Pembrolizumab (Keytruda)
Antineoplastic Agent | Immune Checkpoint Inhibitor |
Keytruda (pembrolizumab) is an immune checkpoint inhibitor, specifically a PD-1 inhibitor, used primarily for the treatment of various cancers including melanoma, non-small cell lung cancer, head and neck cancers, and more.
- Immune-Related Adverse Events (irAEs): Keytruda can cause a range of immune-related adverse events due to its mechanism of action, which involves the activation of the immune system. Common irAEs include dermatitis, colitis, hepatitis, endocrinopathies (such as hypothyroidism or adrenal insufficiency), and pneumonitis. Monitoring and managing these effects is critical.
- Pre-medication is Not Typically Required: Unlike chemotherapy, pre-medication for allergic reactions or nausea is not typically required with pembrolizumab, simplifying the pre-treatment protocol.
- Infusion Reactions: Although less common than with chemotherapy or other biological therapies, infusion-related reactions can occur. Close monitoring during the infusion is necessary, and having treatment protocols for managing reactions is important.
- Regular Monitoring of Thyroid Function: Since pembrolizumab can affect thyroid function, regular monitoring of thyroid-stimulating hormone (TSH) levels is recommended throughout treatment.
- Management of Steroids: The use of systemic steroids to manage immune-related adverse events does not appear to significantly affect the clinical response to pembrolizumab. However, steroids should be used at the lowest effective dose and tapered as soon as clinically feasible.
- Dosing and Administration: Keytruda is usually dosed based on body weight (mg/kg) or as a flat dosing. The typical dosing schedule is every three weeks, which may be convenient for patient scheduling compared to therapies requiring more frequent administration.
- Potential for Hepatic Impairment: Pembrolizumab can cause elevations in liver enzymes. Liver function tests should be monitored regularly, and the drug should be used with caution in patients with pre-existing liver disease.
- Effectiveness in PD-L1 Positive Tumors: While pembrolizumab is effective across a broad range of tumor types, it has shown increased effectiveness in tumors that express PD-L1. Testing for PD-L1 expression can help in decision-making regarding the use of pembrolizumab.
- Handling and Preparation: Unlike cytotoxic chemotherapy, pembrolizumab does not require special handling procedures and does not pose a risk of occupational exposure.
- Long-term Effects: As with other immunotherapies, the long-term immune-related effects are still being studied. Continued vigilance and patient education on the potential for late-onset side effects are important.
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