Example orders for Ipilimumab (Yervoy) in melanoma

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Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.

Ipilimumab (Yervoy)

Original references may be found at Ipilimumab (Yervoy)

Example regimen #1

• Ipilimumab (Yervoy) 3 mg/kg IV on days 1, 22, 43, 64
  • Infuse via non-pyrogenic, low-protein-binding in-line filter. Requires a post infusion flush with NS or D5 after each infusion

12-week course

Supportive medications

• In case of hypersensitivity reaction, contact MD first, and then may use:
  • Hydrocortisone (Cortef) 100 mg IV push
  • Diphenhydramine (Benadryl) 50 mg IV push (only give if >6 hours from last dose of Diphenhydramine (Benadryl))
  • Famotidine (Pepcid) 20 mg IV over 15 minutes
  • Epinephrine (EpiPen) 0.3 mg IM

Hydration:

• 500 ml NS at KVO rate. Use as running IV for chemotherapy infusion. Give up to 500 ml NS.

Monitoring:

• Prior to first dose, check hepatitis B & C, HIV, and pregnancy status, if appropriate
• Prior to each dose, check: CBC with differential, absolute lymphocyte count, platelets, sodium, potassium, chloride, bicarbonate, BUN, creatinine, glucose, calcium, alkaline phosphatase, SGOT (AST), SGPT (ALT), total bilirubin, direct bilirubin, albumin, total protein, LDH, uric acid, amylase, lipase, TSH, Free T4
• Vital signs should be checked every 15 minutes x 1 hour after the first dose of ipilimumab

Clinical scenario & comments:

• 65 year-old lady with locally advanced, recurrent melanoma after prior surgical resection. No previous systemic therapy had been used. My institution includes all 4 doses of ipilimumab to be given over the 12-week course in a single order set.