Update on immunologic therapy with anti-CTLA-4 antibodies in melanoma: identification of clinical and biological response patterns, immune-related adverse events, and their management

Semin Oncol. 2010 Oct;37(5):485-98. doi: 10.1053/j.seminoncol.2010.09.003.


Immune-modifying monoclonal antibodies may induce or enhance the natural immune response against tumor cells. The complex interaction between antigen-presenting cells and T lymphocytes as an immune response is strongly affected by anti-CD152 (cytotoxic T-lymphocyte antigen-4, CTLA-4)-antibodies. However, specific CTLA-4 antibodies can block the CTLA-4 receptor and thus induce an unrestrained T-cell activation. To this stage, treatment of patients with metastatic melanoma with the CTLA-4 antibodies ipilimumab and tremelimumab has only been investigated within clinical trials. The results of a phase III trial in patients with advanced disease treated with ipilimumab alone or in combination with a peptide vaccination (gp100) recently presented at the 2010 annual meeting of the Ameircan Society of Clinical Oncology (ASCO) made groundbreaking news as ipilimumab was demonstrated to be the first drug in melanoma treatment to show a significant prolongation of survival time. Patients undergoing treatment with CTLA-4 antibodies may experience immune-related phenomena and adverse events (irAEs) that differ greatly from the well-known adverse events of cytotoxic drugs and which are due to the CTLA-4 antibodies' specific mode of action. This review gives a condensed overview on the mechanisms of action, an update on clinical data of the two CTLA-4 antibodies, ipilimumab and tremelimumab, and detailed recommendations for adverse event management strategies.

Publication types

  • Review

MeSH terms

  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal / immunology
  • Antibodies, Monoclonal, Humanized
  • Antigens, CD / immunology*
  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / immunology
  • Biomarkers / blood
  • C-Reactive Protein / metabolism
  • CTLA-4 Antigen
  • Chemical and Drug Induced Liver Injury / immunology
  • Chemical and Drug Induced Liver Injury / therapy
  • Digestive System Diseases / chemically induced
  • Digestive System Diseases / immunology
  • Digestive System Diseases / therapy
  • Endocrine System Diseases / chemically induced
  • Endocrine System Diseases / immunology
  • Endocrine System Diseases / therapy
  • Humans
  • Immune System Diseases / chemically induced*
  • Immune System Diseases / therapy
  • Ipilimumab
  • Melanoma / drug therapy*
  • Melanoma / immunology
  • Skin Diseases / chemically induced
  • Skin Diseases / immunology
  • Skin Diseases / therapy
  • Skin Neoplasms / drug therapy*
  • Skin Neoplasms / immunology


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Antigens, CD
  • Antineoplastic Agents
  • Biomarkers
  • CTLA-4 Antigen
  • CTLA4 protein, human
  • Ipilimumab
  • C-Reactive Protein
  • tremelimumab