
  • bloody stools
  • yellowing skin or eyes
  • severe rash, peeling, or blisters
  • confusion
  • severe headache
  • vision changes
  • extreme fatigue or dizziness
  • fast heartbeat
  • fainting
  • high fever
  • signs of an allergic reaction during or after infusion

Do not try to manage possible immune-related side effects on your own. Early treatment can reduce the risk of serious complications.

Dosing frequency and treatment schedule

Opdivo and Keytruda are both given by IV infusion in a medical setting. The schedule depends on the cancer type, dose, treatment combination, and whether the drug is being used before surgery, after surgery, for advanced disease, or after another treatment.

Opdivo dosing can vary by indication and regimen. Some patients receive Opdivo every 2 weeks. Others may receive it every 4 weeks. Combination regimens can also have different schedules.

On the other hand, Keytruda is commonly given as 200 mg every 3 weeks or 400 mg every 6 weeks for adults, depending on the treatment plan.

Dosing and convenience comparison

A less frequent infusion schedule may be more convenient, but convenience is not the only factor. The treatment must match the diagnosis, biomarker results, and approved regimen.

Combination therapies

Both Opdivo and Keytruda are often used with other treatments. Combination therapy may improve outcomes in selected cancers, but it can also increase side effects.

Opdivo may be used with:

• • Yervoy, also called ipilimumab
  • Platinum-doublet chemotherapy in selected lung cancer settings
  • Cabozantinib (Cabometyx) in selected kidney cancer settings
  • Cisplatin and gemcitabine in selected urothelial cancer settings
  • Other cancer-specific regimens

Keytruda may be used with:

• • Chemotherapy
  • Axitinib (Inlyta)
  • Lenvatinib
  • Trastuzumab with fluoropyrimidine and platinum chemotherapy in selected HER2-positive gastric or GEJ cancer
  • Enfortumab vedotin in selected urothelial cancer settings
  • Chemotherapy with or without bevacizumab (Avastin) in selected cervical cancer settings
  • Other cancer-specific regimens

Opdivo cost vs Keytruda

In terms of costs, it’s difficult to compare Opdivo and Keytruda because what you actually pay depends on several factors, such as your insurance, dose, and infusion schedule.

For Opdivo, list prices are as follows:

• • Opdivo 40 mg /4 mL Vial – $1,350.33 per 4 mL vial
  • Opdivo 100 mg /10 mL Vial – $3,375.79 per 10 mL vial
  • Opdivo 120 mg /12 mL Vial – $4,050.96 per 12 mL vial
  • Opdivo 240 mg /24 mL Vial – $8,101.94 per 24 mL vial

Since common adult dosing schedules are 240 mg every 2 weeks or 480 mg every 4 weeks, the approximate monthly cost for Opdivo is around $16,203.88/month.

In comparison, the list price for each recommended dose of Keytruda is $12,272.00 when administered every 3 weeks and $24,544.00 when administered every 6 weeks.

Actual out-of-pocket costs may be lower depending on insurance coverage, copay assistance, infusion center charges, and negotiated discounts. Contact your insurance plan or cancer center financial counselor to estimate your actual out-of-pocket cost.

Which is better, Opdivo or Keytruda?

Neither Opdivo nor Keytruda is considered better overall. They are both important immunotherapy drugs for cancer, but the right choice depends on the clinical situation.

Keytruda may be considered in some settings, such as:

• • First-line NSCLC regimens
  • PD-L1-positive NSCLC
  • Selected triple-negative breast cancer regimens
  • Selected cervical cancer regimens
  • Selected endometrial cancer regimens
  • Selected gastric or GEJ cancer regimens
  • Selected MSI-H or dMMR cancers
  • Selected kidney cancer combinations

Opdivo may be considered in some settings, such as:

• • Advanced melanoma
  • Melanoma combination therapy with Yervoy
  • Selected metastatic NSCLC regimens with Yervoy
  • Selected kidney cancer regimens
  • Selected urothelial cancer settings
  • Selected colorectal cancer with MSI-H or dMMR features
  • Selected liver, esophageal, gastric, or GEJ cancer settings

