Ipilimumab, which is also known as YERVOY™. It is used to treat advanced melanoma (a type of skin cancer). Ipilimumab may also be used to treat other types of cancer as part of a research trial.
This section describes ipilimumab, how it is given and some of its possible side effects. It should ideally be read with our general information about advanced melanoma.
IIpilimumab belongs to a group of cancer drugs known as monoclonal antibodies. Monoclonal antibodies are sometimes called targeted therapies because they work by ‘targeting’ specific proteins (receptors) on the surface of cells. Ipilimumab is a bit different because it works by attaching itself to normal immune cells. This changes the way these cells work and helps the immune system destroy cancer cells.
There are different types of cells within the immune system that help fight infection and diseases such as cancer. One is a T-lymphocyte, or T-cell. In some people, T-cells can recognise and destroy melanoma cells.
T-cells have a protein on their surface called CTLA-4. CTLA-4 switches off the T-cells, and this can stop them from destroying melanoma cells. Ipilimumab works by blocking the CTLA-4 on T-cells so they can respond to the disease for longer.
When ipilimumab is used
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Ipilimumab is licensed to treat people with melanoma that has come back or spread to other areas of the body (advanced melanoma), if they’ve already had treatment with other anti-cancer medicines.
Ipilumumab was only licensed in July 2011. It hasn’t yet been recommended by the National Institute for Health and Clinical Excellence (NICE) for use in the NHS in England and Wales, or by the Scottish Medicines Consortium (SMC) for use in Scotland. NICE and the SMC give advice on which new drugs or treatments should be available on the NHS.
As a result, ipilimumab may not be widely available on the NHS. We have more information about what you can do if a particular drug isn't readily available.
What ipilimumab looks like
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Ipilimumab is a colourless liquid.
How ipilimumab is given
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Ipilimumab is given as a drip into a vein (intravenous infusion). Each infusion is given over approximately 90 minutes. The infusion is repeated every three weeks. To begin with, up to four doses are given. Your doctor or specialist nurse will discuss this with you.
Possible side effects of ipilimumab
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Each person’s reaction to treatment is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone taking ipilimumab.
Side effects happen because ipilimumab affects the immune system, which can lead to inflammation in other parts of the body. The side effects usually begin during treatment, but sometimes they happen months later. Most side effects are temporary, but occasionally they will be permanent and need ongoing treatment.
Side effects of ipilimumab are usually mild, however, some side effects can be more serious. They can have a bigger impact on your life and may greatly reduce your ability to do normal activities. Doctors refer to these as moderate or severe side effects.
Occasionally, the side effects of ipilimumab are life-threatening. It’s important to tell your doctor or nurse as soon as possible if you have moderate or severe side effects. During office hours, you can contact the clinic or ward where you had your treatment. Your chemotherapy nurse or doctor will tell you who to contact during evenings or weekends. Don't try to treat symptoms yourself with other medicines.
If you develop moderate or severe side effects, you may need to be admitted to hospital. You may be given steroids to reverse any damage that the inflammation is causing. Steroids can either be given as tablets or as a drip into a vein (intravenous infusion). Your doctor or nurse will explain this to you.
Your doctor may prescribe other treatments, such as anti-diarrhoea tablets, anti-sickness tablets and painkillers, to control side effects. The next infusion of ipilimumab may have to be delayed to allow any side effects to reduce. In some situations, your doctor may stop your ipilimumab treatment.
The following side effects are listed by the part of the body affected.
Ipilimumab can cause inflammation of the bowels (colitis). This can cause diarrhoea and tummy (abdominal) pain.
Mild diarrhoea - which means up to four loose bowel motions a day - can often be controlled with anti-diarrhoea tablets. Your doctor will give you some tablets to take at home in case you develop diarrhoea.
If the diarrhoea continues even though you’re taking the anti-diarrhoea tablets, or if you have six or more loose bowel motions a day, you may have moderate or severe colitis. Other symptoms include blood or mucus in the bowel motion, abdominal pain and feeling generally unwell. Very rarely, severe colitis can cause a hole (perforation) in the bowel.
Symptoms of colitis may include severe pain, vomiting and a fever (high temperature). If you think you may have the symptoms of moderate or severe colitis or if you're unsure what to do about your diarrhoea, contact your hospital doctor or nurse straight away.
Treatment of colitis includes using steroids to help control the inflammation. If you have severe colitis, you will be admitted to hospital for intravenous fluids and other treatments.
Ipilimumab can cause inflammation of the liver (hepatitis). This is uncommon and is usually mild. Hepatitis is often picked up during a blood test before you develop any symptoms. Early symptoms of hepatitis include feeling very tired (fatigue), feeling sick (nausea) and being sick (vomiting). Your doctor may give you anti-sickness (anti-emetic) tablets to have at home in case you develop nausea.
