Yervoy (ipilimumab)

Yervoy® (ipilimumab) is a type of immunotherapy. It is used to treat melanoma that:1

  • Cannot be removed with surgery (unresectable) or
  • Has spread to distant parts of the body (metastasized)

Yervoy is also used as an adjuvant therapy. Adjuvant therapy is an additional cancer treatment that is given after the primary (main) treatment. Adjuvant therapy can help lower the risk that the cancer comes back. Yervoy is used for stage III melanoma after the skin tumor and lymph nodes are removed with surgery.1

Yervoy can be used alone or with a medication called Opdivo® (nivolumab). Yervoy does not come in generic form.

How does Yervoy work?

Yervoy “removes the brakes” on your immune system’s T-cells. T-cells (T-lymphocytes) are a type of white blood cell.2 T-cells fight cancer and infection. They travel through the body, and when they identify foreign (unhealthy) cells, they become active fighter cells (Figure A below).

A receptor called CLTA-4 acts like a brake on the T-cells. If CTLA-4 binds (connects) with certain proteins on melanoma cells, the T-cell does not become active. Instead, the T-cell leaves the melanoma cell alone (Figure B below).3

Yervoy binds to the CTLA-4 receptor and blocks it (Figure C below).1,3 By removing the brakes, the T-cell can become active and attack the cancer cell.

CTLA-4 stands for “cytotoxic T lymphocyte antigen-4.” Yervoy may described as:

  • immune checkpoint inhibitor
  • anti-CLTA-4 antibody
  • CTLA-4 blocking antibody
Ipilimumab
Ipilimumab
Ipilimumab

How effective is Yervoy?

Yervoy improves progression-free and overall survival of patients with unresectable or metastatic melanoma.4 When used as adjuvant therapy, Yervoy prolongs survival time without recurrence.4

Primary treatment for unresectable or metastatic melanoma. Yervoy was studied in 676 people with unresectable or metastatic melanoma. The response rate to Yervoy was about 11%.5 “Response” has to do with whether the tumor shrinks or grows more slowly while on treatment. Response is only about tumor changes and it does not measure whether you—as a whole patient—have improved. Response is also different from survival. Response to treatment can be partial or complete.

Median overall survival was 10 months. Survival rates in the patients treated with Yervoy were:5

  • About 46% at 12 months
  • About 33% at 18 months
  • About 24% at 24 months

A long-term follow up study showed that 18.2% of patients treated with Yervoy plus chemotherapy were alive 5 years after starting treatment.4,6

Adjuvant treatment after lymph node dissection. In a high-quality study, 951 patients with stage III melanoma were randomly assigned to Yervoy or placebo.7 These patients had already had surgery to remove the skin tumor and affected lymph nodes.

The median recurrence-free survival time was 26.1 months for people who received Yervoy.7 This means that 26.1 months after starting treatment, half of the group had cancer recurrence and half had not. In the placebo group, median recurrence-free survival time was 17.1 months. At 3 years after treatment, 46.5% people in the Yervoy group were still cancer free, compared with 34.8% of the placebo group.

Opdivo plus Yervoy. Opdivo is another immunotherapy. It works on a different receptor than Yervoy to prevent cancer cells from hiding from your immune system. Using these two medications together may increase the time until the cancer progresses.

This combination was studied in 945 patients with metastatic melanoma. Study participants were assigned to treatment with Opdivo or Yervoy or both.8 The patients in this study had never been treated with medication for melanoma. In each arm, the percentage who responded to treatment were:9

  • Opdivo + Yervoy: 50%
  • Opdivo: 40%
  • Yervoy: 14%

The median progression-free survival was:8

  • Opdivo + Yervoy: 11.5 months
  • Opdivo: 6.9 months
  • Yervoy: 2.9 months

This study is still ongoing. More results, including overall survival outcomes, should be coming.

How is Yervoy given?

Before taking Yervoy, read the Medication Guide that comes in the package. Follow your doctor’s instructions for taking Yervoy. Talk to your doctor about how often and how many treatments you will need.

Yervoy is taken through an intravenous (IV) line. Your doctor will administer Yervoy. It takes about 90 minutes to administer the medication.1

Patients with metastatic or unresectable melanoma usually receive Yervoy every 3 weeks.1 A total of 4 doses are given. If you are receiving Yervoy with Opdivo, you will receive both medications on the same day.9

Yervoy is used differently as adjuvant treatment.1 A higher dose is used. The first 4 doses are given every 3 weeks. After that, you will receive a dose of Yervoy every 12 weeks for up to 3 years.

What are the side effects of Yervoy?

The most common side effects of Yervoy are:1

  • Feeling tired
  • Diarrhea
  • Rash or itchy skin
  • Nausea and vomiting
  • Headache
  • Weight loss
  • Fever
  • Decreased appetite
  • Sleep difficulty

Rare but serious possible side effects of Yervoy are:

  • Intestinal inflammation (colitis)
  • Liver inflammation (hepatitis)
  • Skin problems and severe skin reaction
  • Nerve problems that can lead to paralysis
  • Problems with hormone glands (pituitary, adrenal, and thyroid)
  • Eye problems

Who should not take Yervoy?

Yervoy can harm an unborn baby.1 Women who could become pregnant should use effective birth control during treatment. Continue using birth control for at least 3 months after the last dose of Yervoy. Do not breastfeed during treatment with Yervoy or for 3 months after.

Tell your doctor about any medical conditions you have, especially:1

  • Immune system problems (such as Crohn’s disease, ulcerative colitis, lupus, or sarcoidosis).
  • Previous organ transplant.
  • Liver problems.

What precautions are needed when taking Yervoy?

You will need regular blood tests to check for side effects of Yervoy. Your doctor may prescribe corticosteroids or hormone replacement medicines to treat certain side effects.1

Women who can become pregnant should use birth control during and for at least 3 months after treatment.1 Women should not breastfeed during treatment or for 3 months after receiving Yervoy.

Written by: Sarah O'Brien | Last reviewed: May 2017.
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