How oncologists decide

Oncologists may consider:

• • Cancer type
  • Cancer stage
  • Tumor histology
  • PD-L1 result
  • MSI-H or dMMR status
  • TMB-H status
  • EGFR, ALK, BRAF, HER2, and other biomarkers
  • Prior treatments
  • Autoimmune disease history
  • Organ transplant history
  • Current symptoms
  • Performance status
  • Side effect risks
  • Patient goals
  • Insurance coverage
  • Clinical trial options

For many cancers, the choice is not simply Opdivo or Keytruda. The bigger decision may be immunotherapy alone, immunotherapy plus chemotherapy, dual immunotherapy, targeted therapy, surgery, radiation, clinical trial enrollment, or a sequence of treatments.

Who may not be a good candidate for PD-1 immunotherapy?

Some people need extra caution before taking a PD-1 inhibitor. This does not always mean treatment is impossible, but it means that your oncology team will have to carefully weigh benefit and risks.

Examples include:

• • Active autoimmune disease
  • Prior severe immune-related side effect
  • Organ transplant history
  • Need for immune-suppressing medicines
  • Serious uncontrolled infection
  • Poor overall health or frailty
  • Pregnancy or breastfeeding
  • Severe lung, liver, kidney, heart, or endocrine disease

Never start, stop, delay, or switch immunotherapy without guidance from your cancer care team.

Questions to ask your oncologist

Bring these questions to your next appointment:

• • Is Opdivo or Keytruda FDA-approved for my cancer type and stage?

• • Do I need PD-L1, MSI-H, dMMR, TMB, EGFR, ALK, BRAF, HER2, or other testing?

• • Am I a candidate for immunotherapy alone?

• • Would I need chemotherapy or another drug with it?

• • Which clinical trial data apply to patients like me?

• • What side effects should I report right away?

• • How often will I need infusions?

• • How long might treatment continue?

• • What scans and blood tests will monitor the response?

• • What are my options if the cancer grows during treatment?

• • Is there a clinical trial I should consider?

• • What will my insurance likely cover?

Bottom line

Opdivo and Keytruda are prescription cancer immunotherapy drugs called PD-1 inhibitors. Opdivo is nivolumab, made by Bristol Myers Squibb. Keytruda is pembrolizumab, made by Merck.

Both are immune checkpoint inhibitors given by IV infusion. They help the immune system attack cancer by blocking PD-1 on T cells. They are used in multiple cancers, including melanoma, non-small cell lung cancer, kidney cancer, bladder cancer, colorectal cancer with MSI-H or dMMR features, and other tumor types.

Keytruda has FDA-labeled uses in additional cancers such as selected cervical, endometrial, triple-negative breast, and Merkel cell carcinoma settings. Opdivo has important uses in melanoma, kidney cancer, lung cancer, urothelial cancer, gastrointestinal cancers, and other settings. Ask your oncologist which immunotherapy option fits your cancer type, biomarker results, and treatment goals.

Frequently Asked Questions

Sources

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Six-Year Follow-Up Data on CheckMate 227 Survival and Quality of Life Benefits Unveiled for Patients with Metastatic NSCLC and Nivolumab + Ipilimumab Treatment | IASLC. (n.d.). IASLC. https://www.iaslc.org/iaslc-news/press-release/six-year-follow-data-checkmate-227-survival-and-quality-life-benefits

Giacco, V. (2025). Long-term results with nivolumab and ipilimumab in melanoma. Nature Cancer, 6(3), 407. https://doi.org/10.1038/s43018-025-00938-x

Schmid, P., Cortes, J., Dent, R., McArthur, H., Pusztai, L., Kümmel, S., Denkert, C., Park, Y. H., Hui, R., Harbeck, N., Takahashi, M., Im, S., Untch, M., Fasching, P. A., Mouret-Reynier, M., Foukakis, T., Ferreira, M., Cardoso, F., Zhou, X., . . . O’Shaughnessy, J. (2024). Overall Survival with Pembrolizumab in Early-Stage Triple-Negative Breast Cancer. New England Journal of Medicine, 391(21), 1981–1991. https://doi.org/10.1056/nejmoa2409932

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