An anti-CTLA-4 immunotherapy used with durvalumab
Tremelimumab
An immunotherapy given by drip, usually combined with durvalumab, that helps the immune system attack certain cancers.
What is Tremelimumab?
Tremelimumab is a specialist cancer immunotherapy that helps the body's own immune system attack cancer cells. It is given together with another immunotherapy called durvalumab for certain cancers, such as some liver and lung cancers, as a drip into a vein. Because it strongly boosts the immune system, especially when combined with durvalumab, its main risks are serious immune-related side effects that can affect almost any organ, including the bowel (colitis), liver (hepatitis) and hormone glands, as well as reactions during the infusion. These need to be reported early so they can be treated. It is given under the care of a cancer specialist team.
Education and reference only. This is a plain-language guide to Tremelimumab — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Tremelimumab is an immune checkpoint inhibitor, a type of cancer immunotherapy. It is an antibody that blocks a 'brake' on immune cells called CTLA-4, which helps unleash the immune system against cancer. It is usually given together with another immunotherapy called durvalumab, and sometimes with chemotherapy, to treat certain cancers, such as some liver and lung cancers. It is given as an infusion (drip) into a vein under the care of a specialist cancer team. Combining two immunotherapies can work more strongly against the cancer but also increases the chance of immune-related side effects.
How it works
Tremelimumab blocks CTLA-4, a protein that acts as an early brake on immune cells called T-cells, holding back their activation. By releasing this brake, tremelimumab helps more T-cells become active and able to attack cancer. It is usually paired with durvalumab, which works on a different brake (PD-L1), so the two together give the immune system a stronger push against the cancer. The downside of removing these brakes is that the immune system can also turn on healthy tissues, which is why serious immune-related inflammation of organs such as the bowel, liver and hormone glands is the key risk.
Company & origin
Originated / developed by: Specialist manufacturer.
A specialist cancer immunotherapy used in the UK, given together with another immunotherapy called durvalumab, for certain cancers such as liver and lung cancer.
Practical use
How to take Tremelimumab
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It is given as a drip into a vein in a cancer day unit, usually together with durvalumab, on a schedule set by your specialist team.
- Report any new or unusual symptoms, such as diarrhoea, tummy pain, yellowing of the skin or eyes, breathlessness, severe tiredness or a rash, straight away, even after treatment has finished.
- Attend all appointments for blood tests, as these check your hormones, liver and other organs.
- Use effective contraception during treatment and for the period your team advises if you could become pregnant.
- Carry your immunotherapy alert card and show it to any healthcare professional who treats you.
Weighing it up
Advantages & disadvantages of Tremelimumab
Advantages
- Helps the immune system attack certain cancers, offering a treatment option for some liver and lung cancers.
- Often combined with durvalumab for a stronger effect against the cancer.
- Given as a drip on a schedule under specialist care.
Disadvantages
- Can cause serious immune-related side effects, especially when combined with durvalumab, that may affect almost any organ.
- Reactions can occur during the infusion.
- Requires regular hospital visits and blood-test monitoring under a specialist team.
Practical use
Good to know
The most important thing to understand about tremelimumab is that, because it strongly boosts the immune system, especially when combined with durvalumab, it can cause serious immune-related side effects that may affect almost any part of the body. These include inflammation of the bowel (colitis, causing diarrhoea), the liver (hepatitis), the hormone glands (such as the thyroid, pituitary and adrenal glands) and the lungs, skin, kidneys and nervous system. These can come on during treatment or weeks to months after it finishes, and catching them early matters, so any new or unusual symptom should be reported straight away. Reactions can also happen during the drip itself. Because it can harm an unborn baby, effective contraception is important during treatment and for a period afterwards. The specialist team monitors blood tests, including hormone and liver tests, throughout.
Who should not take it / use with caution
- People who have had a serious allergic reaction to tremelimumab should not receive it.
- It is used with great care in people with active autoimmune conditions, as it can make them worse.
- It is generally avoided in pregnancy because it can harm an unborn baby; it is given only under specialist cancer care.
Monitoring
- Regular blood tests, including liver, kidney and hormone (such as thyroid) tests.
- Watching closely for immune-related side effects affecting any organ, during and after treatment.
- Reviewing how the cancer is responding with scans and clinical assessment.
Side effects
- Tiredness, diarrhoea, rash or itching, and reduced appetite.
- Immune-related inflammation of the bowel (colitis), liver (hepatitis), hormone glands, lungs, skin or kidneys.
- Reactions during the drip, such as chills, fever or breathlessness.
- Less commonly but seriously, severe and potentially life-threatening immune reactions affecting the bowel, liver, hormone glands, heart or nervous system.
Key interactions
- Steroids and other medicines that dampen the immune system can reduce how well it works, so tell your team if you take them.
- It is usually combined with durvalumab, and sometimes chemotherapy, which add their own side effects, under specialist supervision.
- Always give your team a full list of your medicines, including anything bought over the counter.
Available as: A solution given as a drip (infusion) into a vein.
Answers
Tremelimumab: frequently asked questions
What is tremelimumab used for?
It is a cancer immunotherapy, usually given together with durvalumab, for certain cancers such as some liver and lung cancers, that helps the immune system attack the cancer.
How does it work?
It blocks a brake on immune cells called CTLA-4, helping more immune cells become active and able to attack cancer, especially when combined with durvalumab.
Why are its side effects more serious?
Because it strongly boosts the immune system, especially combined with durvalumab, the immune system can attack healthy tissues, causing serious inflammation of organs such as the bowel, liver and hormone glands.
When should I report side effects?
Report any new or unusual symptoms straight away, even after treatment ends, as immune-related side effects are easier to treat when caught early.
Do I need contraception?
Yes, if you could become pregnant, effective contraception is important during treatment and for the period your team advises, because it can harm an unborn baby.
Authoritative sources
- BNF
- NICE CKS
Building a medicines information resource?
We create evidence-led, dose-free drug and formulary references for teams.