Keytruda (pembrolizumab)

Keytruda® is an immunotherapy that is a monoclonal antibody. Antibodies are a normal part of the immune system that attach to antigens (such as germs) to mark them for destruction by the immune system. Monoclonal antibodies are created in a laboratory to attach to specific antigens on the surface of cancer cells. Keytruda targets the PD-1 receptor and the molecules which bind to the receptor, PD-L1 and PD-L2. Some cancer cells affect the PD-1 pathway. When this pathway is affected by the cancer cells, the cancer can grow and spread without being kept in check by the T-cells and the immune system. By blocking the PD-1 pathway, Keytruda can help the body’s T-cells and immune system fight the cancer.1,2

Keytruda is used to treat patients with metastatic (spread to distant parts of the body) nonsquamous non-small cell lung cancer (NSCLC) that is positive for PD-L1 and whose disease has progressed after being treated with chemotherapy containing platinum.1 Biomarker testing (also called molecular testing) is done on a biopsy sample of the tumor to check if PD-L1 is present. It is a treatment option for patients whose tumors do not express an abnormal EGFR or ALK gene. Keytruda is also used to treat other types of cancer, such as some melanoma cancers and some squamous cell carcinoma cancers.2

Taking Keytruda

Keytruda is given as an infusion that is administered through an IV (intravenous) line over 30 minutes. It is usually given once every three weeks. Patients may be given medications before the infusion to reduce the chance of allergic reactions to Keytruda. The dosage of Keytruda is determined based on the type of cancer, and may take into account a patient’s weight.2

Side Effects of Keytruda

Keytruda may cause side effects, and in some cases, these side effects can be severe. Any side effects should be reported to a health care professional. Side effects experienced in greater than 30% of patients taking Keytruda include low red blood cells (anemia), fatigue, hyperglycemia (high levels of sugar in the blood), hyponatremia (a decreased level of sodium in the blood), hypoalbuminemia (a decreased level of albumin in the blood), itching, cough, and nausea. Less common side effects experienced in 10-29% of patients receiving Keytruda include rash, decreased appetite, hypertriglyceridemia (an increased level of fatty acids in the blood), constipation, diarrhea, joint pain (arthralgia), pain in arms and legs, shortness of breath, swelling, headache, vomiting, chills, muscle pain (myalgia), insomnia (difficulty sleeping), abdominal pain, back pain, fever, vitiligo (a skin disorder with patchy loss of color), dizziness, and upper respiratory tract infection. Rarely, Keytruda can cause the severe side effect of an immune-mediated reaction. This can affect the bowels, liver, skin, nerves and the endocrine system. Patients will be monitored for symptoms of this reaction (diarrhea, rash, and neuropathy) and blood work may be checked for elevated liver enzymes and thyroid function.2,3

Precautions

Patients receiving Keytruda should talk to their doctor about other medications, herbal remedies, and any supplements they are taking. Patients should talk to their doctor before receiving immunizations or vaccinations while taking Keytruda to make sure they are appropriate. Patients who are pregnant or may become pregnant during treatment should discuss their condition with their doctor before starting Keytruda, as it may be hazardous to the fetus. It is not recommended for men or women to conceive a child while taking Keytruda, and patients are advised to use contraception, such as condoms. It is not known whether Keytruda passes into breast milk, and patients should not breastfeed while taking Keytruda.2

Written by: Emily Downward | Last reviewed: January 2017.
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