Ipilimumab for advanced melanoma: a nursing perspective.
OBJECTIVE
To discuss the response patterns and side effects related to ipilimumab, a new immunotherapeutic agent under investigation in the treatment of advanced melanoma and other malignancies.


METHODS
Published articles, abstracts, research data, and clinical experience.


RESULTS
Ipilimumab is a fully human monoclonal antibody that inhibits the activity of cytotoxic T-lymphocyte antigen-4 (CTLA-4), a naturally immunosuppressive molecule. The most common side effects are immune mediated (e.g., inflammatory diarrhea, pruritus) and appear to occur as a direct result of CTLA-4 inhibition and enhanced immune system activation. Side effects generally are grade I or II and resolve with standard treatments. Most grade III or IV events are managed successfully after swift diagnosis and treatment with corticosteroids; steroid-refractory events resolve after treatment with infliximab or mycophenolate.


CONCLUSIONS
The response patterns and side effects associated with ipilimumab therapy greatly differ from those common to other advanced melanoma therapies (e.g., chemotherapy, cytokines, vaccines).


CONCLUSIONS
Nurses have an important role in educating patients about the differences between anti-CTLA-4 therapy and chemotherapy. In addition, teaching patients to recognize ipilimumab's side effects and report them early can result in fast treatment to prevent symptom progression from grade I or II to III or IV. Communication between nurses and patients throughout the treatment process will help patients benefit maximally from the new therapeutic strategy.
Ledezma
Blanca
B
Angeles Clinic and Research Institute, Santa Monica, CA, USA. bledezma@theangelesclinic.org
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015703:Antigens, CD / Q000276:immunology; D060908:CTLA-4 Antigen; D056486:Chemical and Drug Induced Liver Injury / Q000188:drug therapy / Q000209:etiology; D002986:Clinical Trials as Topic; D003967:Diarrhea / Q000139:chemically induced / Q000178:diet therapy / Q000188:drug therapy; D003875:Drug Eruptions / Q000209:etiology; D005260:Female; D006801:Humans; D007111:Immunity, Cellular; D007155:Immunologic Factors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007376:Interleukin-2 / Q000008:administration & dosage / Q000627:therapeutic use; D000074324:Ipilimumab; D008545:Melanoma / Q000188:drug therapy* / Q000276:immunology / Q000451:nursing / Q000473:pathology; D008875:Middle Aged; D024802:Nurse's Role; D010353:Patient Education as Topic; D010900:Pituitary Diseases / Q000139:chemically induced; D011537:Pruritus / Q000139:chemically induced; D016879:Salvage Therapy; D013602:T-Lymphocytes, Cytotoxic / Q000187:drug effects / Q000276:immunology
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D015703:Antigens, CD; D060908:CTLA-4 Antigen; C556706:CTLA4 protein, human; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D007376:Interleukin-2; D000074324:Ipilimumab