Ipilimumab

Ipilimumab is a targeted therapy drug used to treat advanced melanoma. It is best to read this information with our general information about the type of cancer you have.

Ipilimumab is given into a vein and you usually have it as an outpatient. Your cancer doctor or nurse will tell you how often you will have ipilimumab.

Like all targeted therapy drugs, ipilimumab can cause side effects. Some of the side effects can be serious, so it’s important to read the detailed information below. Your healthcare team can talk to you more about this and give you advice on how to manage any side effects.

Tell your doctor or nurse straight away if you:

  • have a temperature
  • feel unwell
  • have severe side effects, including any we don’t mention here.

Rarely, side effects may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

If you need medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

What is ipilimumab?

Ipilimumab (Yervoy) belongs to a group of cancer drugs known as monoclonal antibodies. Monoclonal antibodies are sometimes called targeted therapies because they ‘target’ specific proteins (receptors) on the surface of cancer cells.

Ipilimumab is used to treat advanced melanoma. Melanoma is a type of skin cancer. It may also be used to treat other types of cancer as part of a research trial.

You will see your doctor regularly while you have this treatment so they can monitor its effects. This information should help you discuss any queries about your treatment and its side effects with your doctor or specialist nurse.

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

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How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos


How ipilimumab works

Ipilimumab works by attaching itself to normal T-cells. T-cells are part of the immune system. They fight infection and diseases. In some people, T-cells can recognise and destroy melanoma cells. But a protein on the surface of T-cells (called CTLA-4) sometimes stops this happening. Ipilimumab blocks this protein so the T-cells can destroy melanoma cells.


When ipilimumab is used

Ipilimumab is used to treat people with melanoma that has either:

  • come back and cannot be removed with surgery, or
  • spread to other parts of the body.

It is also being tested in research trials as a possible treatment for other types of cancer.

Ipilimumab can sometimes be given along with another targeted therapy drug called nivolumab.

Ipilimumab may only be available in some situations. Your cancer doctor can tell you if it is suitable for you. Some people may be given it as part of a clinical trial. If a drug is not available on the NHS, there may be different ways you are still able to have it. Your cancer doctor can give you advice.

We have more information about what you can do if a treatment is not available.


How ipilimumab is given

A nurse will give you ipilimumab as a drip into a vein (intravenous infusion) in your arm. You have it over about 90 minutes. You usually have ipilimumab every three weeks for up to four treatments. Your cancer doctor or specialist nurse will talk to you about how long the treatment will take.


Possible side effects of ipilimumab

We have included the most common side effects of ipilimumab. We have also included some less common and rarer side effects. You may get some of the side effects we mention, but you will not get them all.

If you are also taking other anti-cancer drugs, some side effects may be worse. You may also have side effects not listed here.

Your doctor can prescribe drugs to help control some side effects. It is very important to take them exactly as your nurse or pharmacist has explained.

Your nurse will give you advice about managing side effects. Always tell your doctor or nurse about the side effects you have. After your treatment is over, side effects will slowly start to improve.

Serious and life-threatening side effects

Sometimes cancer drugs can result in very serious side effects, which rarely may be life-threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.

Because ipilimumab affects the immune system, it can cause inflammation in parts of the body. The inflammation may cause severe side effects, which may be life-threatening. The side effects can happen months after treatment is finished. Some people may need treatment in hospital. They may be given steroids to reduce inflammation. Doctors may further delay treatment with ipilimumab or stop it.

It is important to follow the advice your cancer doctor or nurse gives you. They will tell you how and when to contact them about certain side effects. This includes after you have stopped taking ipilimumab.

You may be given a patient alert card containing important safety information about ipilimumab. Carry it with you for at least a year after finishing treatment with ipilimumab. Show it to any doctor involved in your care, not just the doctor who prescribed it. This includes doctors or nurses you may see for medical reasons other than the cancer.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

Skin rash

Ipilimumab can affect your skin. Your doctor or nurse can tell you what to expect. Always let them know about any skin changes.

Ipilimumab can cause an itchy rash which can be mild or more severe. If the rash covers more than half of your body, tell your doctor straight away. You usually need steroid creams or tablets to treat it. Your doctor may stop your treatment until the rash improves.

Less commonly, people may have a very severe skin reaction with inflammation of the skin. This can cause peeling skin and a fever (high temperature). If this happens, it is very important to contact the hospital straight away.

Here are some things you can do to look after your skin:

  • Use tepid water and mild, non-scented soap.
  • Moisturise your skin every day.
  • Do not use skincare products that contain alcohol or anti-acne products.
  • Wear rubber gloves to protect your hands when doing things around the house.

Protect your skin with a high sun protection factor (SPF) suncream and cover up in the sun – you may burn more easily than usual and the sun can make symptoms worse.

Some people may get a loss of skin colour (vitiligo) in patches of their skin.