More severe hepatitis may occur in some people and, rarely, life-threatening liver failure can happen. Symptoms of severe hepatitis include yellowing of your skin and the whites of your eyes (jaundice). Your urine may be a darker colour than normal, and you may have pain in the right side of your abdomen (where the liver is). When the liver is inflamed, your blood may not clot properly. You may bruise very easily or bleed more heavily than usual from minor cuts or grazes. You may have nose bleeds, blood spots, rashes on the skin (petechiae) or bleeding gums.
If you have mild fatigue or nausea that isn’t controlled with anti-sickness tablets, let your doctor or nurse know at your next visit.
If these symptoms continue, if you feel unwell or if you develop any other symptoms of severe hepatitis, it’s important to contact the doctor straight away. They can do tests and, if necessary, start steroid treatment to reduce the inflammation.
Ipilimumab can cause the skin to become inflamed. This can cause a rash (erythema) that may be itchy. It may also cause mouth sores. It’s important to tell your doctor about any skin rashes.
A mild rash affects only a small area of the skin and won’t make you feel ill. A mild rash can often be treated with simple creams.
A more severe rash may affect several areas of the body or cover more than half of the body. It may also make you feel unwell. Tell your doctor straight away if you have a rash like this. It can be treated with steroids creams or tablets.
Rarely, some people develop a very severe skin reaction called toxic epidermal necrolysis (TEN). Symptoms may include large blisters and skin that flakes off and feels very raw, like a scald. Other symptoms of TEN include a fever (high temperature), aching joints, bloodshot and itchy eyes, and mouth sores. Treatment will involve steroids (which may be given intravenously) to reduce inflammation; antibiotics to treat any skin infection; dressings to protect and sooth any skin areas; and painkillers.
If you have severe skin side effects, you will usually be admitted to hospital.
Ipilimumab can affect the nerves. Symptoms of this include numbness and weakness in the arms, legs and face. If you notice any of these symptoms, tell your doctor so they can start steroid treatment.
Ipilimumab can cause inflammation of the glands that produce the different hormones (chemicals that control many of the body’s functions) in the body. Symptoms will vary depending on which glands are affected, so it’s important to contact your doctor if you notice anything abnormal.
Possible symptoms include headaches that don’t go away or are unusual; nausea and vomiting; feeling very tired (fatigue); feeling cold; abdominal pain; mood or behaviour changes; forgetfulness or confusion; dizziness; and fainting.
Changes to hormone levels will often be picked up during a blood test before you develop any symptoms.
Ipilimumab can cause eyesight changes such as blurred or double vision. The eyes may be sore and red. Tell your doctor if you notice any visual changes. Steroid treatment can help reduce these symptoms and make your eyes more comfortable.
If you develop any new symptoms, it’s a good idea to discuss them with your doctor or nurse. If you feel very unwell or have severe symptoms, you should contact your doctor straight away. They can check these symptoms and start treatment if needed.
These side effects can seem very frightening, and it may be difficult to decide whether or not to have ipilimumab. Remember that although some people having this treatment will experience severe side effects, most people will only have mild ones. If moderate or severe side effects do happen, they can usually be treated by your doctor.
Additional information about ipilimumab
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Some other medicines can be harmful to take when you’re having ipilimumab. Let your doctor know about any medications you’re taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
It's not advisable to become pregnant or father a child while taking ipilimumab, as not enough is known about its effect on the developing baby. It’s important to use effective contraception while having this drug and for a year afterwards. You can discuss this with your doctor or specialist nurse.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you’re having cancer treatment. You should tell them the name of your cancer specialist so they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. During office hours, you can contact the clinic or ward where you had your treatment. Your chemotherapy nurse or doctor will tell you who to contact during the evening or at weekends.
This section has been compiled using information from a number of reliable sources, including:
electronic Medicines Compendium (eMC). (accessed October 2011).
Hodi FS, et al. Improved Survival with Ipilimumab in Patients with Metastatic Melanoma. N Engl J Med. 2010; 363(8):711–23.
O’Day S, et al. A Phase III, Randomized, Double-Blind, Multicenter Study Comparing Monotherapy With Ipilimumab or GP100 Peptide Vaccine and the Combination in Patients With Previously Treated, Unresectable Stage III or IV Melanoma. J Clin Oncol. 2010; 28(15s):4.
Robert C, et al. Ipilimumab plus Dacarbazine for Previously Untreated Metastatic Melanoma. N Engl J Med. 2011; 364:2517–2526.
UpToDate. Ipilimumab: Drug Information (accessed October 2011).
Wolchok J, et al. Ipilimumab Monotherapy in Patients With Pretreated Advanced Melanoma: A Randomised, Double-Blind, Multicentre, Phase 2, Dose-Ranging Study. Lancet Oncol. 2010; 11(2):155–64.
With thanks to: Professor Angus Dalgleish, Consultant Medical Oncologist; Peta Hughes, Clinical Nurse Specialist Melanoma; Ann Irwin, Clinical Nurse Specialist Skin Cancer; Dr James Larkin, Consultant Medical Oncologist; Dr Neil Steven, Senior Lecturer and Honorary; and all of the people affected by cancer who reviewed this edition.
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