How is Keytruda used for lung cancer?

Keytruda (pembrolizumab) is a type of immunotherapy that has significantly changed the treatment landscape for lung cancer, especially non-small cell lung cancer (NSCLC). It works by helping the immune system recognize and attack cancer cells more effectively, mainly by blocking the PD-1 pathway that tumors use to evade immune detection.

When Is Keytruda Used for Lung Cancer?

The use of Keytruda as a treatment for lung cancer depends on cancer stage, biomarker status, and previous treatments.

First-Line vs. Later-Line Treatment

• First-line: Keytruda is often used as the initial treatment for advanced NSCLC, either alone or combined with chemotherapy, especially if the tumor expresses the PD-L1 protein.
• Later-line: It may also be prescribed after other treatments have failed, particularly if the cancer has progressed after chemotherapy.

Biomarker Requirements (PD-L1 Expression)

• Keytruda’s effectiveness is closely linked to the presence of PD-L1 on tumor cells. For advanced/metastatic NSCLC, patients typically need to have tumors expressing PD-L1 (tumor proportion score ≥1%) and no EGFR or ALK mutations.
• Biomarker testing is essential to determine eligibility and guide treatment decisions.

Stage-Specific Use

• Resectable Early-Stage NSCLC: Keytruda can be combined with chemotherapy before surgery (neoadjuvant) and continued after surgery (adjuvant) for tumors ≥4 cm or node-positive disease.
• Advanced/Metastatic Disease: Used alone or with chemotherapy for stage IV or inoperable NSCLC, depending on PD-L1 status and genetic markers.

How Is Keytruda Given?

Keytruda is delivered as an intravenous (IV) infusion over 30 minutes. The typical dosing is either 200 mg every 3 weeks or 400 mg every 6 weeks, depending on the treatment plan and patient factors.

In some patients, Keytruda may be used as a single agent without chemotherapy. For many patients with advanced NSCLC, Keytruda is combined with pemetrexed and platinum-based chemotherapy. In early-stage, resectable NSCLC, Keytruda is given with chemotherapy before surgery and continued alone after surgery to help prevent recurrence.

Keytruda for Stage 4 Lung Cancer

For people diagnosed with stage 4 (metastatic) lung cancer, treatment goals focus on extending life and improving quality of life. Keytruda has emerged as a pivotal therapy for advanced non-small cell lung cancer (NSCLC), offering new hope where options were once limited. As an immunotherapy, Keytruda can be used alone or in combination with chemotherapy for many patients with stage 4 NSCLC, depending on specific tumor characteristics such as PD-L1 expression and the absence of certain genetic mutations. Landmark clinical trials have shown that Keytruda-based regimens can significantly improve survival compared to chemotherapy alone, making it a foundational option in the management of metastatic lung cancer.

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Survival Benefit in PD-L1+ Tumors

• Keytruda has shown significant survival benefits in stage IV NSCLC, especially in patients whose tumors express PD-L1.
• In the KEYNOTE-024 trial, the five-year survival rate for patients with metastatic NSCLC and high PD-L1 expression was 32% with Keytruda, compared to 16% for chemotherapy alone.

Data from KEYNOTE Trials

• KEYNOTE-189 and KEYNOTE-407: These pivotal studies established Keytruda plus chemotherapy as a standard first-line treatment, demonstrating a reduction in the risk of death and improved five-year survival rates versus chemotherapy alone.
• Many patients who completed two years of Keytruda remained alive and treatment-free at five years.

How Long Can You Take Keytruda?

Keytruda is usually given for up to two years, as long as it remains effective and side effects are manageable. Treatment may be stopped earlier if the cancer progresses or if side effects become too severe. Some patients who respond well may complete two years and stop, while others may continue longer in special circumstances.

Common Side Effects of Keytruda

Because everyone responds differently to medications, side effects from Keytruda may vary. Keytruda can cause the immune system to attack normal organs, leading to side effects such as:

• Fatigue, rash, diarrhea, cough, fever, decreased appetite, and thyroid problems.
• More serious immune-related reactions can affect the lungs, liver, or endocrine glands and may require stopping treatment.

Most side effects are manageable with supportive care or medications. Severe reactions may require steroids or discontinuation of Keytruda.

Bottom Line

• Keytruda is most beneficial for patients with NSCLC whose tumors express PD-L1 and do not have EGFR or ALK mutations, especially in advanced or metastatic settings.
• Biomarker testing is critical to determine eligibility and guide therapy choices.
• Decisions about Keytruda use should always be made in consultation with an oncology team, considering individual cancer characteristics and overall health.

This is not all the information you need to know about Keytruda (pembrolizumab) for safe and effective use and does not take the place of your doctor’s directions. Review the full patient medication guide and discuss this information and any questions you have with your doctor or other health care provider.

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• Keytruda Information for Consumers
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