Yervoy
Yervoy (ipilimumab) is an immunotherapy medication that’s used to treat several different types of cancer, such as melanoma, non-small cell lung cancer, and renal cell cancer (a type of kidney cancer). It works by turning on your immune system to attack cancer cells. Yervoy (ipilimumab) is given as an injection into the vein (intravenously or IV) at an infusion center or provider’s office. It’s typically given together with another medication called Opdivo (nivolumab). Yervoy (ipilimumab) can cause immune-related side effects such as diarrhea, rash, and trouble breathing.
What is Yervoy (ipilimumab)?
What is Yervoy (ipilimumab) used for?
- Melanoma
- Advanced or metastatic melanoma; by itself or with Opdivo (nivolumab)
- Melanoma that’s been removed by surgery; by itself
- Advanced renal cell carcinoma; with Opdivo (nivolumab)
- Metastatic colorectal cancer after previous treatment with chemotherapy; with Opdivo (nivolumab)
- Advanced liver cancer that was previously treated with Nexavar (sorafenib); with Opdivo (nivolumab)
- Metastatic non-small cell lung cancer (NSCLC) in people with PD-L1 expression; with Opdivo (nivolumab) and with or without additional chemotherapy
- Advanced malignant pleural mesothelioma; with Opdivo (nivolumab)
- Advanced or metastatic esophageal cancer; with Opdivo (nivolumab)
How Yervoy (ipilimumab) works
Your immune system plays an important role in our body (for example, to fight bacterial infections). The immune system can also help attack and kill cancer cells that it recognizes as abnormal. Some cancer cells can hide from the immune system by using the CTLA-4 pathway. When a cancer cell uses the CTLA-4 pathway, it stops our immune cells from attacking the cancer cell. This allows the cancer to grow.
Yervoy (ipilimumab) is an immunotherapy medication that blocks the CTLA-4 pathway; it’s known as a CTLA-4 inhibitor. By blocking this pathway, the medication helps the immune system recognize and attack cancer cells. As a result, the immune system can kill the cancer cells and stop the cancer from growing.
Drug facts
More on Yervoy (ipilimumab) essentials
Side effects of Yervoy (ipilimumab)
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
When used by itself:
- Tiredness (up to 51%)
- Rash (up to 50%)
- Diarrhea (up to 49%)
- Higher liver enzyme levels (up to 46%)
- Itching (up to 45%)
- Anemia (up to 41%)
- Muscle pain (up to 36%)
- Headache (up to 33%)
- Weight loss (up to 32%)
- Nausea (up to 31%)
- Lower white blood cells (up to 29%)
- Changes in blood sugar levels (up to 26%)
- Lower appetite (up to 24%)
- Cough (up to 22%)
Less Common Side Effects
- Vomiting
- Fever
- Joint pain
- Trouble breathing
Yervoy (ipilimumab) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious immune-related side effects: rash, diarrhea, trouble breathing, severe stomach pain, chest pain
- Serious reaction during infusion: itching, trouble breathing, fast heart beat, feeling warm or hot
The following Yervoy (ipilimumab) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
More common
Bloody, black, or tarry stools
indigestion
itching, skin rash
severe stomach pain, cramping, or burning
unusual tiredness or weakness
vomiting
vomiting of material that looks like coffee grounds, severe and continuing
watery or bloody diarrhea
Less common
Blistering, crusting, irritation, itching, or reddening of the skin
bloody or cloudy urine
blurred vision or other changes in vision
burning, dry, or itching eyes
burning, tingling, numbness or pain in the hands, arms, feet, or legs
chills
clay-colored stools
cracked, dry, or scaly skin
dark urine
darkening of the skin
decreased appetite
decreased frequency or amount of urine
difficulty with breathing, chewing, swallowing, or talking
dizziness
double vision
drooping eyelids
drowsiness
eye discharge or excessive tearing
eye pain or sensitivity to light
fainting
headache, possibly severe
hives or welts
loss of appetite
mental depression
muscle weakness
pain, itching, burning, swelling, bleeding, or a lump under the skin where the needle was placed
painful or difficult urination
redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid
sensation of pins and needles
severe tiredness
sores, ulcers, or white spots on the lips or in the mouth
stabbing pain
stomach tenderness
swelling of the face, feet, or lower legs
swollen glands
unusual bleeding or bruising
unusual weight gain
yellow eyes or skin
Rare
blue or pale skin
chest pain, possibly moving to the left arm, neck, or shoulder
confusion
difficulty with moving
fast heartbeat
general feeling of discomfort or illness
increased thirst
lower back or side pain
muscle pain or stiffness
muscle weakness
pain or burning in the throat
pain, swelling, or redness in the joints
pains in the stomach or side, possibly radiating to the back
skin irritation or rash, including rash that looks like psoriasis
sores, welts, or blisters on the skin
stiff neck or back
Incidence not known
