Patient Handout: Ipilimumab (Yervoy)

What is Ipilimumab?

Ipilimumab, sold under the brand name Yervoy, is an immunotherapy medication used to treat certain types of cancer. It is a CTLA-4 inhibitor that helps your immune system recognize and attack cancer cells more effectively. Ipilimumab is used to treat cancers such as:

• Melanoma (skin cancer)
• Non-small cell lung cancer (NSCLC)
• Renal cell carcinoma (kidney cancer)
• Colorectal cancer (in combination with nivolumab)
• Hodgkin lymphoma (in combination with nivolumab)

Ipilimumab is used to help fight cancer by stimulating your immune system, especially if the cancer is difficult to treat with other therapies.

How Does Ipilimumab Work?

Ipilimumab works by blocking the CTLA-4 protein on immune cells, specifically T-cells. CTLA-4 is a negative regulator of the immune system that prevents the immune cells from attacking normal tissues. Cancer cells can often exploit this pathway to evade the immune system. By blocking CTLA-4, ipilimumab “releases the brakes” on the immune system, allowing it to better recognize and attack cancer cells.

How is Ipilimumab Given?

Ipilimumab is given as an intravenous (IV) infusion.

• Dosage: The dose of ipilimumab depends on the type of cancer and your treatment plan. Your doctor will determine the exact dosage and schedule.
• Frequency: Ipilimumab is typically given every 3 weeks for a set number of doses, depending on the type of cancer and your response to treatment.
• Infusion Time: The infusion typically takes about 90 minutes. The healthcare team will monitor you closely during the infusion and after it to watch for any potential side effects.

Possible Side Effects

Ipilimumab may cause side effects, some of which can be serious. Not all patients experience side effects, and many side effects can be managed with medications or treatment adjustments.

Common Side Effects:

• Fatigue: Tiredness or weakness is common during treatment. Rest as needed and let your doctor know if it becomes overwhelming.
• Rashes: A rash may develop on your skin, which can range from mild to severe. Contact your doctor if you develop a rash, especially if it becomes painful or blisters.
• Diarrhea or Colitis: Diarrhea, abdominal pain, or blood in the stool may be signs of inflammation of the intestines (colitis).
• Nausea and Vomiting: Some patients experience nausea and vomiting, which can sometimes be controlled with medication.
• Loss of Appetite: You may lose your appetite, which can affect your eating habits.

Serious Side Effects:

• Immune-related adverse effects: Ipilimumab works by stimulating the immune system, which can sometimes lead it to attack healthy organs and tissues in your body. These side effects may occur during treatment or even after treatment has ended and may affect several organs, including:
  • Colitis (inflammation of the colon): Symptoms include diarrhea (sometimes with blood), stomach pain, or cramping.
  • Hepatitis (liver inflammation): Symptoms of liver problems include yellowing of the skin or eyes (jaundice), dark urine, or upper-right abdominal pain.
  • Pneumonitis (lung inflammation): Symptoms include coughing, difficulty breathing, or chest pain.
  • Nephritis (kidney inflammation): Symptoms may include changes in urination, swelling in the legs or ankles, or decreased urine output.
  • Endocrine problems: Ipilimumab can cause inflammation of the thyroid (hyperthyroidism or hypothyroidism), adrenal glands, and other hormone-producing glands. Symptoms may include weight changes, mood changes, dizziness, or fatigue.

Injection Site Reactions:

• Ipilimumab is given by IV infusion, so injection site reactions (such as redness, swelling, or pain at the site of the IV) are not common but can occur.

Precautions Before Taking Ipilimumab

Before starting treatment with ipilimumab, inform your healthcare provider if you:

• Have any autoimmune diseases (such as rheumatoid arthritis, lupus, or multiple sclerosis), as ipilimumab can worsen autoimmune conditions.
• Have a history of lung, liver, kidney, or heart problems, as ipilimumab can cause inflammation in these organs.
• Are pregnant or planning to become pregnant, as ipilimumab can harm an unborn baby. You should use effective birth control during treatment and for at least 3 months after completing treatment.
• Are breastfeeding, as ipilimumab can pass into breast milk, and breastfeeding is not recommended during treatment.
• Have received organ transplants or are taking medications to suppress your immune system, as ipilimumab may affect how your body responds to these medications.

What to Avoid While Taking Ipilimumab

• Infections: Ipilimumab may weaken your immune system, so you may be at higher risk of infections. Avoid contact with sick people and practice good hygiene.
• Vaccines: Live vaccines (e.g., yellow fever, measles, etc.) should generally be avoided during treatment with ipilimumab. Speak to your healthcare provider before getting any vaccines.
• Pregnancy: As mentioned, ipilimumab can harm an unborn baby, so use effective contraception to prevent pregnancy during treatment and for at least 3 months afterward.

Regular Monitoring

Your healthcare provider will regularly monitor you during treatment with ipilimumab to check for side effects, including:

• Blood tests: To monitor liver, kidney, and thyroid function, as well as your blood cell counts.
• Imaging tests: Your doctor may order scans (e.g., CT or MRI) to track the progress of your cancer.
• Vital signs: Your healthcare provider may check your blood pressure, heart rate, and temperature to ensure your body is responding well to treatment.

When to Contact Your Doctor

Contact your healthcare provider immediately if you experience any of the following symptoms:

• Severe diarrhea or blood in your stool (possible colitis)
• Severe rash, blistering, or peeling of the skin
• Shortness of breath, chest pain, or persistent cough (possible lung problems)
• Yellowing of the skin or eyes, dark urine, or stomach pain (possible liver problems)
• Severe fatigue, dizziness, or weight changes (possible endocrine issues)
• Fever, chills, or signs of infection (possible immune system reaction)

Disclaimer:

This handout is for educational purposes only and should not be considered medical advice. Always follow the instructions provided by your healthcare provider regarding treatment and care. For personalized advice, consult your healthcare provider or pharmacist.