Pembrolizumab Treatment: Uses, Dosage, Side Effects & Costs

Summary of Key Points

Pembrolizumab is an immunotherapy used to treat several types of cancer, including melanoma and lung cancer. It works by helping your immune system recognize and attack cancer cells. Pembrolizumab is given through an intravenous (IV) infusion, typically every 3 to 6 weeks. Side effects can vary, so it’s important to discuss any concerns with your healthcare provider. You can also consult one of our telemedicine providers for personalized advice.

Names of Medication

US Brand Name: Keytruda

Generic Name: Pembrolizumab

The generic name is the standard name for a medication, while the brand name is assigned by the manufacturer. In this article, the generic name will be listed in parentheses.

Pharmacologic Category

Pembrolizumab belongs to the following pharmacologic categories:

1. Anti-PD-1 Monoclonal Antibody
2. Immune Checkpoint Inhibitor

Pembrolizumab Dosage

Pembrolizumab is prescribed for various cancers, with the dosage tailored to the specific condition being treated. Always consult your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to discuss your dosing regimen.

Pembrolizumab Dosage for Melanoma

Dosage: 200 mg every 3 weeks or 400 mg every 6 weeks.

Duration: Continue until disease progression or unacceptable toxicity.

Pembrolizumab Dosage for Non-Small Cell Lung Cancer (NSCLC)

Dosage: 200 mg every 3 weeks or 400 mg every 6 weeks.

Duration: Continue until disease progression or unacceptable toxicity.

Pembrolizumab Dosage for Head and Neck Squamous Cell Carcinoma (HNSCC)

Dosage: 200 mg every 3 weeks or 400 mg every 6 weeks.

Duration: Continue until disease progression or unacceptable toxicity.

Pembrolizumab Dosage for Urothelial Carcinoma

Dosage: 200 mg every 3 weeks or 400 mg every 6 weeks.

Duration: Continue until disease progression or unacceptable toxicity.

Pembrolizumab Dosage for Hodgkin Lymphoma

Dosage: 200 mg every 3 weeks or 400 mg every 6 weeks.

Duration: Continue until disease progression or unacceptable toxicity.

Pembrolizumab Dosage for Gastric Cancer

Dosage: 200 mg every 3 weeks or 400 mg every 6 weeks.

Duration: Continue until disease progression or unacceptable toxicity.

Pembrolizumab Dosage for Cervical Cancer

Dosage: 200 mg every 3 weeks or 400 mg every 6 weeks.

Duration: Continue until disease progression or unacceptable toxicity.

Pembrolizumab Dosage for Esophageal Cancer

Dosage: 200 mg every 3 weeks or 400 mg every 6 weeks.

Duration: Continue until disease progression or unacceptable toxicity.

Pembrolizumab Dosage for Merkel Cell Carcinoma

Dosage: 200 mg every 3 weeks or 400 mg every 6 weeks.

Duration: Continue until disease progression or unacceptable toxicity.

Pembrolizumab Dosage for Triple-Negative Breast Cancer (TNBC)

Dosage: 200 mg every 3 weeks or 400 mg every 6 weeks.

Duration: Continue until disease progression or unacceptable toxicity.

Dosage Forms and Strengths

Pembrolizumab is available in the following dosage form:

1. Injection: 100 mg/4 mL (25 mg/mL) in a single-dose vial

Administration Instructions for Pembrolizumab

Pembrolizumab is administered as an intravenous (IV) infusion, typically over 30 minutes, in a healthcare setting such as a hospital or clinic by a trained professional. The infusion schedule is usually every 3 or 6 weeks, depending on your treatment plan. It’s important to attend all scheduled appointments and inform your healthcare provider if you experience any side effects or reactions during or after the infusion.

Pembrolizumab Side Effects and Adverse Reactions

Like all medications, Pembrolizumab can cause side effects. It’s important to be aware of these and report any unusual symptoms to your healthcare provider. Below are some common and serious side effects:

Common Pembrolizumab Side Effects

1. Fatigue: Feeling unusually tired or weak.
2. Rash: Skin irritation or redness.
3. Diarrhea: Loose or frequent bowel movements.
4. Nausea: Feeling sick to your stomach.

Serious Pembrolizumab Side Effects

Immune-related reactions: Pembrolizumab can cause your immune system to attack healthy organs and tissues, leading to inflammation in areas such as the lungs, liver, or intestines. Symptoms may include shortness of breath, chest pain, or severe abdominal pain.

Endocrine disorders: This medication can affect hormone levels, potentially leading to thyroid problems or diabetes. Symptoms may include weight changes, increased thirst, or frequent urination.

If you experience any serious side effects, seek medical attention immediately. You can also consult one of our telemedicine providers for advice on managing side effects.

Contraindications for Pembrolizumab Treatment

A contraindication is a specific condition where a medication should not be used due to potential harm. If you have any of the following conditions, Pembrolizumab may increase the risk of serious side effects or complications. Always consult your healthcare provider before starting any new medication. If you’re unsure, one of our providers can assist you through telemedicine.

1. Severe allergic reactions to Pembrolizumab or its ingredients: If you’ve had a severe allergic reaction (anaphylaxis) to Pembrolizumab or any of its components, taking it again could cause life-threatening symptoms like difficulty breathing, swelling, or hives.
2. Active autoimmune diseases: Pembrolizumab stimulates the immune system, which can worsen autoimmune conditions like lupus or rheumatoid arthritis. If you have an active autoimmune disease, Pembrolizumab may cause your immune system to attack healthy tissues.
3. Organ transplant recipients: Pembrolizumab may increase the risk of organ rejection in patients who have received a solid organ transplant (such as a kidney or liver). This is because the medication enhances the immune system, which might attack the transplanted organ.
4. Pregnancy: Pembrolizumab can harm an unborn baby, so it is contraindicated during pregnancy. More details are provided in the pregnancy section below.

