Ipilimumab is a type of cancer treatment called immunotherapy. You might have ipilimumab to treat:
- melanoma that can’t be removed with surgery or has spread to another part of the body (advanced melanoma)
- advanced kidney cancer (renal cell carcinoma) with another drug called nivolumab
Or you might have it as part of a clinical trial for other types of cancer.
How ipilimumab works
Ipilimumab works by blocking a protein that stops your immune system from working properly and attacking cancer cells. It helps to make your immune system find and kill cancer cells.
How you have ipilimumab
Into your bloodstream
You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:
- central line
- PICC line
If you don't have a central line
You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.
When you have ipilimumab
You usually have ipilimumab every 3 weeks. You have up to 4 treatments.
If you are having ipilimumab for melanoma or kidney cancer you might have it with another type of immunotherapy drug called nivolumab.
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
We haven't listed all the side effects. It is very unlikely that you will have all of these side effects, but you might have some of them at the same time.
How often and how severe the side effects are can vary from person to person. They also depend on what other treatment you are having. For example, your side effects could be worse if you are also having other drugs or radiotherapy.
When to contact your team
Your doctor or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects aren’t getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
Common side effects
These side effects happens in more than 10 in 100 people (10%). You might have one or more of them. They include:
High temperature (fever)
If you get a high temperature, let your health care team know straight away. Ask them if you can take paracetamol to help lower your temperature.
A rash can also be itchy. Less commonly your skin might go red, get dry and develop pale white patches of skin (vitiligo)
Let your doctor or nurse know if you get any skin rash or a rash that gets worse, or you’re worried about any other changes to your skin.
Contact your advice line if you have 4 loose watery poos (diarrhoea) or more in 24 hours. Or if you have diarrhoea for more than 3 days. Or if you can't drink to replace the lost fluid. Also, call if you have blood or mucus in your poo, your poo looks darker than usual, or if you develop pain in your tummy (abdomen).
Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty of liquid to replace the fluid lost.
Loss of appetite
You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.
Tiredness and weakness (fatigue)
You might feel very tired and as though you lack energy.
Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.
Tell your team if you feel tired and weak, you may need a blood test to check your hormone levels.
Feeling or being sick
Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.
Inflammation around the injection site
Tell your nurse if you notice any signs of redness or irritation around the injection site.
Occasional side effects
These side effects happen between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:
- changes to hormone levels in your body
- breathing problems – symptoms include shortness of breath and a cough
- headaches and dizziness – call your advice line if you have these symptoms
- inflammation of the bowel– rarely you may develop an ulcer or hole in the bowel wall (perforation)
- shivering (chills) or flu-like symptoms
- low levels of red blood cells (anaemia) – you might feel tired, short of breath and look pale
- pain in the area of your cancer, tummy, joints, bones, or muscles
- changes to the levels of minerals in your body – you have blood tests to check this
- not enough fluid in your body (dehydration)
- feeling confused
- numbness, tingling and pain in your hands and feet
- eye problems including blurred vision and pain - tell your doctor straight away if any problems with your eyesight
- low blood pressure – you may feel dizzy, lightheaded, or may faint
- reddening of your face and neck (flushing), feeling warm (hot flush), or night sweats
- bleeding from your stomach or bowel
- liver changes that are picked up on blood tests - call your advice line if you have yellowing of the skin or eyes (jaundice), dark urine or pain on your right side of tummy
- hair loss or thinning, rarely your hair may change colour
- muscle spasms and less commonly muscle twitching or jerking
- fluid build up causing swelling in the body (oedema)
- weight loss
- sore mouth
Rare side effects
These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:
- increased risk of infection that can be life threatening – symptoms might include fever, cough, blocked or runny nose, and headache
- low platelets which means you may bruise and bleed easily
- an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness
- inflammation of parts of your body including the blood vessels, liver, lungs, kidneys or pancreas
- high levels of chemicals in your blood due to the breakdown of tumour cells (tumour lysis syndrome) - you have regular blood tests to check for this
- mood changes, feeling depressed, or loss of interest in sex
- problems with coordination, speech and balance
- an irregular or abnormal heart beat
- thickening of your blood vessels
- stomach ulcer – symptoms include pain, burping, heartburn, and indigestion
- kidney problems – symptoms include not peeing enough, unable to pee (retention), passing blood, or confusion
- periods stopping (amenorrhea)
Coping with side effects
We have more information about side effects and tips on how to cope with them.
What else do I need to know?
Other medicines, foods and drink
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
Pregnancy and contraception
It is unknown whether treatment may or may not harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment.
Talk to your doctor or nurse about effective contraception you can use during treatment. Ask how long you should use it before starting treatment and after treatment has finished.
It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.
Treatment for other conditions
Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).
- have other vaccines, but they might not give you as much protection as usual
- have the flu vaccine (as an injection)
Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.
More information about this treatment
For further information about this treatment go to the electronic Medicines Compendium (eMC) website.
You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.