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Ipilimumab (Yervoy)

This page tells you about the biological therapy ipilimumab and its possible side effects. There is information about

 

What ipilimumab is

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 cannot 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.

 

How ipilimumab works

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.

 

How you have ipilimumab

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 just before your course of treatment starts and it stays in place as long as you need it.

You have the treatment over 90 minutes every 3 weeks. The dose may be controlled by a pump. You usually have 4 treatments.

The side effects associated with ipilimumab are listed below. The side effects may be different if you are having it with other drugs.

 

Common side effects

More than 10 in every 100 people have one or more of these.

  • A skin reaction in 4 out of 10 people (40%) – you may have a rash similar to acne on your face, neck and trunk or your skin may be dry and itchy. This can be very severe for some people. You may need to have steroids to help control this or you may need to stop your treatment for a short time
  • Weakness – do not drive or operate machinery if you feel weak or dizzy
  • 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 (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
  • 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
 

Occasional side effects

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, which may make you feel tired and less able to react to things as you would usually. You may also have blurred vision or a low sex drive or put on weight. You will have regular blood tests to check your hormone levels
  • Headaches and dizziness
  • 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
  • Numbness or tingling in fingers and toes, which can cause difficulty with fiddly things such as doing up buttons – this may start within a few days or weeks and usually goes within a few months of finishing treatment
  • Sore, watery, eyes or dry, itchy eyes – tell your doctor or nurse if you have any eye symptoms
  • Dehydration in people who have severe diarrhoea – drink plenty of fluids if you have diarrhoea
  • Hot flushes and sweats
  • Constipation
  • Low blood pressure
  • Pain in your joints and muscles
  • Hair loss or thinning
  • Indigestion
  • Sudden abdominal (tummy) pain due to bleeding in the stomach or bowel – let your doctor or nurse know straight away if you have this
  • Weight loss
  • Confusion and changes in mood
  • A faster heart rate
  • Loss of fertility – you may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you plan to have a baby in the future
  • 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 feel cold and shivery
  • 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, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)
 

Rare side effects

Fewer than 1 in 100 people have these.

  • Women may stop having periods (amenorrhoea) but this may be temporary
  • Kidney changes – you will have regular blood tests to check how well your kidneys are working
  • 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 have regular blood tests to check your uric acid levels and may have a tablet called allopurinol to take. Drinking plenty of fluids helps to flush out the excess uric acid
  • A split in the wall of the bowel (bowel perforation) is very rare but is a serious side effect if it happens
  • Liver changes – you are unlikely to notice any symptoms and your liver function will almost certainly go back to normal when treatment is finished. You will have regular blood tests to check how well your liver is working
  • 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 inflammation of the nerves causing fainting and pain, weakness or paralysis of the hands and feet, and possible difficulty in speaking or coordinating movements
 

Important points to remember

You won’t get all the side effects mentioned here and some may be very mild. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

  • How many times you've had a drug before
  • Your general health
  • How much of the drug you have (the dose)
  • Other drugs you are having

Coping with side effects

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 does not mean that the treatment is not working.

Other medicines

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Drugs that may react with ipilimumab include the following

  • Steroids – when taking ipilimumab you may need to take steroids to reduce the side effects and your doctor or pharmacist will monitor this
  • Medicines to stop your blood clotting
  • A biological therapy called verumafenib (Zelboraf)

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.

Contraception

Ipilimumab may have a harmful effect on a baby developing in the womb. It is important not to become pregnant or father a child while having this treatment. Talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant.

Breastfeeding

Breastfeeding is not advisable during this treatment because the drug may come through in the breast milk.

 

Immunisations and ipilimumab

You should not 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.

 

More information on ipilimumab

This page does not 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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Updated: 15 November 2013