Anti-PD-1 monoclonal antibody (immune checkpoint inhibitor)

Pembrolizumab

Brand names: Keytruda

Adult dose

Dose: 200mg IV q3w or 400mg IV q6w (per indication and protocol)

Route: IV infusion

Frequency: q3w or q6w

Clinical pearls

Numerous NICE TAs: melanoma, NSCLC, urothelial, head & neck, RCC, Hodgkin lymphoma, MSI-high tumours, TNBC, endometrial, cervical
SACT-funded specialist oncology only
UK Oncology Nursing Society irAE management guidance / ESMO toxicity guidelines

Contraindications

Active autoimmune disease (relative)
Solid organ transplant recipient (relative — graft rejection risk)
Hypersensitivity

Side effects

Immune-related adverse events: pneumonitis, colitis, hepatitis, endocrinopathies (thyroid, adrenal, hypophysitis, T1DM), nephritis, dermatitis (incl. SJS/TEN), myocarditis, neurological (myasthenia, GBS)
Infusion reactions
Fatigue

Interactions

Systemic corticosteroids/immunosuppressants (avoid prophylactic; use to manage irAEs)

Monitoring

TFTs
Cortisol/ACTH
LFTs
Renal function
Glucose
Symptoms of irAEs at every cycle

Reference: BNF; multiple NICE TAs; ESMO Immuno-oncology toxicity guidelines; SmPC; https://bnf.nice.org.uk/drugs/pembrolizumab-specialist-drug/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways