Imjudo
Imjudo (tremelimumab) is an immunotherapy treatment for certain types of liver cancer and non-small cell lung cancer (NSCLC) in adults. It is given together with other anticancer medications. Imjudo (tremelimumab) is given as an infusion through the vein (IV). For liver cancer, it’s given just once on the first day of treatment. For NSCLC, it’s given every 3 weeks. It’s convenient since it lasts a while in the body, but commonly causes mild rash and diarrhea. Imjudo (tremelimumab) can also cause other rare, serious side effects due to overstimulating the immune system.
What is Imjudo (tremelimumab)?
What is Imjudo (tremelimumab) used for?
- Hepatocellular carcinoma (liver cancer) that can’t be removed with surgery, together with Imfinzi (durvalumab)
- Metastatic non-small cell lung cancer without EGFR or ALK gene changes, together with Imfinzi (durvalumab) and platinum-based chemotherapy
How Imjudo (tremelimumab) works
Your immune system keeps your body healthy by fighting infections and cancer cells. Typically, your body has a system in place to prevent the immune system from becoming too active and attacking healthy cells in your body. There's a special protein called CTLA-4 that cells in your body use to keep the immune system in check. But sometimes, cancer cells use this protein as a way to “hide” from your immune system, allowing the cancer to grow and spread.
Imjudo (tremelimumab) is an immune checkpoint inhibitor (immunotherapy). More specifically, it’s an CTLA-4 inhibitor. By blocking CTLA-4, Imjudo (tremelimumab) helps the immune system detect and attack cancer cells.
Drug facts
Side effects of Imjudo (tremelimumab)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Abnormal liver labs (up to 63%)
- Lower blood cell counts (up to 52%)
- Lower blood sodium levels (46%)
- Higher blood sugar (39%)
- Lower blood calcium levels (34%)
- Higher blood potassium levels (28%)
- Abnormal kidney labs (21%)
- Rash (32%)
- Diarrhea (27%)
- Fatigue (26%)
- Itching (23%)
- Muscle, bone, or joint pain (22%)
Less Common Side Effects
- Nausea
- Low appetite
- Stomach pain
- Fever
- Low thyroid hormone levels
- Trouble sleeping
Please note: Side effects listed are from studies in people with liver cancer who received treatment with Imjudo (tremelimumab) along with Imfinzi (durvalumab).
Imjudo (tremelimumab) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Immune-related adverse events: trouble breathing, cough, diarrhea, mucus or blood in the stool, stomach pain or cramps, rash
- Infusion-related reactions: shortness of breath, itching, chills, flushing, upset stomach, or chest discomfort
The following Imjudo (tremelimumab) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Dry cough, shortness of breath or trouble breathing
- Eye pain, redness, irritation, or discharge with blurry or decreased vision
- Heart muscle inflammation—unusual weakness or fatigue, shortness of breath, chest pain, fast or irregular heartbeat, dizziness, swelling of the ankles, feet, or hands
- Hormone gland problems—headache, sensitivity to light, unusual weakness or fatigue, dizziness, fast or irregular heartbeat, increased sensitivity to cold or heat, excessive sweating, constipation, hair loss, increased thirst or amount of urine, tremors or shaking, irritability
- Infusion reactions—chest pain, shortness of breath or trouble breathing, feeling faint or lightheaded
- Kidney injury (glomerulonephritis)—decrease in the amount of urine, red or dark brown urine, foamy or bubbly urine, swelling of the ankles, hands, or feet
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Pain, tingling, or numbness in the hands or feet, muscle weakness, change in vision, confusion or trouble speaking, loss of balance or coordination, trouble walking, seizures
- Pancreatitis—severe stomach pain that spreads to your back or gets worse after eating or when touched, fever, nausea, vomiting
- Rash, fever, and swollen lymph nodes
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
- Stomach pain that is severe, does not go away, or gets worse
- Sudden or severe stomach pain, bloody diarrhea, fever, nausea, vomiting
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Bone, joint, or muscle pain
- Diarrhea
- Fatigue
- Loss of appetite
- Nausea
- Skin rash
Pros and cons of Imjudo (tremelimumab)
Pros
- Lasts a long time in the body, so it doesn’t need to be given daily
- Only a single dose needed along with Imfinzi (durvalumab) for hepatocellular carcinoma (HCC)
- Uses your own immune system to attack the cancer
Cons
- Commonly causes rash, fatigue, and nausea
- Can cause rare but serious immune-related side effects
- Requires monitoring time after infusion to check for infusion reactions
Pharmacist tips for Imjudo (tremelimumab)
- Imjudo (tremelimumab) is given as an infusion through the vein (IV). It’s uncommon, but some people have reactions to the IV infusion. You’ll be monitored for an hour after finishing your Imjudo (tremelimumab) infusion to make sure you don’t have any reactions to the treatment. Let your healthcare team know immediately if you notice any signs of an infusion reaction, like trouble breathing, dizziness, chest pain, flushing, or chills during or after the infusion. They can pause the infusion and manage your symptoms. Once the reaction is under control, they can restart the infusion at a slower rate, and give you medications to prevent reactions in the future.
