Example orders for Ipilimumab (Yervoy) in melanoma
Carboplatin & Paclitaxel (CP)
CP: Carboplatin & Paclitaxel
Regimen
| Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
|---|---|---|---|---|
| Forde et al. 2022 (CheckMate 816) | 2017-2019 | Phase 3 (C) | 1a. CP & Nivolumab 1b. CVb & Nivolumab 1c. DC & Nivolumab |
Inferior EFS |
Note: there were additional comparator options depending on histology; see the respective histology-specific pages for more details. This study was conducted in the United States. The reason for the study was that an unanswered question at the time was whether adding an immune checkpoint inhibitor would improve outcomes.
Biomarker eligibility criteria
- CheckMate 816: No sensitizing EGFR or ALK mutations
Chemotherapy
- Carboplatin (Paraplatin) AUC 5 or 6 IV once on day 1
- Paclitaxel (Taxol) 175 or 200 mg/m2 IV once on day 1
21-day cycle for 3 cycles
Subsequent treatment
References
- CheckMate 816: Forde PM, Spicer J, Lu S, Provencio M, Mitsudomi T, Awad MM, Felip E, Broderick SR, Brahmer JR, Swanson SJ, Kerr K, Wang C, Ciuleanu TE, Saylors GB, Tanaka F, Ito H, Chen KN, Liberman M, Vokes EE, Taube JM, Dorange C, Cai J, Fiore J, Jarkowski A, Balli D, Sausen M, Pandya D, Calvet CY, Girard N; CheckMate 816 Investigators. Neoadjuvant Nivolumab plus Chemotherapy in Resectable Lung Cancer. N Engl J Med. 2022 May 26;386(21):1973-1985. Epub 2022 Apr 11. link to original article contains dosing details in manuscript PubMed NCT02998528
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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.