The use of corticosteroids to treat ipilimumab side effects in metastatic melanoma

This study investigated the effects on the immune system associated with the use of ipilimumab (Yervoy) to treat melanoma. Researchers suggested that one-third of the patients treated with ipilimimuab required treatment for the negative side effects. 

Ipilimumab is an antibody that helps the immune system to combat tumor cells. It is a standard treatment for metastatic (spread to other parts of the body) melanoma. However, negative side effects associated with the immune system are very common and can be severe. Ipilimumab treatment can lead to the immune system attacking healthy cells in the body. These negative effects are normally treated with corticosteroids or anti-TNFalpha antibodies, treatments that reduce the strength of the immune system. The incidence rate of immune side effects associated with ipilimumab that require treatment is still unclear.

The objective of this study was to investigate the frequency of use of corticosteroids and anti-TNF alpha therapy. The effect of these treatments on overall survival (OS, time from treatment until death from any cause) and time to treatment failure (TTF; time from ipilimumab treatment to disease progression or death) was also investigated.

This study included information about 298 metastatic melanoma patients treated with ipilimumab. Negative immune side effects were experienced by 254 (85%). The most common effect was diarrhea (in 14% of the patients). 19% of patients experienced severe side effects causing them to stop treatment.

103 patients (35%) required treatment with corticosteroid. The most common reasons for starting treatment were diarrhea (48.5%), liver inflammation (21.3%), and skin inflammation (20.3%). 31 of these patients also required treatment with an anti-TNF alpha therapy following corticosteroid treatment. 

The average OS was 16.5 months, with a 2-year OS rate of 39%. The average TTF was 5.7 months. No difference in OS or TTF was detected when patients experienced negative immune side effects and/or were treated with corticosteroids.  

This study suggested that immune side effects are common, and one-third of patients receiving ipilimumab required treatment with corticosteroids.