Pembrolizumab (Head and Neck SCC)

How it works

Pembrolizumab is a monoclonal antibody against the programmed death-1 (PD-1) receptor; by blocking PD-1 binding to PD-L1 and PD-L2 it releases inhibition of tumour-specific T cells and enhances antitumour immunity.

Prescribing in practice

• Immune-related adverse events can affect any organ system — pneumonitis, colitis, hepatitis, endocrinopathies, nephritis and severe skin reactions — and may be serious or delayed, demanding early recognition and corticosteroid/immunosuppressive treatment.
• Eligibility and combination choice depend on PD-L1 expression testing, and infusion-related reactions can occur.
• Treatment must be initiated and supervised by oncologists experienced in immunotherapy, with endocrinopathies often requiring hormone replacement rather than stopping the drug alone.

Monitoring

Check liver, thyroid, renal function and glucose before dosing and investigate new respiratory, gastrointestinal, endocrine, renal or skin symptoms promptly as possible immune-related toxicity.

Counselling the patient

• Report new or worsening symptoms quickly — breathlessness, persistent diarrhoea, jaundice, extreme fatigue or rash — as the treatment can make your immune system attack healthy organs.
• Carry your immunotherapy alert card and show it to every healthcare professional.
• Reactions can develop weeks or months later, so continue reporting symptoms even after treatment ends.

Evidence & guidelines

Pembrolizumab is licensed in recurrent/metastatic head and neck SCC on the basis of randomised trials (including KEYNOTE-048) showing improved survival, with NICE positioning informed by PD-L1 expression.