Pembrolizumab Immunotherapy Current & Future of Cancer Treatment

Biliary Tract Cancer:

Pembrolizumab is used in combination with gemcitabine hydrochloride and cisplatin for biliary tract cancer that is either unresectable or has metastasized. This regimen aims to manage the disease when surgical options are no longer viable.

Breast Cancer:

For triple-negative breast cancer (TNBC), Pembrolizumab is employed in multiple scenarios:

• Advanced Stage: It is combined with chemotherapy for patients whose tumors express the PD-L1 protein and are either recurrent, unresectable, or metastatic.
• Early-Stage: It is used with chemotherapy before surgery and continued alone after surgery in patients with high-risk early-stage TNBC, aiming to reduce recurrence.

Cervical Cancer: Pembrolizumab’s role in cervical cancer includes:

• Stage III/IVA: Used alongside chemotherapy and radiation therapy for advanced-stage cervical cancer.
• Recurrent or Metastatic: Combined with chemotherapy, with or without bevacizumab, for cancers that are PD-L1 positive and have either relapsed or metastasized.
• PD-L1 Positive Refractory Cases: Administered alone for cancers that have worsened during or after chemotherapy.

Classic Hodgkin Lymphoma:

Pembrolizumab is used:

• Adults: For cases that are refractory or have relapsed after initial treatments.
• Children: For relapsed or refractory cases after at least two other treatment lines.

Cutaneous Squamous Cell Carcinoma:

For this skin cancer, Pembrolizumab is indicated in patients whose disease has recurred or spread and is not amenable to surgical or radiation therapy.

Endometrial Carcinoma:

Pembrolizumab is approved for:

• Combination Therapy: With carboplatin and paclitaxel followed by monotherapy for patients with advanced or recurrent endometrial cancer.
• Lenvatinib Combination: For cancers that are not microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR), which have progressed after other therapies.
• Monotherapy: For MSI-H or dMMR cancers that are not curable by surgery or radiation.

Esophageal and Gastroesophageal Junction Cancer:

Pembrolizumab is used:

• Chemotherapy: Combined with platinum-based chemotherapy and a fluoropyrimidine for cancers that cannot be treated with surgery or chemoradiation.
• As Monotherapy: For squamous cell cancers that are PD-L1 positive, following prior systemic therapy.

Gastric Cancer:

For advanced gastric or gastroesophageal junction adenocarcinoma:

• HER2 Positive: Pembrolizumab is used with trastuzumab, fluoropyrimidine, and platinum-based chemotherapy.
• HER2 Negative: Administered with fluoropyrimidine and platinum-based chemotherapy.

Hepatocellular Carcinoma:

Pembrolizumab is indicated for patients who have progressed on sorafenib, providing an alternative therapeutic approach for advanced liver cancer.

Melanoma:

Pembrolizumab is applied in:

• Advanced Cases: For cancers that are unresectable or metastatic.
• Adjuvant Therapy: In adults and children aged 12 years and older with stage IIB, IIC, or III melanoma, following surgical resection.

Merkel Cell Carcinoma:

Pembrolizumab is used for Merkel cell carcinoma that has recurred or spread in both adults and children.

Microsatellite Instability-High (MSI-H) or Mismatch Repair Deficient (dMMR) Cancers

Pembrolizumab treats:

• Solid Tumors: In both adults and children with TMB-H solid tumors that have progressed after other treatments and are not amenable to other therapies.
• Colorectal Cancer: Specific focus on cancers with MSI-H or dMMR characteristics.

Non-Small Cell Lung Cancer (NSCLC):

For NSCLC, Pembrolizumab is utilized:

• First-Line Treatment: With pemetrexed and platinum-based chemotherapy for nonsquamous cancers without EGFR or ALK mutations, or with carboplatin and paclitaxel for squamous cancers.
  Adjuvant Therapy: Used alone after platinum-based chemotherapy and surgery to prevent recurrence.
• Monotherapy: As a first-line treatment for stage III cancers with PD-L1 positivity, or for those with disease progression after prior therapies.

Primary Mediastinal Large B-Cell Lymphoma:

Pembrolizumab is indicated for adults and children with refractory or relapsed primary mediastinal large B-cell lymphoma after at least two other therapies.

Renal Cell Carcinoma:

Pembrolizumab is employed:

• First-Line Therapy: With axitinib or lenvatinib for cancers that are unresectable or metastatic.
• Adjuvant Therapy: To reduce recurrence risk after kidney surgery in high-risk patients.

Solid Tumors with High Tumor Mutational Burden (TMB-H):

For TMB-H tumors that have spread or are unresectable, Pembrolizumab is used when other therapies are unsuitable or ineffective.

Squamous Cell Carcinoma of the Head and Neck:

Pembrolizumab is utilized:

• First-Line: Combined with platinum-based chemotherapy and fluorouracil for unresectable tumors.
• Monotherapy: For PD-L1 positive tumors or those progressing after chemotherapy.

Urothelial Carcinoma:

Pembrolizumab is indicated:

• With Enfortumab Vedotin: For cancers that have spread.
• Monotherapy: For cancers that have spread or worsened after platinum-based chemotherapy or have not responded to BCG therapy.
  
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