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(trade name)


Therapeutic: antineoplastics
Pharmacologic: monoclonal antibodies
Pregnancy Category: D


Treatment of unresectable or metastatic melanoma with disease progression despite ipilimumab and a BRAF inhibitor (if positive for the BRAF V600 mutation).


Programmed death (PD) receptor-1–blocking antibody (an IgG4 kappa immunglobulin) that blocks the interaction between PD-1 and its ligands PD-L1 and PD-L2 resuling in inhibition of T-cell proliferation and decreased cytokine production.

Therapeutic effects

Decreased spread of melanoma.


Absorption: IV administration results in complete bioavailability.
Distribution: Unknown.
Metabolism and Excretion: Unknown.
Half-life: 26 days.

Time/action profile (response)

IVwithin 3 mounkmay persist for > 8.8 mos


Contraindicated in: Obstetric: Pregnancy (may cause fetal harm); Lactation: Discontinue pembrolizumab or discontinue breastfeeding.
Use Cautiously in: Obstetric: Females with reproductive potential; Moderate to severe hepatic impairment; Pediatric: Safe and effective use in children has not been established.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness (most frequent)
  • fatigue (most frequent)
  • headache (most frequent)
  • insomnia (most frequent)


  • immune-mediated pneumonitis (life-threatening)


  • immune-mediated colitis (life-threatening)
  • immune-mediated Hepatitis (life-threatening)
  • ↓ appetite (most frequent)
  • constipation (most frequent)
  • diarrhea (most frequent)
  • nausea (most frequent)


  • immune-mediated nephritis (life-threatening)


  • pruritus (most frequent)
  • rash (most frequent)
  • vitiligo


  • immune-mediated hypophysitis (life-threatening)
  • immune-mediated hyperthyroidism
  • immune-mediated hypothyroidism


  • arthralgia (most frequent)
  • back pain (most frequent)
  • extremity pain (most frequent)
  • mylagia (most frequent)


  • anemia (most frequent)


  • sepsis (life-threatening)
  • other immune mediated adverse reactions


Drug-Drug interaction

None noted.


Intravenous (Adults) 2 mg/kg every 3 wk.


Lyophilized powder for injection (requires reconstitution): 50 mg/single use vial

Nursing implications

Nursing assessment

  • Monitor for signs and symptoms of immune-mediated pneumonitis (shortness of breath, chest pain, new or worse cough) periodically during therapy. Evaluate with x-ray. Treat with corticosteroids for ≥Grade 2 pneumonitis. Withhold pembrolizumab and monitor symptoms for moderate (Grade 2) pneumonitis; resume therapy when recovery to Grade 0 to 1. Permanently discontinue for severe (Grade 3) or life-threatening (Grade 4) pneumonitis.
  • Monitor for signs and symptoms of colitis (diarrhea, abdominal pain, mucus or blood in stool, with or without fever). Treat with corticosteroids for ≥Grade 2 colitis. Withhold pembrolizumab and monitor symptoms for moderate (Grade 2) or severe (Grade 3) colitis; resume therapy when recovery to Grade 0 to 1. Permanently discontinue for life-threatening (Grade 4) colitis.
  • Assess for signs and symptoms of immune-mediated hepatitis (yellowing of skin or whites of eyes, unusual darkening of urine, unusual tiredness, pain in right upper stomach) before each dose. Treat with corticosteroids for ≥Grade 2. Withhold or discontinue pembrolizumab depending on severity of liver enzyme elevations. Resume therapy when recovery to Grade 0 to 1.
  • Monitor for clinical signs and symptoms of hypophysitis (persistent or unusual headache, extreme weakness, dizziness or fainting, vision changes) during therapy. Treat with corticosteroids for ≥Grade 2 hypophysitis. Withhold pembrolizumab and monitor symptoms for moderate (Grade 2) hypophysitis; withhold or discontinue for severe (Grade 3), and resume therapy when recovery to Grade 0 to 1. Permanently discontinue for life-threatening (Grade 4) hypophysitis.
  • Lab Test Considerations: Monitor for changes in renal function. Treat with corticosteroids for ≥Grade 2 nephritis. Withhold pembrolizumab and monitor symptoms for moderate (Grade 2) nephritis; resume therapy when recovery to Grade 0 to 1. Permanently discontinue for severe (Grade 3) or life-threatening (Grade 4) nephritis.
    • Monitor for changes in thyroid function at start of and periodically during therapy, and as indicated based on clinical evaluation. Administer corticosteroids for ≥Grade 3 hyperthyroidism, withhold pembrolizumab for severe (Grade 3) hyperthyroidism and resume therapy when recovery to Grade 0 to 1. Permanently discontinue for life-threatening (Grade 4) hyperthyroidism. Manage hypothyroidism with thyroid replacement without interruption of therapy or corticosteroids.