- It’s common to have rash with Imjudo (tremelimumab) that can be itchy. Let your healthcare team know if you have a worsening rash, blisters, or peeling skin. They might recommend other treatments for your rash and have you take a break from Imjudo (tremelimumab) while your skin returns to normal.
- Fatigue is a common side effect of cancer treatments including Imjudo (tremelimumab). If you feel tired or weak, do your best to stay well-rested, eat well, and stay hydrated. Light exercise and movement can also help prevent fatigue. You might need to adjust your routine to schedule activities when you have more energy.
- Diarrhea is another common Imjudo (tremelimumab) side effect. Keep track of your bowel habits to make sure you’re having regular bowel movements while taking this medication. Contact your healthcare team if you notice blood or mucus in your stool, have severe stomach pain, or are having more bowel movements a day than usual. They’ll check if you have an infection that’s causing your diarrhea, make sure the diarrhea isn’t making you dehydrated, and recommend strategies or medications to manage the diarrhea.
- Immune-related adverse events are rare but serious side effects of immunotherapy, including Imjudo (tremelimumab). These side effects can happen to any part of your body at any time, even after you’ve stopped taking this medication. Your provider will monitor your blood tests to check if you have signs of these reactions. Keep track of how you’re feeling, and contact your provider if you notice anything out of the ordinary with your body, such as new or worsening shortness of breath, skin changes, chest pain, vision changes, or muscle and joint soreness.
- Imjudo (tremelimumab) is likely to cause harm or death to the unborn baby, based on studies done in animals. If you’re able to become pregnant, your provider will have you do a pregnancy test before starting this medication. Use birth control while on Imjudo (tremelimumab) and for 3 months after stopping this medication.
- There aren’t any studies about whether Imjudo (tremelimumab) is safe while breastfeeding, so you should avoid breastfeeding while taking Imjudo (tremelimumab) and for at least 3 months after stopping the medication.
Common questions about Imjudo (tremelimumab)
No. Imjudo (tremelimumab) is an immunotherapy, which works by turning your immune system on to attack cancer cells. This is unlike traditional chemotherapy, which directly attacks rapidly dividing cells (including tumor cells). Talk with your provider if you have more questions about the differences between immunotherapy and chemotherapy.
Usually, the Imjudo (tremelimumab) infusion takes about an hour. When you receive Imjudo (tremelimumab) for the first time, your provider will ask you to stay for about an hour afterward so they can make sure you don’t have an infusion reaction. If your first infusion goes smoothly, you won’t need to stay as long after future doses. Keep in mind that after you’ve finished the Imjudo (tremelimumab) infusion and monitoring time, your provider will also give you other infusions that are part of your treatment plan. Depending on what other infusions you’re scheduled to receive as part of your treatment, your appointment might take most of the day. Make sure to wear comfortable clothing, pack some snacks and water, and bring something (like books or music) to help pass the time.
In general, immunotherapy, like Imjudo (tremelimumab), takes longer to work than traditional chemotherapy, so you might not notice any signs that the medication is working at the start of your treatment. Instead, you might need to take it for a few months to see how it's affecting the cancer. During treatment, your provider will ask how you’re feeling, check blood tests, and do scans every few weeks to see how the cancer is responding to the medication. If your symptoms aren’t getting worse, and your cancer isn’t growing or spreading based on those tests, those are good signs that the treatment is working. Check in with your provider to see how often you need to come in for physicals and tests.
