Classification: Monoclonal Antibody
About: Ipilimumab (Yervoy®)
The immune system works by creating antibodies, which are proteins that attach to antigens found on the surface of a cell. The antibody “calls” the immune system to attack the cell it is attached to, resulting in the immune system killing the cell. Monoclonal antibodies are created in a lab to attach to the antigens found on specific types of cancer cells. These antibodies can work in different ways, including stimulating the immune system to kill the cell, blocking cell growth or other functions necessary for cell growth.
Ipilimumab is a type of monoclonal antibody therapy, which works to stimulate the immune system to destroy cancer cells. T-cells are a type of white blood cell that are very important to the normal functioning of the immune system. Ipilimumab works as a form of immunotherapy and blocks the activity of cytotoxic T lymphocyte-associated antigen 4 (CTLA-4), a molecule found on T cells that suppresses immune activity. By blocking CTLA-4, T-cells function better and the immune response is stimulated to find and kill cancer cells.
How to Take Ipilimumab
Ipilimumab is given intravenously (directly into a vein). The actual dose is based on your body size and will be determined by your healthcare provider. How often you receive the medication depends on the type of cancer you have and if you experience side effects.
Make sure your care team is aware of all medications (including prescription and over-the-counter), supplements, and vitamins you are taking. Steroids should be avoided while on immunotherapy, unless directed by your care team.
Tell your care team about all your medical conditions, including those that are autoimmune in nature (Crohn’s disease, lupus, rheumatoid arthritis, etc.) as these can get worse with immunotherapy. You should also notify your provider if you have had or plan on having an allogeneic stem cell transplant as this medication can worsen a side effect of the transplant called graft-versus-host disease.
Possible Side Effects of Ipilimumab
There are a number of things you can do to manage the side effects of ipilimumab. Talk to your care team about these recommendations. They can help you decided what will work best for you. These are some of the most common or important side effects:
This medication stimulates your immune system. Your immune system can attack normal organs and tissues in your body, leading to serious or life-threatening complications. It is important to notify your healthcare provider right away if you develop any of the following symptoms:
- Diarrhea / Intestinal problems (colitis, inflammation of the bowel): Abdominal pain, diarrhea, cramping, mucus or blood in the stool, dark or tar-like stools, fever. Diarrhea means different things to different people. Any increase in your normal bowel patterns can be defined as diarrhea and should be reported to your healthcare team.
- Bowel obstruction or perforation: Abdominal pain, fever, constipation, bloating, and cramping. Any decrease in your normal bowel patterns should be reported.
- Skin reactions: Report rash, with or without itching (pruritis), sores in your mouth, blistering or peeling skin, as these can become severe and require treatment with corticosteroids.
- Liver problems (hepatitis, inflammation of the liver): Yellowing of the skin or eyes, your urine appears dark or brown, pain in your abdomen, bleeding or bruising more easily than normal, or severe nausea and vomiting.
- Brain and/or nerve problems: Report any headache, drooping of eyelids, double vision, trouble swallowing, weakness of arms, legs, or face, or numbness or tingling in the hands or feet to your healthcare team.
- Eye problems: Report any changes in vision, blurry or double vision, and eye pain or redness.
- Lung problems (pneumonitis, inflammation of the lung): New or worsening cough, shortness of breath, trouble breathing, or chest pain.
- Kidney problems: (kidney inflammation or failure) Decreased urine output, blood in the urine, swelling in the ankles, loss of appetite.
- Hormone abnormalities: Immune reactions can affect the pituitary, thyroid, pancreas, and adrenal glands, resulting in inflammation of these glands, which can affect their production of certain hormones. Some hormone levels can be monitored with blood work. It is important that you report any changes in how you are feeling to your care team. Symptoms of these hormonal changes can include: headaches, nausea, vomiting, constipation, rapid heart rate, increased sweating, extreme fatigue, weakness, changes in your voice, changes in memory and concentration, increased hunger or thirst, increased urination, weight gain, hair loss, dizziness, feeling cold all the time, and changes in mood or behavior (including irritability, forgetfulness and decreased sex drive).
- Heart problems: Inflammation in the heart muscle can happen in rare cases. If you develop any of these symptoms, report them to your provider right away: chest pain, shortness of breath, trouble breathing when lying down or waking up gasping for air, heart palpitations (feeling like your heart is racing), swelling in your feet or legs, lightheadedness or fainting.
Infusion-Related Side Effects
The infusion can cause a reaction that may lead to chills, fever, low blood pressure, dizziness, feeling like you are going to pass out, and difficulty breathing. Let your nurse know right away if you are experiencing any changes in how you are feeling.
Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.
Less common, but important side effects can include:
- Allergic Reactions: In some cases, patients can have an allergic reaction to this medication. Signs of a reaction can include shortness of breath or difficulty breathing, chills, fever, rash, itching, dizziness, feeling faint, back and/or neck pain, and swelling of the face. If you notice any changes in how you feel during the infusion, let your nurse know immediately.
- Allogeneic Stem Cell Transplant Reactions: Patients who receive this medication before or after having an allogeneic stem cell transplant can be at an increased risk of graft vs. host disease, veno-occlusive disease, and fever syndrome. Your providers will monitor you closely for these side effects.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment and for 3 months after the last dose. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should not breastfeed while receiving this medication and for 3 months after the last dose.