Imjudo (Tremelimumab)

• Imjudo (tremelimumab) is an immune checkpoint inhibitor that blocks CTLA‑4, a key regulator of T‑cell activation, and is approved for the treatment of malignant pleural mesothelioma, a rare cancer of the lining of the lungs. The therapy is indicated for adult patients with unresectable disease who have not responded to prior chemotherapy. Administration is performed by intravenous infusion under medical supervision, with dosing determined by the treating oncologist based on clinical guidelines. Patients are monitored for immune‑related adverse events throughout the treatment course, and therapy may be continued until disease progression or unacceptable toxicity.
• Malignant pleural mesothelioma: improves overall survival in adult patients with unresectable disease.

• Tremelimumab is a fully human IgG2 monoclonal antibody that binds to cytotoxic T‑lymphocyte‑associated protein 4 (CTLA‑4) on the surface of activated T cells. By preventing CTLA‑4 from interacting with its ligands CD80/CD86, the drug releases the inhibitory checkpoint, leading to enhanced T‑cell proliferation, cytokine production, and a strengthened antitumor immune response against malignant cells.

Common Side Effects

• Fatigue: mild to moderate tiredness experienced during or after infusion.
• Rash: skin erythema or pruritus that may appear on trunk or limbs.
• Diarrhea: loose stools that can range from mild to moderate severity.
• Nausea: transient feeling of queasiness often managed with anti‑emetics.
• Infusion‑related reactions: transient chills, fever, or flushing during administration.
• Headache: mild to moderate cephalgia occurring during treatment.

Serious or Rare Side Effects

• Immune‑mediated colitis: severe inflammation of the colon requiring immunosuppression.
• Hepatitis: liver enzyme elevations or clinical hepatitis.
• Pneumonitis: inflammatory lung disease that may be life‑threatening.
• Endocrinopathies: thyroiditis, hypophysitis, or adrenal insufficiency.
• Severe infusion reactions: anaphylaxis or hypotension.
• Myocarditis: inflammation of heart muscle with potential cardiac dysfunction.

Before initiating therapy, patients should be evaluated for pre‑existing autoimmune conditions and baseline organ function.

• Monitor immune‑related adverse events: assess for signs of colitis, hepatitis, pneumonitis, and endocrinopathies throughout treatment.
• Assess baseline organ function: perform liver, renal, and pulmonary tests prior to first dose.
• Avoid live vaccines: administration of live attenuated vaccines may cause infection while immune system is modulated.
• Use caution in patients with active infections or uncontrolled autoimmune disease.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Major Interactions (Avoid)

• Concurrent use with other CTLA‑4 or PD‑1/PD‑L1 inhibitors: may amplify immune activation and toxicity.
• Live vaccines: increased risk of infection due to immune modulation.
• Strong systemic immunosuppressants (e.g., high‑dose steroids): may reduce therapeutic efficacy.

Moderate Interactions (Monitor Closely)

• Corticosteroids used for managing adverse events: may require dose adjustment of immunotherapy.
• Anticoagulants: monitor for bleeding if infusion‑related reactions cause vascular injury.