Ipilimumab (Yervoy)

Ipilimumab is a type of immunotherapy. It is also known as Yervoy.

It is a treatment for a number of different cancer types. You also might have it as part of a clinical trial.

You pronounce ipilimumab as ih-pih-lih-moo-mab.

Depending on your cancer type you might have it in combination with other cancer drugs.

How does ipilimumab work?

Ipilimumab works by blocking a protein that stops your immune system from working properly and attacking cancer cells. It helps to make your immune system find and kill cancer cells. 

How do you have ipilimumab?

You have ipilimumab as a drip into your bloodstream (intravenously).

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

How often do you have ipilimumab?

You have ipilimumab as cycles of treatment. This means that you have the drug and then a rest to allow your body to recover.

You usually have ipilimumab every 3 weeks. You have up to 4 treatments. 

You have ipilimumab over 30 or 90 minutes each time, depending on your cancer type.

You might have it with another type of immunotherapy drug called nivolumab. This is a standard immunotherapy combination for some cancer types.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of ipilimumab?

Side effects can vary from person to person. They also depend on what other treatment you are having. 

When to contact your team

Your doctor, pharmacist or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

High temperature (fever)

Tell your healthcare team straightaway if you get a high temperature. Ask them if you can take paracetamol to help lower your temperature.

Skin rash

A rash can also be itchy. Less commonly your skin might go red, get dry and develop pale white patches of skin (vitiligo). Rarely you might develop a condition that looks like scalding of the skin, or your skin may peel.

Let your doctor or nurse know if you get any skin rash or a rash that gets worse, or you’re worried about any other changes to your skin.

Diarrhoea

Contact your advice line if you have 4 loose watery poos (diarrhoea) or more in 24 hours. Or if you have diarrhoea for more than 3 days. Or if you can't drink to replace the lost fluid. Also, call if you have blood or mucus in your poo, your poo looks darker than usual, or if you develop pain in your tummy (abdomen).

Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty of liquid to replace the fluid lost.

Loss of appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Tiredness and weakness (fatigue)

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Tell your team if you feel tired and weak, you may need a blood test to check your hormone levels.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Inflammation around the injection site

Tell your nurse if you notice any signs of redness or irritation around the injection site.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• changes to hormone levels in your body
• changes to the pituitary gland which can affect how well it works
• breathing problems – symptoms include shortness of breath and a cough
• headaches and dizziness – call your advice line if you have these symptoms
• inflammation of the bowel – rarely you may develop an ulcer or hole in the bowel wall (perforation)
• shivering (chills) or flu-like symptoms
• low levels of red blood cells (anaemia) – you might feel tired, short of breath and look pale
• pain in the area of your cancer, tummy, joints, bones, or muscles
• changes to the levels of minerals in your body – you have blood tests to check this
• not enough fluid in your body (dehydration)
• feeling confused
• numbness, tingling and pain in your hands and feet
• eye problems including blurred vision and pain - tell your doctor straight away if any problems with your eyesight
• low blood pressure – you may feel dizzy, lightheaded, or may faint
• reddening of your face and neck (flushing), feeling warm (hot flush), or night sweats
• bleeding from your stomach or bowel
• constipation
• acid reflux
• liver changes that are picked up on blood tests - call your advice line if you have yellowing of the skin or eyes (jaundice), dark urine or pain on your right side of tummy
• hair loss or thinning, rarely your hair may change colour
• muscle spasms and less commonly muscle twitching or jerking
• fluid build up causing swelling in the body (oedema)
• weight loss
• sore mouth (mucosal inflammation)

Rare side effects

This side effects happens in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

• increased risk of infection that can be life threatening – symptoms might include fever, cough, blocked or runny nose, and headache
• a serious reaction to an infection - signs can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering - contact your advice line straight away if you have any of these symptoms
• a serious infection to the inner lining of your tummy
• inflammation of tissues covering the brain and spinal cord (aseptic meningitis) - symptoms might include fever, headaches, neck pain or stiffness, feeling or being sick or sensitivity to light
• the immune system attacking the nervous system (Guillain-Barre syndrome) - causing numbness, weakness and pain in the body
• low platelets which means you may bruise and bleed easily
• an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness
• problems with the brain including swelling
• inflammation of parts of your body including the blood vessels, liver, lungs, kidneys or pancreas
• high levels of chemicals in your blood due to the breakdown of tumour cells (tumour lysis syndrome) - you have regular blood tests to check for this
• mood changes, feeling depressed, or loss of interest in sex
• tremor
• fainting
• problems with coordination, speech and balance
• muscle stiffening or muscle weakness
• an abnormal heart beat
• problems with your blood vessels including inflammation or blood vessel thickening
• stomach ulcer – symptoms include pain, burping, heartburn, and indigestion
• kidney problems – symptoms include not peeing enough, unable to pee (retention), passing blood, or confusion
• periods stopping (amenorrhea)

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Pregnancy and contraception

It is unknown whether treatment may or may not harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment. Let your team know straight away if you or your partner become pregnant while having treatment.

Talk to your doctor or nurse about effective contraception you can use during treatment. Ask how long you should use it before starting treatment and after treatment has finished.

Fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.