Ipilimumab

INTRODUCTION

Indications

Treatment of unresectable/metastatic melanoma.

Action

Binds to cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4). CTLA-4 is a negative regulator of T-cell activation; binding results in augmented T-cell activation and proliferation. Therapeutic Effects: ↓ spread of melanoma.

Adverse Reactions/Side Effects

CNS: fatigue. EENT: immune-mediated ocular disease. GI: IMMUNE-MEDIATED COLITIS, IMMUNE-MEDIATED HEPATITIS, colitis, diarrhea. Derm: IMMUNE-MEDIATED DERMATITIS, INCLUDING TOXIC EPIDERMAL NECROLYSIS, pruritus, rash. Endo: IMMUNE-MEDIATED ENDROCRINOPATHIES, INCLUDING HYPOPITUITARISM, HYPOTHYROIDISM, HYPERTHYROIDISM, ADRENAL INSUFFICIENCY, CUSHING's SYNDROME, AND HYPOGONADISM. Neuro: IMMUNE-MEDIATED NEUROPATHY.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for the following immune-mediated responses, and report these responses to the physician or nursing staff immediately.

  • ∘ Colitis (diarrhea, abdominal pain, cramps, nausea, fecal incontinence).

  • ∘ Hepatitis (anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, skin rashes, flu-like symptoms, muscle/joint pain).

  • ∘ Skin reactions (severe rash, dermatitis, exfoliation, epidermal necrolysis).

  • ∘ Thyroid dysfunction, including hyperthyroidism (tachycardia, nervousness, heat intolerance, weight loss, muscle wasting), or hypothyroidism (bradycardia, lethargy, cold intolerance, weight gain, muscle weakness).

  • ∘ Neuropathy (numbness, tingling, pain, weakness).

  • ∘ Adrenal dysfunction, including adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) or Cushing's syndrome (puffiness in the face, increased abdominal fat, thin arms and legs, abdominal skin striations, changes in skin pigmentation, bruising, deposition of fat behind the base of the neck).

  • ∘ Hypopituitarism (fatigue, weight loss, decreased libido, hot flashes in women, cold intolerance, anemia, alopecia, stunted growth in children).

  • ∘ Ocular disease (blurred vision, loss of vision, other vision problems).

Interventions

• For patients who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to maintain muscle strength and aerobic capacity during cancer chemotherapy or to help restore function after chemotherapy.

• Because of numerous immune-mediated problems, use caution during aerobic exercise and endurance conditioning because of potential pulmonary toxicity. Terminate exercise if patient exhibits untoward symptoms (chest pain, shortness of breath, unusual fatigue) or displays other criteria for exercise termination (See Appendix L).

Patient/Client-Related Instruction

• Instruct patient or family/caregivers to report other bothersome side effects such as severe or prolonged skin reactions (rash, itching) or GI problems (diarrhea, abdominal pain).

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Crosses the placenta

Metabolism and Excretion: Unknown

Half-life: 14.7 days

Contraindications/Precautions

Contraindicated in: Lactation: Avoid breast-feeding.