Ipilimumab (RCC — in Combination)

How it works

It blocks CTLA-4 on T cells, removing an inhibitory signal and augmenting T-cell activation and proliferation against tumour cells.

Prescribing in practice

• It causes immune-related adverse events that can affect any organ system (including colitis, hepatitis, pneumonitis, endocrinopathies and skin reactions) and may be severe or life-threatening, requiring prompt corticosteroid or immunosuppressive management per protocol.
• Immune toxicities are more frequent and severe with combination ipilimumab plus nivolumab than with single-agent checkpoint inhibition.
• Endocrinopathies such as hypophysitis and thyroid dysfunction may present non-specifically and can be irreversible; assess against the SPC and local immunotherapy pathways.

Monitoring

Monitor liver function, thyroid and other endocrine function, blood glucose and clinical symptoms before each cycle and review for emergent immune-related toxicity throughout treatment.

Counselling the patient

• Report new or worsening symptoms promptly, including diarrhoea, breathlessness, rash, severe fatigue or unusual thirst.
• Carry an alert card noting you are receiving immunotherapy.
• Side effects can appear weeks or months after treatment, so keep reporting new symptoms.

Evidence & guidelines

The CheckMate 214 trial established ipilimumab plus nivolumab for intermediate/poor-risk advanced renal cell carcinoma, and it is recommended by NICE.