Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2013 Jun;18(6):733-43.
doi: 10.1634/theoncologist.2012-0483. Epub 2013 Jun 17.

Ipilimumab and its toxicities: a multidisciplinary approach

Leslie A Fecher  1 , Sanjiv S Agarwala, F Stephen Hodi, Jeffrey S Weber
Affiliations
Review

Ipilimumab and its toxicities: a multidisciplinary approach

Leslie A Fecher et al. Oncologist. 2013 Jun.

Abstract

The treatment for metastatic melanoma has evolved significantly in the past few years. Ipilimumab, an immunotherapy, is now in mainstream oncology practice given that it has shown improved overall survival in randomized clinical trials. Other immune modulating agents, such as programmed death receptor-1 and programmed death receptor ligand-1 antibodies, are showing promise in early clinical trials. This manuscript will review ipilimumab and its most common side effects. Immune-related adverse events (irAEs) are important to recognize early, and their presentation, timing of onset, and general recommendations for workup and management will be reviewed. Assembling a multidisciplinary team, as well as thorough education of the patient, is recommended to optimize patient care.

Keywords: AEOSI; Antibody; CTLA-4; Immune-mediated toxicity; Ipilimumab; Melanoma; immune-related adverse events.

PubMed Disclaimer

Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

Figures

Figure 1.
Figure 1.
T-cell activation, inactivation, and proliferation. (A): T-cell activation occurs via costimulatory binding of B7 to CD28. (B): CTLA-4 is upregulated in malignancy and binds B7, thus inhibiting T-cell activation. (C): Antagonism of CTLA-4 via ipilimumab promotes T-cell activation/proliferation. (Reprinted with permission [11].) Abbreviations: APC, antigen presenting cell; CTLA-4, cytotoxic T-lymphocyte antigen-4; TCR, T-cell receptor; MHC, major histocompatibility complex.
Figure 2.
Figure 2.
Algorithm for skin irAE management.
Figure 3.
Figure 3.
Lund Browder chart for estimating body surface area involved by rash. (Adapted from [30].)
Figure 4.
Figure 4.
Algorithm for gastrointestinal irAE management.
Figure 5.
Figure 5.
Algorithm for hepatic irAE management.
Figure 6.
Figure 6.
Algorithm for endocrine irAE management.
See this image and copyright information in PMC

Comment in

References

    1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10–29. - PubMed
    1. Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27:6199–6206. - PMC - PubMed
    1. Tsao H, Atkins MB, Sober AJ. Management of cutaneous melanoma. N Engl J Med. 2004;351:998–1012. - PubMed
    1. Hodi FS, O'Day SJ, McDermott DF, et al. Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010;363:711–723. - PMC - PubMed
    1. Robert C, Thomas L, Bondarenko I, et al. Ipilimumab plus dacarbazine for previously untreated metastatic melanoma. N Engl J Med. 2011;364:2517–2526. - PubMed

MeSH terms