Hair thinning

Your hair may start to thin. Rarely, this treatment can cause complete hair loss. Effects on your hair are temporary. Hair usually begins to grow back and thicken a few weeks after treatment ends.

Diarrhoea

If you have diarrhoea, contact the hospital for advice. Try to drink at least 2 litres (3½ pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Feeling tired

Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.

Feeling sick

Your doctor can give you anti-sickness drugs to help prevent or control sickness. If you still feel sick, tell your doctor. They can prescribe other anti-sickness drugs that may work better for you.

Constipation

This treatment can cause constipation. Here are some tips that may help:

  • Drink at least 2 litres (3½ pints) of fluids each day.
  • Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
  • Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.

Pain

You may get pain in the area of the melanoma. Ipilimumab can also cause pain in your muscles or joints, and spasms in your muscles. Tell your doctor if you get any of these side effects. They can prescribe painkillers or other medicines to help. Let them know if the pain does not get better.

Effects on the eyes

You may get blurred vision or pain in the eye. Less commonly, ipilimumab may cause inflammation of the eyes with red and sore eyes. Tell your doctor straight away if you get any of these symptoms or any changes to your eyesight. They can prescribe treatment to help.

Breathlessness or a cough

Some people may become breathless or have a cough. Let your doctor know if this happens. They can give you medicines to help. Tell your doctor if your breathing gets worse.

Anaemia (low number of red blood cells)

This treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this.

If you are very anaemic, you may need a drip to give you extra blood cells. This is called a blood transfusion.

Changes in the way the liver works

Ipilimumab may cause changes in the way your liver works. This will return to normal when the treatment finishes. You have regular blood tests to check that your liver is working properly.

Less commonly, ipilimumab may cause severe inflammation of the liver (hepatitis). Tell your doctor straight away if you have yellowing of the whites of the eyes or skin (jaundice), itchy skin or urine that is darker than usual.

Watch our hair loss video playlist

In these videos, people with experience of cancer and hair loss share their stories. You can also watch tutorials on wigs, headwear and eye make up.

Watch our hair loss video playlist

In these videos, people with experience of cancer and hair loss share their stories. You can also watch tutorials on wigs, headwear and eye make up.


Less common side effects of ipilimumab

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.

If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:

  • your temperature goes over 37.5°C (99.5°F)
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection.

Symptoms of an infection include:

  • feeling shaky
  • a sore throat
  • a cough
  • diarrhoea
  • needing to pass urine a lot.

It is important to follow any specific advice your cancer treatment team gives you.

The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.

Effects on the nerves

Ipilimumab can cause inflammation of the nerves that can sometimes cause very serious problems. Contact the hospital straight away if you have unusual weakness in your arms, legs or face, or tingling in your hands or feet.

Severe tummy pain

Rarely, ipilimumab can cause a hole (perforation) in the bowel, which can be very serious. Contact the hospital straight away if you have severe pain in the tummy or sickness and vomiting. Always let them know if you have bleeding from the back passage, black stools, are vomiting up blood or have vomit that looks like coffee grounds.

Effects on hormone levels

Ipilimumab can cause inflammation of glands that make hormones, such as the pituitary gland, the adrenal gland and the thyroid gland. Sometimes, the result of this is that the affected gland cannot make enough of the hormone it usually makes. These changes are often picked up with a blood test before you have symptoms.

Tell your doctor if you have any of the following:

  • headaches that do not go away
  • extreme tiredness or sleepiness
  • weight gain
  • feeling dizzy or faint
  • changes in behaviour or mood, such as irritability or feeling confused.

Changes in the way the kidneys work

Ipilimumab can affect how your kidneys work. You have blood tests before and during treatment to check your kidneys. The nurse will ask you to drink plenty of fluids to protect your kidneys. Tell them if there are any changes in how much urine you are passing.


Other information about ipilimumab

Driving

Ipilimumab may affect your ability to drive. Do not drive if you are dizzy, have blurred vision or feel very tired. Talk to your doctor if you have any concerns.

Other medicines

Some medicines, including those you can buy in a shop or chemist, can be harmful to take while you are having ipilimumab. Tell your doctor about any medicines you are taking, including ones you can buy for yourself, complementary therapies, and herbal drugs.

Contraception

Your doctor will advise you not to become pregnant or father a child while taking ipilimumab. This is because not enough is known about its effect on the developing baby. It is important to use effective contraception while having this drug. You can discuss this with your doctor or specialist nurse.

Breastfeeding

Women are advised not to breastfeed during treatment with ipilimumab. This is in case there is any of the drug in their breast milk.

Fertility

Doctors do not yet know how ipilimumab may affect your fertility. If you are worried about this, talk to your doctor before treatment starts.

Medical or dental treatment

If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having ipilimumab or have had previous treatment with it. Tell them the name of your cancer doctor so they can ask for advice.

Always tell your dentist if you are having ipilimumab.