Ipilimumab (Yervoy)

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 advanced melanoma. Advanced cancer means that the melanoma has spread deeply into the skin and cannot be removed or it has spread to another part of the body. Ipilimumab is licensed for people who have had other treatments which are no longer working.

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 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.

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

• A skin reaction occurs 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
• 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
• Loss of skin colour (known as vitiligo) and your skin may be sensitive to sunlight – don’t sit out in the sun, and cover up or use sun block on exposed skin
• 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
• Constipation occurs in up to 2 out of 10 people (20%)
• Loss of appetite
• Headaches and dizziness

Some people have a temporary drop in the number of blood cells made by the bone marrow, leading to the following effects. Between 1 and 10 in every 100 people have one or more of these.

• 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, 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)

Some of these side effects can be life threatening, particularly infections. You should contact your treatment centre if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Some people may have one or more of the following side effects

• 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 will have blood tests to check your hormone levels
• 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
• Low levels of potassium, sodium and phosphate in your blood – you will have regular blood tests to check the levels of these compounds
• A cough and shortness of breath
• An allergic reaction while you have the treatment, causing a high temperature, chills, shivering (rigors), a headache, and feeling sick. A few people have a more severe reaction, with wheezing, an itchy rash, and a drop in blood pressure. 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
• Low blood pressure
• Pain and weakness affecting your joints, muscles and abdomen
• Changes in mood and confusion
• A faster heart rate
• Loss of fertility – we don’t know exactly how this drug affects fertility so talk with your doctor before starting treatment if having a baby is important to you
• Ipilimumab may have a harmful effect on a baby developing in the womb – do talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant

Fewer than 1 in 100 people have these.

• Women may stop having periods (amenorrhoea) but this may be temporary
• A mild effect on the liver – 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
• Kidney problems – 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

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

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. Your nurse will give you a contact number. You can ring them if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

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