IPILIMUMAB

By Gary M. White, MD

Note, this is a brief summary only and is meant to emphasize dermatologic aspects. More complete information, including the package insert and recent studies should be consulted before prescribing.


Ipilimumab (Yervoy) is FDA-approved for the treatment of melanoma. It is a monoclonal antibody that activates the immune system by targeting CTLA-4, a protein receptor that down-regulates the immune system. It has been reported to cause dermatomyositis [JAMA Derm 2015;151;195].

Indications

YERVOY is a human cytotoxic T-lymphocyte antigen 4 (CTLA-4)-blocking antibody indicated for: • Treatment of unresectable or metastatic melanoma. (1.1) • Adjuvant treatment of patients with cutaneous melanoma with pathologic involvement of regional lymph nodes of more than 1 mm who have undergone complete resection, including total lymphadenectomy.

YERVOY is also FDA approved for the treatment of unresectable or metastatic melanoma in pediatric patients 12 years of age or older.

Vitiligo-Like Hypopigmentation

The incidence of vitiligo-like hypopigmentation in patients treated with ipilimumab is about 2%. Treatment is observation and sun protection. Does this side effect portend a better therapeutic response?

Pruritus

Pruritus occurs in 30% of patients. Itching can be severe. Treatment includes topical steroids, oral antihistamines, and emollients. In severe cases, gabapentin, oral steroids, and pregabalin may be considered.

Maculopapular Rash

A maculopapuluar rash is common in patients treated with ipilimumab.

RegionalDerm

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