How long you’ll need to take Imjudo (tremelimumab) depends on the reason you’re taking the medication, how well your cancer responds to the medication, and whether you have side effects from the medication. For liver cancer, you’ll only need 1 dose of Imjudo (tremelimumab), but you’ll continue Imfinzi (durvalumab) for as long as it continues to keep your cancer from growing. For lung cancer, you’ll receive up to a maximum of 5 Imjudo (tremelimumab) doses, but you’ll continue Imfinzi (durvalumab) and platinum-based chemotherapy as long as your lung cancer doesn’t get worse.
If you have diarrhea or more bowel movements a day than usual, contact your healthcare team. They can order tests to see if there’s something other than your cancer treatment that’s causing the diarrhea. If appropriate, your provider can also recommend medications or other strategies to manage the diarrhea. For example, it’s important to drink plenty of fluids, since frequent loose stools can lead to dangerous dehydration. You should also avoid foods that irritate the gut, like fried foods, spicy foods, coffee, and prune juice. Keep track of the amount and frequency of your bowel movements so you can identify patterns in your symptoms.
Rash and itching are common, mild side effects of Imjudo (tremelimumab). To prevent rash and itching, use alcohol-free, unscented moisturizer. Let your healthcare team know if you notice any new or worsening rashes, peeling, or blistering while taking Imjudo (tremelimumab). These might be signs of more serious side effects that need immediate medical attention. Depending on how severe your condition is, your provider might recommend medications, such as corticosteroids, to lower the inflammation causing the rash. Or, they might have you take a break from Imjudo (tremelimumab) while your skin clears up.
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Risks and warnings for Imjudo (tremelimumab)
Imjudo (tremelimumab) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Immune-related adverse events
Imjudo (tremelimumab) works by activating the immune system to attack cancer. But in some people, the immune system can become overactive and cause very serious immunotherapy side effects. These reactions can happen any time after you start Imjudo (tremelimumab) treatment. Most commonly, they affect the lungs, gut, and skin, but they can affect any part of the body.
Before each Imjudo (tremelimumab) dose, your provider will check your blood tests to see if your organs are healthy. Let your provider know if you have new or worsening breathing problems, rash, or diarrhea. Those could be signs of rare, serious immunotherapy side effects.
If you experience an immune-related side effect, it’s important that you get medical attention as soon as possible to lower the risk of serious damage. Your provider might have you take a break from Imjudo (tremelimumab) while checking up on you. They might also recommend steroids or other medications to stop the inflammation from the overactive immune system.
Infusion-related reactions
Some people had reactions to the Imjudo (tremelimumab) infusion, which in rare cases was life-threatening. Alert your healthcare team if you have trouble breathing, chills, flushing, upset stomach, or chest discomfort with the infusion. They’ll pause the infusion and give you medication to manage your symptoms. If the infusion reaction isn’t serious, they’ll resume the Imjudo (tremelimumab) infusion at a slower rate to make sure you’re doing well with the infusion. They might also give you medications to take before your Imjudo (tremelimumab) infusion to prevent reactions in the future.
Harm to the unborn baby
Based on how Imjudo (tremelimumab) works and on animal studies, Imjudo (tremelimumab) is likely to cause harm to the unborn baby. If you’re able to have children, your provider will ask you to do a pregnancy test before starting Imjudo (tremelimumab). Use birth control if you’re taking Imjudo (tremelimumab), and continue using birth control until 3 months after stopping the medication. If you become pregnant while taking Imjudo (tremelimumab), let your healthcare team know right away.
Imjudo (tremelimumab) dosage
Typical dosage for Imjudo (tremelimumab)
Your provider will determine your Imjudo (tremelimumab) treatment schedule based on the cancer type. You’ll also receive other medications, like Imfinzi (durvalumab) and/or chemotherapy, as part of your treatment plan, sometimes even on the days you’re not receiving Imjudo (tremelimumab).
- Liver cancer (adults who weigh 66 lbs or more): The typical dose is 300 mg infused through the veins (IV) on Day 1 of your first treatment cycle only.
- NSCLC (adults who weigh 66 lbs or more): The typical dose is 75 mg infused through the veins (IV) for a maximum of 5 doses.
- Cycles 1 to 4: Once every 3 weeks during the first 4 treatment cycles.
- Cycle 5: No Imjudo (tremelimumab) infusion.
- Cycle 6: Once on Day 1 of the 6th treatment cycle.
Your dose will be different if your body weight is less than 66 lbs.
Imjudo (tremelimumab) images