Drug to Drug Interactions

Certain medications can interact with Pembrolizumab, potentially increasing side effects or reducing its effectiveness. It is important to inform your healthcare provider about all medications you are taking, including over-the-counter drugs, supplements, and herbal products. Below are some key medications that may interact with Pembrolizumab treatment:

Corticosteroids: (e.g., Prednisone, Dexamethasone) These medications suppress the immune system and may reduce the effectiveness of Pembrolizumab, which works by boosting immune activity.

Immunosuppressants: (e.g., Tacrolimus, Cyclosporine) Commonly used after organ transplants or for autoimmune conditions, these drugs can interfere with Pembrolizumab by dampening the immune response, potentially increasing the risk of organ rejection or reducing the treatment’s efficacy.

Live vaccines: (e.g., MMR, Varicella) Pembrolizumab can weaken your immune response to live vaccines, increasing the risk of infection. It is recommended to avoid live vaccines while undergoing Pembrolizumab treatment.

Pembrolizumab in Pregnancy

Is it safe to take Pembrolizumab when pregnant?

No, Pembrolizumab is not considered safe during pregnancy. It can harm an unborn baby, potentially leading to birth defects or miscarriage. Women who are pregnant or planning to become pregnant should avoid Pembrolizumab. Effective contraception should be used during treatment and for at least four months after the last dose. If you become pregnant while taking Pembrolizumab, contact your healthcare provider immediately. Our telemedicine providers are available for further guidance.

Pembrolizumab while Breastfeeding

Is it safe to take Pembrolizumab while breastfeeding?

Breastfeeding is not recommended while taking Pembrolizumab. Although it is not known whether Pembrolizumab passes into breast milk, the potential for serious side effects in a nursing infant means breastfeeding should be avoided during treatment and for at least four months after the last dose. If you are breastfeeding or planning to breastfeed, discuss alternative feeding options with your healthcare provider.

Estimated Cost of Pembrolizumab

The cost of Pembrolizumab can vary depending on your location and pharmacy. Without insurance, a 30-day supply using a GoodRx coupon may range from $9,000 to $12,000. Prices can fluctuate, so it’s a good idea to check with your pharmacy or use a discount service like GoodRx for the most up-to-date pricing.

Possible Alternatives to Pembrolizumab

If Pembrolizumab is not suitable for you, there are alternative treatments and lifestyle changes that may help manage your condition. Below are some alternatives for diseases commonly treated with Pembrolizumab. Always consult your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available for immediate advice.

1. Melanoma: Alternatives include targeted therapies (e.g., Vemurafenib, Dabrafenib) or other immunotherapies (e.g., Ipilimumab). Sun protection and regular skin checks are essential lifestyle changes.
2. Non-small cell lung cancer: Chemotherapy (e.g., Carboplatin, Paclitaxel) or targeted therapies (e.g., Erlotinib) may be alternatives. Quitting smoking and maintaining a healthy lifestyle can improve outcomes.
3. Head and neck squamous cell carcinoma: Radiation therapy, surgery, or chemotherapy (e.g., Cisplatin) are potential alternatives. Avoiding tobacco and alcohol can reduce the risk of recurrence.
4. Urothelial carcinoma: Chemotherapy (e.g., Gemcitabine, Cisplatin) or surgery may be considered. Staying hydrated and avoiding smoking can help manage symptoms.
5. Hodgkin lymphoma: Chemotherapy (e.g., ABVD regimen) or radiation therapy may be alternatives. Regular exercise and a balanced diet support overall health during treatment.
6. Gastric cancer: Chemotherapy (e.g., Fluorouracil, Oxaliplatin) or surgery are possible alternatives. A healthy diet and avoiding processed foods may help manage symptoms.
7. Cervical cancer: Radiation therapy or chemotherapy (e.g., Cisplatin) are alternatives. Regular Pap smears and HPV vaccination reduce the risk of cervical cancer.
8. Esophageal cancer: Surgery, radiation therapy, or chemotherapy (e.g., Carboplatin, Paclitaxel) may be alternatives. Avoiding smoking and alcohol can lower the risk of esophageal cancer.
9. Merkel cell carcinoma: Radiation therapy or surgery may be alternatives. Protecting your skin from UV radiation helps prevent recurrence.
10. Triple-negative breast cancer: Chemotherapy (e.g., Doxorubicin, Cyclophosphamide) or other immunotherapies may be considered. Regular exercise and a healthy diet support overall well-being during treatment.

Recent Updates on Pembrolizumab Research

Recent studies on Pembrolizumab show promising results in expanding its use for various cancers. Ongoing research is exploring its effectiveness in combination with other therapies, such as chemotherapy and radiation, to improve outcomes in patients with advanced cancers. Additionally, new trials are investigating the use of Pembrolizumab in earlier stages of cancer, potentially offering more patients long-term remission. Researchers are also studying biomarkers to help predict which patients will respond best to Pembrolizumab, allowing for more personalized treatment plans.

As research continues to evolve, Pembrolizumab remains a vital option for many cancer patients. If you have questions about whether Pembrolizumab is right for you, our telemedicine providers are available to discuss your treatment options and the latest research findings.

James Kingsley

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