Ipilimumab

Ipilimumab Brand Name– YERVOY

What is Ipilimumab

Ipilimumab is a recombinant, human monoclonal antibody that binds to the cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and blocks the interaction of CTLA-4 with its ligands CD80/CD86.

Blockade of CTLA-4 augments T cell activation and proliferation, including tumor-infiltrating T-effector cells.

The inhibition of CTLA-4 signaling may cause a decrease in T-cell regulatory function resulting in an increase in T-cell antitumor responsiveness. Ipilimumab is produced in mammalian (Chinese hamster ovary) cell culture.

Ipilimumab is indicated for use in patients with hepatocellular cancer, malignant melanoma, renal cell carcinoma, non-small cell lung cancer (NSCLC), and microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) metastatic colorectal cancer.

Ipilimumab may cause fatal immune-mediated adverse reactions such as enterocolitis, hepatitis, dermatitis, neuropathy, and endocrinopathy; an interruption or discontinuation of therapy may be necessary for suspected immune-mediated adverse reactions.

Indications

  1. colorectal cancer
  2. hepatocellular cancer
  3. malignant melanoma
  4. non-small cell lung cancer (NSCLC)
  5. renal cell cancer

For the treatment of malignant melanoma

for the adjuvant treatment of cutaneous melanoma with pathologic involvement of regional lymph nodes of more than 1 mm, in patients who have undergone complete resection, including total lymphadenectomy

Side Effects

  1. abdominal pain
  2. abdominal pain
  3. acne vulgaris
  4. acneiform rash
  5. acute respiratory distress syndrome (ARDS)
  6. adrenocortical insufficiency
  7. adrenocortical insufficiency
  8. alopecia
  9. anemia
  10. anemia
  11. anorexia
  12. anorexia
  13. antibody formation
  14. aplastic anemia
  15. arthralgia
  16. arthralgia
  17. arthropathy
  18. ascites
  19. asthenia
  20. atopic dermatitis
  21. atrial fibrillation
  22. back pain
  23. blepharitis
  24. blurred vision
  25. bone pain
  26. bullous rash
  27. chills
  28. colitis
  29. colitis
  30. conjunctivitis
  31. constipation
  32. constipation
  33. cough
  34. cough
  35. Cushing’s syndrome
  36. dehydration
  37. diabetes mellitus
  38. diarrhea
  39. diarrhea
  40. dizziness
  41. dizziness
  42. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
  43. dyspepsia
  44. dyspnea
  45. dyspnea
  46. edema
  47. edema
  48. elevated hepatic enzymes
  49. elevated hepatic enzymes
  50. encephalopathy
  51. enterocolitis
  52. enterocolitis
  53. eosinophilia
  54. erythema multiforme
  55. esophagitis
  56. exfoliative dermatitis
  57. fatigue
  58. fatigue
  59. fever
  60. fever
  61. gastritis
  62. GI perforation
  63. graft-versus-host disease (GVHD)
  64. Guillain-Barre syndrome
  65. headache
  66. headache
  67. hearing loss
  68. hemoptysis
  69. hepatic failure
  70. hepatitis
  71. hepatitis
  72. hepatitis B exacerbation
  73. hepatotoxicity
  74. hyperamylasemia
  75. hyperamylasemia
  76. hyperbilirubinemia
  77. hyperbilirubinemia
  78. hyperglycemia
  79. hyperglycemia
  80. hyperkalemia
  81. hyperkalemia
  82. hyperthyroidism
  83. hyperthyroidism
  84. hypocalcemia
  85. hypocalcemia
  86. hypoesthesia
  87. hypokalemia
  88. hypokalemia
  89. hypomagnesemia
  90. hypomagnesemia
  91. hyponatremia
  92. hyponatremia
  93. hypophysitis
  94. hypopituitarism
  95. hypopituitarism
  96. hypotension
  97. hypothyroidism
  98. hypothyroidism
  99. ileus
  100. infection
  101. influenza
  102. infusion-related reactions
  103. insomnia
  104. insomnia
  105. interstitial nephritis
  106. iritis
  107. leukopenia
  108. leukopenia
  109. lymphopenia
  110. lymphopenia
  111. maculopapular rash
  112. malaise
  113. meningitis
  114. muscle cramps
  115. musculoskeletal pain
  116. musculoskeletal pain
  117. myalgia
  118. myasthenia
  119. myocarditis
  120. nausea
  121. nausea
  122. neutropenia
  123. neutropenia
  124. ocular inflammation
  125. palmar-plantar erythrodysesthesia (hand and foot syndrome)
  126. pancreatitis
  127. paresthesias
  128. peptic ulcer
  129. pericarditis
  130. peripheral edema
  131. peripheral neuropathy
  132. pharyngitis
  133. pneumonitis
  134. pneumonitis
  135. pruritus
  136. pruritus
  137. psoriasis
  138. pulmonary embolism
  139. rash
  140. rash
  141. renal failure (unspecified)
  142. retinal detachment
  143. rhabdomyolysis
  144. rhinitis
  145. skin hypopigmentation
  146. skin ulcer
  147. Stevens-Johnson syndrome
  148. stomatitis
  149. synovitis
  150. thrombocytopenia
  151. thrombocytopenia
  152. toxic epidermal necrolysis
  153. urticaria
  154. uveitis
  155. vasculitis
  156. vertigo
  157. Vogt-Koyanagi-Harada syndrome
  158. vomiting
  159. vomiting
  160. weight loss
  161. weight loss
  162. xerosis
  163. xerostomia

Monitoring Parameters

  • LFTs
  • ophthalmologic exam
  • serum creatinine
  • serum electrolytes
  • thyroid function tests (TFTs)

Contraindications

  • adrenal insufficiency
  • allogeneic stem cell transplant
  • autoimmune disease
  • breast-feeding
  • colitis
  • contraception requirements
  • Crohn’s disease
  • diabetes mellitus
  • diarrhea
  • encephalopathy
  • Guillain-Barre syndrome
  • hepatic disease
  • hepatitis
  • hyperthyroidism
  • hypophysitis
  • hypopituitarism
  • hypothyroidism
  • immune-mediated reactions
  • immunosuppression
  • inflammatory bowel disease
  • infusion-related reactions
  • iritis
  • mental status changes
  • myasthenia gravis
  • ocular disease
  • organ transplant
  • pancreatitis
  • peripheral neuropathy
  • pneumonitis
  • pregnancy
  • pulmonary disease
  • renal disease
  • renal impairment
  • reproductive risk
  • rheumatoid arthritis
  • sarcoidosis
  • serious rash
  • systemic lupus erythematosus (SLE)
  • thyroid disease
  • type 1 diabetes mellitus
  • ulcerative colitis
  • uveitis
  • viral infection

Interactions

  • Clozapine
  • Palifermin
  • Penicillamine
  • Tuberculin Purified Protein Derivative, PPD
  • Vemurafenib
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