Imjudo (Tremelimumab)

Imjudo is a CTLA‑4 checkpoint inhibitor used in the treatment of specific solid tumours and in clinical investigation of other cancers.

• Malignant mesothelioma: improves overall survival when combined with durvalumab in patients with unresectable disease.
• Advanced non‑small cell lung cancer (investigational): being evaluated for efficacy in combination regimens.
• Metastatic melanoma (investigational): studied as part of checkpoint‑inhibitor combination therapies.

• Tremelimumab is a monoclonal antibody that binds to the cytotoxic T‑lymphocyte‑associated protein 4 (CTLA‑4) receptor on T cells, blocking its interaction with the co‑stimulatory molecules CD80/CD86. This inhibition releases the brake on T‑cell activation, enhancing proliferation and cytokine release, thereby strengthening the antitumor immune response.

Common Side Effects

• Fatigue: mild to moderate tiredness experienced during treatment.
• Rash: skin erythema or maculopapular eruptions.
• Diarrhea: loose stools, sometimes watery.
• Nausea: feeling of sickness, occasional vomiting.
• Infusion‑related reactions: flushing, chills, or mild hypotension during administration.
• Pruritus: itching of the skin.

Serious or Rare Side Effects

• Immune‑mediated colitis: severe inflammation of the colon requiring prompt treatment.
• Hepatitis: liver inflammation with elevated enzymes.
• Endocrinopathies: thyroiditis, hypophysitis, or adrenal insufficiency.
• Pneumonitis: inflammation of lung tissue, potentially life‑threatening.
• Severe infusion reactions: anaphylaxis or cytokine release syndrome.
• Myocarditis: inflammation of heart muscle, rare but critical.

Before initiating therapy, clinicians should evaluate patient history and monitor for immune‑related events.

• Monitor immune‑related adverse events: perform regular assessments of organ function and symptom review.
• Assess pre‑existing autoimmune disease: weigh risk versus benefit and consider close monitoring.
• Screen for infections: test for latent tuberculosis, hepatitis B/C, and HIV before treatment.
• Avoid concurrent high‑dose immunosuppressants unless medically required: they may diminish therapeutic effect.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Tremelimumab may interact with other agents that modify immune function.

Major Interactions (Avoid)

• Concurrent use with other immune checkpoint inhibitors: heightened risk of severe immune toxicity.
• Live vaccines: contraindicated due to potential for uncontrolled infection.
• High‑dose systemic steroids or other strong immunosuppressants: may reduce antitumor efficacy.

Moderate Interactions (Monitor Closely)

• CYP450 substrate drugs: monitor levels as immune modulation can affect metabolism.
• Anticoagulants: observe for bleeding if severe infusion reactions cause thrombocytopenia.
• Non‑live vaccines: efficacy may be reduced; assess immune response.