Pembrolizumab injection is prescribed to treat different types of cancer such as
• Melanoma or skin cancer
• Non-Small-Cell lung cancer (NSCLC)
• Head and neck cancer
• Urothelial carcinoma (Cancer of the bladder and urinary tract)
• Hodgkin’s disease (Cancer of the immune system)
• Colorectal cancer (Cancer of the large intestine)
Pembrolizumab is a monoclonal antibody chosen to treat cancers in the following situations.
• Cancer that has moved from its primary site to other parts of the body
• Cancer that cannot be treated or removed by surgery
• Treatment failure with other cancer treating medicines
• Worsening of cancer during treatment with other drugs
• Recurrence or a case of cancer that returns after treatment
Pembrolizumab works by stimulating the body’s immune system to fight against cancer cells.
Pembrolizumab should not be used in patients with-
• Allergy to pembrolizumab
• Pregnancy and breastfeeding
• Stemcell or organ transplant due to rejection
• Steroid or immune suppressive treatment
Caution is required in treating patients with-
• Liver dysfunction
• Airway disease
• Inflammatory bowel disease (Crohn’s disease, ulcerative colitis)
• Kidney disorder
• The recommended adult dose of pembrolizumab is 200 mg given every three weeks until the progression of the disease or until patients experience any unacceptable toxicity.
• It is also given for up to 24 months in patients whose disease condition is under control i.e., without any progression or not moving to an advanced level.
• The prescribed dose for children is 2mg/kg body weight, and the maximum dose should however not exceed 200 mg.
• The dose of pembrolizumab can be adjusted or reduced if any side effects occur and the dose can be resumed to normal when the side effects are greatly reduced.
• Pembrolizumab can be permanently discontinued if any life-threatening side effects occur during the treatment.
• Pembrolizumab should be given as an injection directly into the vein or intravenously in a very slow manner over a period of at least 30 minutes.
• Pembrolizumab comes as a powder which can be initially mixed with sterile water for injection and further diluted either with sodium chloride 0.9% or dextrose 5%.
• The reconstituted or diluted solutions of pembrolizumab should be used within 6 hours if stored at room temperature between 20°C to 25°C, and within 24 hours if kept in a refrigerator (2°C to 8°C); any unused solutions after that should be discarded.
• The refrigerated solution of pembrolizumab should be allowed to come to room temperature before administering to the patient.
• Never give other medicines through the same intravenous (IV) line to avoid any drug-induced side effects.
• Women of reproductive potential are advised to use an effective contraception during the treatment with pembrolizumab and should continue the contraception for at least four months after the last dose of pembrolizumab to avoid pregnancy.
• Breastfeeding mothers should not breastfeed their children during pembrolizumab treatment and for at least four months after stopping pembrolizumab.
• Patients should consult their physician immediately for managing the condition appropriately if any serious side effects, or symptoms and signs of any illnesses occur.
• A condition of colitis with severe loose stools and stomach pain
• Hepatitis or symptoms and signs of jaundice with nausea or vomiting
• Infection of the airways with cough, chest pain, and difficulty in breathing
• Symptoms and signs of the following
• Thyroid disorders
• Type 1 diabetes
• Nephritis or swelling of the kidneys
• Administering steroids and hormone replacement therapy can be considered if patients experience any symptoms and signs of pituitary disorders such as hypopituitarism or hypophysitis.
• Pembrolizumab can lead to life-threatening infusion-related reactions such as serious allergic reactions along with wheezing, rashes, itching, low blood pressure, and chills. In such cases, the pembrolizumab infusion can be stopped permanently.
• Patients taking pembrolizumab should not receive live vaccines such as BCG, mumps, measles, rubella, and yellow fever during the treatment and for at least six months after the last dose of pembrolizumab because the vaccines may not offer full protection.
• Patients should be given pembrolizumab only in a hospital setting and must be monitored closely particularly during administration to manage any complications.
• Gastrointestinal: Loose stools, nausea, vomiting, stomach pain, loss of appetite
• Nervous system: Headache, dizziness, tiredness, taste disturbances, inability to sleep, confusion, numbness of hands and feet
• Respiratory: Difficulty in breathing or wheezing, cough, sore throat, swelling of sinuses or tonsils
• Skin: Rashes, itching, changes in color, pimples
• Others: Fever, heart rate abnormalities, vision disturbances, muscle pain, joint pain, thyroid disorders, high blood sugar, laboratory abnormalities of liver enzymes, albumin, sodium, creatinine, and hemoglobin
The patient should inform the doctor during treatment with pembrolizumab if symptoms of the disease do not get better or if the sickness gets worse than before.
• Patients on steroids and immunosuppressant medicines should stop their intake before pembrolizumab is given to avoid immune-related side effects.
• A list of prescription, non-prescription or herbal supplements taken by the patient should be given to the doctor before pembrolizumab is prescribed to minimize some severe drug-related side effects.
• Store pembrolizumab injections in their original carton in a refrigerator at 2°C to 8°C.
• Protect from excess light and moisture.
• Do not store pembrolizumab vials in a freezer and do not shake.