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Patient Handout: Pembrolizumab (Keytruda)

What is Pembrolizumab?

Pembrolizumab, marketed under the brand name Keytruda, is an immunotherapy medication used to treat several types of cancer, including:

  • Non-small cell lung cancer
  • Melanoma
  • Head and neck squamous cell carcinoma
  • Classical Hodgkin lymphoma
  • Urothelial carcinoma (bladder cancer)
  • Cervical cancer
  • Esophageal cancer

Pembrolizumab works by helping your immune system recognize and fight cancer cells. It is a PD-1 inhibitor, which means it blocks a protein called PD-1 that prevents immune cells from attacking cancer cells. By blocking PD-1, pembrolizumab helps to activate your immune system to target and destroy cancer cells.

How Does Pembrolizumab Work?

Pembrolizumab belongs to a class of drugs called immune checkpoint inhibitors. Cancer cells can use the PD-1 protein to hide from your immune system, making it harder for your body to fight the cancer. Pembrolizumab blocks this “shielding” effect, allowing your immune cells (specifically T-cells) to identify and destroy cancer cells.

How is Pembrolizumab Given?

Pembrolizumab is typically given as an intravenous (IV) infusion:

  • Administration: The medication is injected into your vein through an IV.
  • Infusion Schedule: Pembrolizumab is usually given every 3 weeks or 6 weeks, depending on your condition and your doctor’s instructions.
  • Duration: Each infusion typically takes about 30 minutes to an hour. Your healthcare team will monitor you during the infusion to check for any reactions.

Possible Side Effects

Like all medications, pembrolizumab can cause side effects. Some side effects may be serious. Please contact your healthcare provider if you experience any of the following:

Common Side Effects:

  • Fatigue: Feeling tired or weak is common while receiving treatment with pembrolizumab. Rest when necessary, but notify your healthcare provider if fatigue is severe or persistent.
  • Skin reactions: Rash, redness, or itching may occur. In some cases, the rash can be more severe and lead to blistering. If this happens, contact your doctor.
  • Diarrhea: Some patients experience diarrhea. Make sure to stay hydrated and contact your healthcare provider if it is severe or persistent.
  • Loss of Appetite: Some people may experience a decrease in appetite. Eating small, frequent meals may help.
  • Cough or Shortness of Breath: Respiratory issues such as a dry cough or shortness of breath may occur. If these symptoms worsen, contact your doctor.

Serious Side Effects:

  • Immune System Reactions: Pembrolizumab works by activating your immune system, which can sometimes lead it to attack healthy tissues. This can cause serious inflammation in various organs, including the lungs, liver, intestines, or endocrine glands (e.g., thyroid).
    • Symptoms of immune-related side effects may include:
      • Persistent cough, chest pain, or difficulty breathing (lung inflammation)
      • Abdominal pain, diarrhea, or blood in the stool (intestinal inflammation)
      • Yellowing of the skin or eyes, dark urine, or liver pain (liver inflammation)
      • Weakness, weight gain, or changes in mood (endocrine issues, such as thyroid problems)
  • Severe Allergic Reactions: Though rare, some people may have an allergic reaction to pembrolizumab. Signs of an allergic reaction may include:
    • Rash, hives, itching
    • Swelling of the face, lips, or throat
    • Difficulty breathing or swallowing
    • If any of these symptoms occur, seek medical help immediately.
  • Inflammation of the Heart (Myocarditis): Pembrolizumab may cause inflammation of the heart, leading to symptoms like chest pain, rapid or irregular heartbeat, or difficulty breathing. If you experience these, inform your healthcare provider right away.
  • Neurological Issues: Pembrolizumab can occasionally cause neurological symptoms such as severe headaches, vision problems, or confusion. Seek medical advice if you notice these symptoms.

Precautions Before Taking Pembrolizumab

Before receiving pembrolizumab, inform your healthcare provider if you:

  • Have a history of autoimmune disease: Pembrolizumab may cause your immune system to attack healthy tissue. If you have conditions like lupus, rheumatoid arthritis, or colitis, your doctor may need to adjust your treatment plan.
  • Have lung problems: Pembrolizumab can cause lung inflammation or other breathing problems. Let your doctor know if you have any history of lung disease, such as asthma or chronic obstructive pulmonary disease (COPD).
  • Have liver problems: Since pembrolizumab can affect the liver, inform your doctor if you have liver conditions like hepatitis or cirrhosis.
  • Have kidney problems: Pembrolizumab can also impact kidney function. Your doctor may monitor kidney health during treatment.
  • Are pregnant or planning to become pregnant: Pembrolizumab can harm an unborn baby. It’s important to avoid pregnancy while receiving treatment and for a certain period after treatment. Use effective contraception during and after treatment.
  • Are breastfeeding: It’s not known if pembrolizumab passes into breast milk, so it’s generally advised not to breastfeed during treatment.

What to Avoid While Taking Pembrolizumab

  • Infections: Since pembrolizumab works by stimulating your immune system, it may make you more susceptible to infections. Avoid close contact with people who have contagious illnesses, and practice good hygiene, such as frequent handwashing.
  • Live Vaccines: Live vaccines may not be safe while undergoing treatment with pembrolizumab. Consult your healthcare provider before receiving any vaccinations during treatment.

Regular Monitoring

Your healthcare provider will monitor your health regularly during pembrolizumab treatment. This includes:

  • Blood tests: To check for signs of inflammation or organ damage, particularly the liver, lungs, and intestines.
  • Symptoms assessment: Your doctor will assess any new or unusual symptoms you experience, including respiratory or gastrointestinal issues.
  • Imaging tests: To monitor the progress of cancer treatment and check for any side effects related to the medication.

When to Contact Your Doctor

Contact your healthcare provider immediately if you experience any of the following:

  • Shortness of breath, persistent cough, or chest pain (possible lung issues)
  • Abdominal pain, diarrhea, or blood in the stool (possible intestinal issues)
  • Yellowing of the skin or eyes, dark urine, or pain in the upper abdomen (possible liver issues)
  • Swelling of the face, lips, or throat, or trouble breathing (allergic reaction)
  • Severe weakness, confusion, or mood changes (endocrine problems)
  • Severe headache, vision problems, or confusion (neurological symptoms)

Disclaimer:

This handout is for educational purposes only and should not be considered medical advice. Always follow the instructions provided by your healthcare provider regarding treatment and care. For personalized advice, consult your healthcare provider or pharmacist.