Pembrolizumab

How it works

It blocks the PD-1 receptor on T cells, preventing PD-L1/PD-L2 engagement and restoring T-cell-mediated antitumour immune responses.

Prescribing in practice

• Immune-related adverse events can affect any organ — including pneumonitis, colitis, hepatitis, endocrinopathies and skin reactions — and may be severe or fatal, requiring prompt recognition and corticosteroid or immunosuppressive management.
• New or worsening cough, breathlessness or chest pain must be investigated promptly for immune-mediated pneumonitis.
• Monitor for infusion-related reactions and screen endocrine and organ function before and during treatment.

Monitoring

Monitor thyroid, liver, renal and glucose parameters and watch for respiratory, gastrointestinal, hepatic, endocrine and dermatological immune-related effects throughout treatment.

Counselling the patient

• Report any new breathlessness, cough, diarrhoea, rash or unusual tiredness promptly, even after treatment ends.
• Carry your immunotherapy alert card and show it to any clinician.
• Attend all blood tests and review appointments.

Evidence & guidelines

NICE and trial evidence support pembrolizumab for several lung cancer settings, alone or combined with chemotherapy.