Tarhini, A. (2013). Immune-mediated adverse events associated with ipilimumab CTLA-4 blockade therapy: The underlying mechanisms and clinical management. Scientifica, 2013, 857519.
DOI Link
Purpose & Patient Population
PURPOSE: To review ipilimumab adverse effects, mechanisms of action, and management
TYPES OF PATIENTS ADDRESSED: Adults receiving ipilimumab
Type of Resource/Evidence-Based Process
RESOURCE TYPE: Expert opinion
Phase of Care and Clinical Applications
PHASE OF CARE: Active antitumor treatment
Results Provided in the Reference
N/A
Guidelines & Recommendations
Dermatologic: Topical corticosteroids are recommended for persistent grade 1–2 skin effects. Oral prednisone is recommended for persistent skin effects or grade 3–4 effects. IV prednisone is recommended for grade 4 effects. Drug interruption is recommended for grade 3 and permanent discontinuation for grade 4.
Gastrointestinal: Loperamide or lomotil and fluid/electrolyte replacement are recommended for grade 1 diarrhea. Corticosteroids are recommended for persistent grade 2 diarrhea. For grade 3–4 diarrhea, discontinue ipilimumab and give high-dose IV steroids. Consider infliximab if no improvement occurs with IV steroids.
Limitations
Expert opinion level evidence only
Nursing Implications
Patients receiving immunotherapy need to be monitored for immune-related adverse events, and quickly managed appropriately to prevent more severe complications. In addition, nurses should be aware of potential side effects of systemic steroid therapy if initiated.