This page tells you about the biological therapy ipilimumab and its possible side effects. There is information about
Ipilimumab is pronounced ip-ill-i-moo-mab. It is also known by its brand name Yervoy. It is a type of monoclonal antibody. Monoclonal antibodies are a type of biological therapy.
Ipilimumab is a treatment for melanoma that is advanced. Advanced melanoma means that the melanoma has spread deeply into the skin and can't be removed or it has spread to another part of the body.
You may also have ipilimumab as part of clinical trials for other types of cancer including advanced prostate cancer.
Ipilimumab works by stimulating T-cells in the body’s immune system. T-cells help to fight cancer and disease. CTLA-4 is a molecule found on the surface of T-cells and it switches them off. Ipilimumab blocks CTLA-4 so that the T-cells stay switched on and active and can attack the cancer cells.
You have ipilimumab into your bloodstream (intravenously). You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in before or during your course of treatment and it stays in place as long as you need it.
You can read our information about having chemotherapy into a vein.
You have the treatment over 90 minutes every 3 weeks. The dose may be controlled by a pump. You usually have 4 treatments.
You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
We've listed the side effects associated with ipilimumab. You can use the links to find out more about each side effect. Where there is no link, please go to our information about cancer drug side effects or use the search box at the top of the page.
You may have a few side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on
- How many times you've had the drug before
- Your general health
- The amount of the drug you have (the dose)
The side effects may be different if you are having ipilimumab with other medicines.
Tell your doctor or nurse straight away if any of the side effects get severe.
More than 10 in every 100 people have one or more of these.
- A skin reaction happens in 4 out of 10 people (40%) – you might have a rash similar to acne on your face, neck and trunk. Or you may have dry, bumpy, itchy skin. This can be very severe for some people. You may need to have steroids to help control it or you may need to stop your treatment for a short time
- Diarrhoea happens in about 3 out of 10 people (30%). In some people this becomes severe and you may need to have steroids or to stop treatment
- Tiredness and weakness (fatigue) affects about 1 in 2 people (50%) during and after treatment. Most people find their energy levels are back to normal within 6 months to a year. Don't drive or operate machinery if you feel weak or dizzy
- Feeling or being sick affects about 3 out of every 10 people (30%) but is usually well controlled with anti sickness medicines
- Loss of appetite
- A high temperature for a few hours after having the drug
Between 1 and 10 in every 100 people have one or more of these.
- Pain in the area of the tumour
- Hormone changes – some people make lower amounts of particular hormones. This might make you feel tired and less able to react to things as you would usually. You may also have a low sex drive or put on weight. You will have regular blood tests to check your hormone levels
- Headaches, dizziness, pain, weakness and cramps caused by damage to nerves
- Blurred vision or pain in the eye
- Loss of skin colour (known as vitiligo) and your skin may be sensitive to sunlight. Don't sit out in the sun, and do cover up or use sun block on exposed skin
- A temporary reddening of the face and neck and a feeling of intense heat with sweating, especially at night
- Sore, watery eyes or dry, itchy eyes – tell your doctor or nurse if you have any eye symptoms
- Dehydration can occur in people who have severe diarrhoea – drink plenty of fluids if you have diarrhoea and tell your doctor or nurse
- Breathlessness and a cough due to lung changes
- Low blood pressure
- Pain in your joints and muscles
- Muscle spasms
- Hair loss or thinning
- Sudden abdominal (tummy) pain due to bleeding in the stomach or bowel – let your doctor or nurse know straight away if you have this or sudden severe heartburn
- Weight loss
- Confusion and mood changes
- A faster heart rate
- Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
- Muscle cramps
- An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
- Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
- Bruising more easily due to a drop in platelets – you may have nosebleeds, or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae)
- Liver changes that are very mild and unlikely to cause symptoms. They will almost certainly go back to normal when treatment is finished. Tell your doctor or nurse if you have yellowing of the skin or whites of the eyes and if your urine is darker than usual
Fewer than 1 in 100 people have these.
- Women may stop having periods (amenorrhoea) but this may be temporary
- Kidney changes – let your doctor or nurse know if you are passing less urine than usual
- A very small number of people have high uric acid levels in their blood due to the breakdown of tumour cells (tumour lysis syndrome). You will need to drink plenty of fluids and may have a tablet called allopurinol to take
- A split in the wall of the bowel (bowel perforation) is very rare but is serious if it happens. Tell your doctor or nurse straight away if you have sudden, severe tummy pain
- An allergic reaction while you have the treatment, causing a high temperature, chills, shivering (rigors), a headache, and feeling sick. Your nurse will give you medicines before treatment to try to prevent a reaction. They will stop or slow your drip if it occurs. Let your doctor or nurse know if you have fever or chills the night after having the drip
- Sadness and depression
- Severe and possibly life threatening inflammation of the nerves causing pain, weakness or paralysis in the hands and feet (Guillain-Barré syndrome) and fainting
- Fluid collection in the brain causing difficulty in coordinating movements (ataxia), shaking, muscle spasm and difficulty speaking
- Inflammation of the eyelids
- An irregular or abnormal heart beat
- Low blood pressure when standing up, making you feel dizzy or faint
- Severe breathing problems – tell your doctor or nurse straight away if you have this
- Severe and possibly life threatening peeling of the skin (toxic epidermal necrolysis)
- Change in hair colour
Effects on many body systems including the eyes, ears, skin, and the covering of the brain and spinal cord (the meninges), which can be serious. Tell your doctor or nurse straight away if you have any of these effects – sudden changes in eyesight, deep pain in the eyes, sickness, severe headache, a feeling that the room is spinning (vertigo), nausea, drowsiness or loss of hearing
Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Changes in melanoma areas
During the first 4 treatments, the areas of melanoma on the skin may keep growing or new areas may appear. This doesn't mean that the treatment is not working.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.
If you are on a low salt diet
Ipilimumab contains some salt. Before you start treatment tell your doctor if you are on a low salt (low sodium) diet.
Pregnancy and contraception
This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Don't breastfeed during this treatment because the drug may come through in the breast milk.
You shouldn't have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
This page doesn't list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.
If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.
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