Back, leg, or stomach pains
blistering, peeling, or loosening of the skin
bleeding gums
general body swelling
inability to move the arms and legs
joint or muscle pain
nosebleeds
red irritated eyes
red skin lesions, often with a purple center
throbbing pain
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Yervoy (ipilimumab)
Pros
- Less likely to cause side effects that are common with traditional chemotherapy (such as nausea or hair loss)
- Given every 3 to 12 weeks so it doesn’t require frequent infusion appointments
- First-choice treatment for some people with melanoma skin cancer
Cons
- Might cause immune-related side effects like diarrhea, rash, and liver problems
- Might require breaks from treatment and a corticosteroid to manage side effects
- Given through an IV, which requires using a needle
Pharmacist tips for Yervoy (ipilimumab)
- Yervoy (ipilimumab) can cause immune-related side effects that can happen anywhere in your body. They can be signs that the medication made your immune system too active. Contact your provider right away if you have any new symptoms such as rash, diarrhea, trouble breathing, or severe fatigue.
- Ask your provider before using any over-the-counter medications to treat any side effects you might have from Yervoy (ipilimumab). Side effects caused by immunotherapy medications like Yervoy (ipilimumab) usually need to be quickly treated with a corticosteroid such as prednisone. Other medications you might otherwise use, such as diphenhydramine (Benadryl) for rash, won’t work as well.
- If you need to take a steroid like prednisone for a few weeks to help with any side effects, don’t stop taking the steroid medication suddenly because this can cause uncomfortable symptoms. When it’s time to stop the steroid medication, your provider will give you a plan to do so slowly and safely.
- Make sure to get your lab work done as your provider instructs you to during treatment with Yervoy (ipilimumab). Lab work helps your provider check for possible immune-related side effects that might not cause symptoms, such as kidney, liver, or thyroid problems. Your provider will contact you and make a treatment plan if they detect any changes in your lab test results.
- Yervoy (ipilimumab) can harm an unborn baby. If you’re able to have children, use reliable birth control while you’re getting treated with Yervoy (ipilimumab) and for 3 months after your last dose. Let your provider know if you become pregnant during or after treatment.
Common questions about Yervoy (ipilimumab)
Yervoy (ipilimumab) is an immunotherapy medication, which means it works by telling the immune system to turn on or activate. Sometimes, cancer cells can find ways to hide from the immune system, which allows them to keep growing. Yervoy (ipilimumab) works to make sure the immune system stays turned on so immune cells can find and attack cancer cells.
Cancer cells use many different methods to hide from the immune system so they can keep growing. For example, certain cancer cells can use the CTLA-4 and PD-1 pathways to avoid detection from the immune system. As a result, the immune system doesn’t attack and kill these cancer cells. While Yervoy (ipilimumab) blocks the cancer cells from using the CTLA-4 pathway, some cancer cells might also use the PD-1 pathway to dodge attacks from the immune system. So, using a second medication like Opdivo (nivolumab) together with Yervoy (ipilimumab) helps block both pathways at the same time. The two medications work together to help the immune system attack and kill cancer cells better.
Contact your provider right away if you have diarrhea, especially if you have at least 4 bowel movements more than what’s usual for you in one day. Diarrhea is a sign that the medication caused your immune system to become too active. Treatment for immune-related diarrhea is different from treatment for other types of diarrhea. So, it’s important that you don’t try to manage it at home with over-the-counter medications until you speak with your provider. Usually, treatment involves taking a corticosteroid like prednisone and a break from Yervoy (ipilimumab). Remember to stay hydrated, eat bland foods like apples and bread, and avoid foods that might make any diarrhea worse (e.g., alcohol, caffeine, greasy foods). These dietary changes won’t treat diarrhea, but they can help prevent it from getting any worse.
Hair loss isn’t a common side effect of Yervoy (ipilimumab). So if you’re taking Yervoy (ipilimumab) by itself, you shouldn’t lose your hair. But sometimes, Yervoy (ipilimumab) might be given along with chemotherapy, such as when it’s used to treat non-small cell lung cancer. It’s possible that the other cancer medications you take with Yervoy (ipilimumab) might cause hair loss. If that’s the case, hair usually grows back after you stop treatment. Speak with your provider about ways to manage hair loss if you experience this side effect.
