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PROGRAMMED DEATH RECEPTOR-1 (PD-1) BLOCKING ANTIBODY
Keytruda (pembrolizumab) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to treat certain adults with triple-negative breast cancer.
These insights are based on 481 comments about Keytruda from MyBCTeam members. These are the experiences of a small number of individuals and are not meant to be medical advice.
Benefits:
Considerations:
Keytruda is a type of immunotherapy called a programmed death receptor-1 (PD-1)-blocking antibody. It blocks the PD-1 pathway, which can keep the immune system from recognizing and attacking cancer cells. In triple-negative breast cancer, this may help the immune system find and attack cancer cells.
Doctors prescribe Keytruda when adults have certain forms of triple-negative breast cancer. The exact use depends on the stage of cancer and whether the tumor has a specific PD-L1 level.
Keytruda may be used:
Keytruda is available in two forms. The intravenous form is given through a vein as an infusion, usually every three weeks or every six weeks.
A different form, Keytruda Qlex, is given as an injection under the skin of the thigh or abdomen by a healthcare provider. Keytruda Qlex is also given every three weeks or every six weeks, but it has different dosing and administration instructions than intravenous Keytruda.
For early-stage disease, Keytruda is given with chemotherapy before surgery and then continues alone after surgery. In advanced disease, treatment usually continues until the cancer gets worse or side effects become unacceptable or intolerable.
For intravenous Keytruda, the recommended dose for triple-negative breast cancer is 200 milligrams every three weeks or 400 milligrams every six weeks.
For Keytruda Qlex, the recommended dose is 395 milligrams of pembrolizumab and 4,800 units of berahyaluronidase alfa every three weeks, or 790 milligrams of pembrolizumab and 9,600 units of berahyaluronidase alfa every six weeks. Keytruda Qlex is injected under the skin over about one minute for the every-three-week dose or about two minutes for the every-six-week dose.
Doctors may pause treatment, delay the next dose, or stop treatment if side effects are serious or too difficult to manage.
This information is based on the prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.
These insights are based on 481 comments about Keytruda from MyBCTeam members.
Members who use Keytruda often say it helps to stay in close contact with their care team, especially about side effects, lab changes, and scheduling. Many also describe practical ways to get through treatment, such as resting when needed, staying hydrated, and preparing for a long treatment timeline that may continue after surgery or radiation.
Report new symptoms quickly, even if earlier doses were easy.
“I have received eight doses of Keytruda with minor side effects until right before my final dose, number 9. My TSH was high, T3 normal, and T4 low. I have contacted my endocrinologist as recommended by the oncologist.”
Keep up with labs and follow-up tests so your team can watch for changes.
“My cardiologist did an echocardiogram, EKG, and another blood test before and halfway through chemo. Every time I had chemo, weekly for 12 weeks, labs were drawn showing impact on kidneys, liver, white and red cells, etc. If negative, I couldn’t have chemo that week.”
Ask your care team what your Keytruda schedule will look like.
“I have a 30-minute infusion of Keytruda every three weeks, and I haven’t had any problems with it so far.”
Rest, hydrate, and pace yourself during treatment.
“Rest when you need to, stay really hydrated. Stay off of Google.”
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In clinical trials, the most common side effects of Keytruda used with chemotherapy or chemoradiotherapy were reported in at least 20 percent of people.
These side effects include:
Keytruda Qlex may also cause administration-related reactions, including reactions at the injection site. Your doctor can tell you whether you are receiving Keytruda as an intravenous infusion or Keytruda Qlex as an injection under the skin.
Keytruda can cause serious side effects that may require immediate medical attention. Immune-mediated side effects occur when the immune system attacks healthy organs or tissues and include:
Other serious side effects that may require immediate attention include:
Get medical help right away if you think you are having a serious reaction.
Before starting Keytruda, your doctor will test or check:
Tell your doctor if you have any allergies to pembrolizumab or any ingredients in Keytruda. If you are receiving Keytruda Qlex, also tell your doctor if you have had an allergic reaction to berahyaluronidase alfa, hyaluronidase, or any ingredients in Keytruda Qlex.
Tell your doctor about all medications you take, including prescription drugs, over-the-counter medicines, and supplements.
Keytruda is also FDA-approved to treat many other cancers. These include melanoma, non-small cell lung cancer, malignant pleural mesothelioma, head and neck squamous cell cancer, classical Hodgkin lymphoma, primary mediastinal large B-cell lymphoma, urothelial cancer, microsatellite instability-high or mismatch repair-deficient cancer, colorectal cancer, gastric cancer, esophageal cancer, cervical cancer, hepatocellular carcinoma, biliary tract cancer, Merkel cell carcinoma, renal cell carcinoma, endometrial carcinoma, tumor mutational burden-high cancer, cutaneous squamous cell carcinoma, and ovarian cancer. Not all forms of Keytruda are approved for every use.
Keytruda can harm your baby if you are pregnant. Your doctor should check your pregnancy status before you start treatment if you can become pregnant.
Females who can become pregnant should use effective birth control during treatment and for four months after the last dose. Do not breastfeed during treatment with Keytruda or for four months after the last dose.
These answers are fact-checked by our editorial staff.
How effective is Keytruda?
In a study of people with high-risk early-stage triple-negative breast cancer, Keytruda was used with chemotherapy before surgery and then continued by itself after surgery. People who received Keytruda were more likely to have no cancer found in the tissue removed during surgery. This is called a pathologic complete response.
The rate was 63 percent with Keytruda plus chemotherapy and 55.6 percent with chemotherapy alone. The study also showed that people who received Keytruda lived longer without certain cancer-related events and had better overall survival than people who did not receive Keytruda.
Can Keytruda cause thyroid or adrenal problems in triple-negative breast cancer?
Yes. Keytruda can cause immune-mediated hormone gland problems, including hypothyroidism, hyperthyroidism, hypophysitis, and adrenal insufficiency.
In pooled clinical data for intravenous Keytruda, hypothyroidism occurred in 8 percent of people, hyperthyroidism in 3.4 percent, hypophysitis in 0.6 percent, and adrenal insufficiency in 0.8 percent.
What tests or monitoring are needed with Keytruda for triple-negative breast cancer?
People taking Keytruda should be monitored closely. Liver enzymes, creatinine, thyroid function, and blood counts should be checked at baseline and periodically during treatment.
For people with triple-negative breast cancer treated before surgery, blood cortisol should also be checked at baseline, before surgery, and as clinically indicated.
On MyBCTeam, people share their experiences with triple-negative breast cancer, get advice, and find support from others who understand.
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