Potential Nursing Diagnoses

Diarrhea (Adverse Reactions)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)


  • Intravenous Administration
  • Intermittent Infusion: Reconstitute by injecting 2.3 mL of Sterile Water for Injection along vial walls; swirl slowly, do not shake. Allow up to 5 min for bubbles to clear. Solution is clear to slightly opalescent, colorless to slightly yellow; do not administer solution if discolored or contains particulate matter other than translucent to white proteinaceous particles. Solution is stable at room temperature for up to 4 hr and 24 hr if refrigerated. Diluent: 0.9% NaCl. Mix using gently inversion. Concentration: 1 mg/mL to 10 mg/mL.
  • Rate: Infuse through a sterile, non-pyrogenic, low-protein binding 0.2 micron to 0.5 micron in-line or add-on filter over 30 min.
  • Y-Site Incompatibility: Do not administer other drugs through same infusion line.

Patient/Family Teaching

  • Explain purpose of pembrolizumab to patient.
  • Advise patient to notify health care professional immediately if signs and symptoms of pneumonitis, colitis, hepatitis, kidney problems (change in amount or color of urine), hormone gland problems (rapid heart beat, weight loss, increased sweating, weight gain, hair loss, feeling cold, constipation, deepening of voice, muscle aches, dizziness or fainting, persistent or unusual headache) occur.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
  • Advise female patient of reproductive potential to use highly effective contraception during and for 4 mo after last dose; may cause fetal harm. Avoid breastfeeding during therapy.
  • Emphasize importance of keeping scheduled appointments for blood work or other laboratory tests.

Evaluation/Desired Outcomes

  • ↓ spread of melanoma.
References in periodicals archive ?
M2 PHARMA-March 16, 2018-NICE recommends MSD's Keytruda for bladder cancer
M2 EQUITYBITES-March 16, 2018-NICE recommends MSD's Keytruda for bladder cancer
Keytruda will continue to dominate the first-line non-small cell lung cancer market, Fernandez tells investors in a research note.
A Phase 3 study (Study 307), sponsored by Eisai, is ongoing to evaluate separate combinations of LENVIMA with KEYTRUDA (pembrolizumab) or LENVIMA with everolimus versus chemotherapy alone for the treatment of RCC.
Against this background, The tendering objective of the present award procedure is to conclude a contract for the supply of the following tendered specialty products: Keytruda plv ilsg 50mg dfl or keytruda konz 25mg / ml dfl4ml, Bridion ijlsg 100mg / ml 2ml, Bridion ijlsg 100mg / ml 5 ml, Noxafil msr tbl 100 mg, Noxafil msr tbl 100 mg and noxafil sus 40 mg / ml 105 ml.
SELLAS' Wilms tumor-1 (WT1)-targeting peptide immunotherapeutic agent, galinpepimut-S, will be administered in combination with MSD's anti-PD-1 therapy KEYTRUDA in a Phase 1/2 trial enrolling patients in five cancer indications, including both hematologic malignancies and solid tumors.
com/quote/nyse/merck-co/mrk) NYSE:MRK ) Keytruda recently did all the more impressive.
The collaboration is intended to assess Genexine's GX-188E, HPV therapeutic DNA vaccine, in combination with Merck's anti-PD-1 therapy, Keytruda (pembrolizumab), for treating patients with human pappilomavirus (HPV)-induced cancers.
Merck & Co scored a double hit on Sunday with new clinical data showing its Keytruda immunotherapy offered big benefits in previously untreated lung cancer patients, either when given on its own or with chemotherapy.
Ces patients ont pris le Keytruda pendant un peu plus de onze mois.
A small study published earlier this year in the New England Journal of Medicine showed that 92 per cent of patients with advanced colon and rectal cancers who had mismatch repair defects responded to Merck & Co's immunotherapy drug Keytruda.
CHICAGO, Sha'ban 11, 1436, May 29, 2015, SPA -- Patients with colon and other cancers who have a specific defect in genes needed for DNA repair are far more likely to respond to a new class of drugs such as Merck & Co's Keytruda, which enlist the immune system to attack tumors, a new study has shown, Reuters reported.