It depends on how severe the immune-related side effect is. In most cases, you’ll need to pause Yervoy (ipilimumab) treatment and take a corticosteroid like prednisone if you have an immune-related side effect. This helps calm down your immune system. Then, if the side effect gets better, you might be able to restart Yervoy (ipilimumab). But in some cases, an immune-related side effect is serious enough that you’ll have to stop taking Yervoy (ipilimumab) altogether.
How long you take Yervoy (ipilimumab) depends on many factors, like what type of cancer you have, whether you’re taking it by itself or with other cancer medications, and whether you’re having any side effects from treatment. Sometimes (like for metastatic melanoma or advanced renal cell cancer), Yervoy (ipilimumab) is given for 4 doses only. Other times (like for malignant pleural mesothelioma), Yervoy (ipilimumab) is given every 6 weeks for as long as it’s working for you and as long as you don’t have severe side effects. Your provider will check your scan results to see how well treatment is working for you. Talk with your provider about how long you should take Yervoy (ipilimumab).
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Risks and warnings for Yervoy (ipilimumab)
Yervoy (ipilimumab) 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 side effects
Side effects from immunotherapy are typically called immune-related adverse events (irAEs). They happen when the immune system becomes too active and attacks healthy cells along with cancer cells. These side effects can happen anywhere in your body. They can be mild, serious, or even life-threatening. And they can happen at any time during treatment.
Some of these side effects, like changes in lab values that show how well your liver and kidneys are working, might not cause noticeable symptoms. You’ll need blood tests done often so your provider can monitor for those side effects closely. But you might notice certain other immune-related side effects, like diarrhea, skin rash, or shortness of breath. Call your provider right away if you experience any of these symptoms. You might need to pause or stop Yervoy (ipilimumab) and take a corticosteroid depending on how severe your symptoms are.
Infusion reactions
Rarely, people taking Yervoy (ipilimumab) have had severe or life-threatening reactions during their infusion. Let your nurse know right away if you feel itchy or warm, have trouble breathing, feel nauseous, or suddenly have a fast heart rate while receiving Yervoy (ipilimumab). Most of the time, giving the infusion slower can help. But sometimes, having a serious reaction means that you shouldn’t take Yervoy (ipilimumab) again to avoid having another reaction in the future.
Stem cell transplant complications
- Risk factors: People who’ve received a stem cell (bone marrow) transplant
Some people who’ve taken immunotherapy medications like Yervoy (ipilimumab) and who’ve also had a stem cell transplant have experienced serious problems like graft-versus-host-disease. If you’ve taken an immunotherapy medication like Yervoy (ipilimumab) and have also had a stem cell transplant, your provider will follow up with you closely for signs and symptoms of these problems.
Harm to unborn baby
Based on animal studies, Yervoy (ipilimumab) might harm an unborn baby or raise the risk for miscarriage (pregnancy loss) when taken during pregnancy. For this reason, if you’re able to get pregnant, your provider might require a negative pregnancy test before you start Yervoy (ipilimumab). You should use birth control while taking Yervoy (ipilimumab) and for 3 months after your last dose of medication. Let your provider know right away if you become pregnant while you’re taking Yervoy (ipilimumab).
Yervoy (ipilimumab) dosage
Typical dosage for Yervoy (ipilimumab)
Your provider will calculate your dose based on your body weight in kilograms. Your Yervoy (ipilimumab) dose will vary depending on the type of cancer that’s getting treated and the other medications in your treatment plan, such as Opdivo (nivolumab) or other chemotherapy.
In general, Yervoy (ipilimumab) is given as an infusion through the vein (IV) at an infusion center or a provider’s office.
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When Yervoy (ipilimumab) is used by itself: The typical dose is either 3 mg/kg given IV every 3 weeks for 4 doses only; or 10 mg/kg given IV every 3 weeks for the first 4 doses, then every 12 weeks for up to 3 years.
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When Yervoy (ipilimumab) is given together with Opdivo (nivolumab): A common dose for Yervoy (ipilimumab) is 1 mg/kg given IV either every 3 or every 6 weeks. Another common dose is 3 mg/kg given IV every 3 weeks.
Interactions between Yervoy (ipilimumab) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Tofacitinib
What are alternatives to Yervoy (ipilimumab)?
