Kahler, K.C., & Hauschild, A. (2011). Treatment and side effect management of CTLA-4 antibody therapy in metastatic melanoma. Journal of the German Society of Dermatology, 9, 277–286.
DOI Link
Purpose & Patient Population
PURPOSE: To review the clinical use, mechanism of action, and side effects of CTLA-4 treatment, and to provide guidelines for side effect management
TYPES OF PATIENTS ADDRESSED: Adult patients with melanoma receiving CTLA-4 antibody treatment
Type of Resource/Evidence-Based Process
RESOURCE TYPE: Expert opinion
Phase of Care and Clinical Applications
PHASE OF CARE: Active antitumor treatment
Results Provided in the Reference
N/A
Guidelines & Recommendations
Skin effects: Reports that 47%–68% reportedly develop maculopapular rash, which usually appears after about three weeks of therapy. Most cases are not severe, and treatment with topical steroids or urea-based topical treatment along with antipruritic agents.
Diarrhea: Provides an algorithm for management—for mild (grade 1–2) diarrhea, use symptomatic therapy and, if no improvement, corticosteroids (e.g., prednisolone 1mg/kg/day). For severe (grade 3–4) diarrhea, use high-dose steroids (e.g., meythlyprednisolone 2 mg/kg 1–2 times daily) and, if no improvement, possibly infliximab 5 mg/kg.
Limitations
Expert opinion level information
Nursing Implications
Currently, limited research evidence regarding interventions for the prevention and management of various side effects associated with immunotherapies exists. Corticosteroids are suggested to treat most side effects.