Pembrolizumab

Pembrolizumab (Keytruda, Merck Sharp & Dohme B.V.) has 42 EU-approved indications in 16 tumour types. 20 need a biomarker result: PD-L1 (14) and MMR/MSI (6).
Approved indications of Pembrolizumab
Biomarker requirementRegimenSettingConditions
Non-small cell lung cancer7
None
+ platinum-containing chemotherapy
Neoadj.
early
Then adjuvant monotherapy after surgery; High risk of recurrence
None
Monotherapy
Adj.
early
After neoadjuvant pembrolizumab + platinum-containing chemotherapy and surgical resection; High risk of recurrence
None
Monotherapy
Adj.
After complete resection and platinum-based chemotherapy; High risk of recurrence
None
+ carboplatin and either paclitaxel or nab-paclitaxel
1L
metastatic
Squamous only
EGFR/ALK-negative
+ pemetrexed and platinum chemotherapy
1L
metastatic
Non-squamous only
PD-L1 TPS ≥ 50%, EGFR/ALK-negative
Monotherapy
1L
metastatic
None
PD-L1 TPS ≥ 1%
Monotherapy
2L
advanced
After at least one prior chemotherapy regimen; prior targeted therapy if EGFR or ALK positive
Mesothelioma1
None
+ pemetrexed and platinum chemotherapy
1L
advanced
Non-epithelioid only; Pleural mesothelioma only
Triple-negative breast cancer3
None
+ chemotherapy
Neoadj.
Then adjuvant monotherapy after surgery; Locally advanced or early-stage; high risk of recurrence
None
Monotherapy
Adj.
After neoadjuvant pembrolizumab + chemotherapy and surgical resection; Locally advanced or early-stage; high risk of recurrence
PD-L1 CPS ≥ 10
+ chemotherapy
1L
advanced
No prior chemotherapy for metastatic disease
Small intestine cancer1
MMR/MSI deficient
Monotherapy
2L
advanced
Disease progression on or following at least one prior therapy
Colorectal cancer2
MMR/MSI deficient
Monotherapy
1L
metastatic
None
MMR/MSI deficient
Monotherapy
2L
advanced
After previous fluoropyrimidine-based combination therapy
Gastric and GEJ adenocarcinoma3
PD-L1 CPS ≥ 1, HER2-negative
+ fluoropyrimidine and platinum-containing chemotherapy
1L
advanced
None
PD-L1 CPS ≥ 1; HER2 IHC 3+ or IHC 2+/ISH-positive
+ trastuzumab, fluoropyrimidine and platinum-containing chemotherapy
1L
advanced
None
MMR/MSI deficient
Monotherapy
2L
advanced
Disease progression on or following at least one prior therapy
Oesophageal cancer1
PD-L1 CPS ≥ 10
+ platinum and fluoropyrimidine-based chemotherapy
1L
advanced
None
Biliary tract cancer2
None
+ gemcitabine and cisplatin
1L
advanced
None
MMR/MSI deficient
Monotherapy
2L
advanced
Disease progression on or following at least one prior therapy
Ovarian cancer1
PD-L1 CPS ≥ 1
+ paclitaxel, with or without bevacizumab
2L
advanced
After one or two prior systemic treatment regimens; platinum-resistant
Endometrial cancer3
None
+ carboplatin and paclitaxel
1L
advanced
Candidates for systemic therapy
None
+ lenvatinib
Any line
advanced
Disease progression on or following prior treatment with a platinum-containing therapy in any setting; Not candidates for curative surgery or radiation
MMR/MSI deficient
Monotherapy
Any line
advanced
Disease progression on or following prior treatment with a platinum-containing therapy in any setting; Not candidates for curative surgery or radiation
Cervical cancer2
None
+ chemoradiotherapy (external beam radiation therapy followed by brachytherapy)
1L
locally adv.
No prior definitive therapy; FIGO 2014 Stage III - IVA
PD-L1 CPS ≥ 1
+ chemotherapy with or without bevacizumab
Any line
advanced
None
Renal cell carcinoma3
None
Monotherapy
Adj.
Following nephrectomy, or following nephrectomy and resection of metastatic lesions; Increased risk of recurrence
None
+ axitinib
1L
advanced
None
None
+ lenvatinib
1L
advanced
None
Urothelial carcinoma5
None
+ enfortumab vedotin
Neoadj.
early
Muscle-invasive only; Then adjuvant pembrolizumab + enfortumab vedotin after surgery
None
+ enfortumab vedotin
Adj.
early
Muscle-invasive only; After neoadjuvant pembrolizumab + enfortumab vedotin and radical cystectomy
None
+ enfortumab vedotin
1L
advanced
None
None
Monotherapy
2L
advanced
After prior platinum-containing chemotherapy
PD-L1 CPS ≥ 10
Monotherapy
Any line
advanced
Cisplatin-ineligible
Melanoma2
None
Monotherapy
Adj.
After complete resection; Stage IIB, IIC or III
None
Monotherapy
Any line
advanced
None
Head and neck squamous cell carcinoma5
PD-L1 CPS ≥ 1
Monotherapy
Neoadj.
locally adv.
Then adjuvant pembrolizumab + radiation therapy with or without concomitant cisplatin, followed by monotherapy after surgery
PD-L1 CPS ≥ 1
+ radiation therapy with or without concomitant cisplatin, followed by monotherapy
Adj.
locally adv.
After neoadjuvant pembrolizumab and surgical resection
PD-L1 CPS ≥ 1
+ platinum and 5-fluorouracil (5-FU) chemotherapy
1L
advanced
None
PD-L1 CPS ≥ 1
Monotherapy
1L
advanced
None
PD-L1 TPS ≥ 50%
Monotherapy
2L
advanced
Progressing on or after platinum-containing chemotherapy
Hodgkin lymphoma1
None
Monotherapy
3L+
Classical Hodgkin lymphoma only; Failed autologous stem cell transplant (ASCT), or following at least two prior therapies when ASCT is not a treatment option; Aged 3 years and older
Full text of section 4.1 (therapeutic indications)

Melanoma KEYTRUDA as monotherapy is indicated for the treatment of adults and adolescents aged 12 years and older with advanced (unresectable or metastatic) melanoma. KEYTRUDA as monotherapy is indicated for the adjuvant treatment of adults and adolescents aged 12 years and older with Stage IIB, IIC or III melanoma and who have undergone complete resection (see section 5.1). Non-small cell lung carcinoma (NSCLC) KEYTRUDA, in combination with platinum-containing chemotherapy as neoadjuvant treatment, and then continued as monotherapy as adjuvant treatment, is indicated for the treatment of resectable non-small cell lung carcinoma at high risk of recurrence in adults (for selection criteria, see section 5.1). KEYTRUDA as monotherapy is indicated for the adjuvant treatment of adults with non-small cell lung carcinoma who are at high risk of recurrence following complete resection and platinum-based chemotherapy (for selection criteria, see section 5.1). KEYTRUDA as monotherapy is indicated for the first-line treatment of metastatic non-small cell lung carcinoma in adults whose tumours express PD-L1 with a ≥ 50% tumour proportion score (TPS) with no EGFR or ALK positive tumour mutations. KEYTRUDA, in combination with pemetrexed and platinum chemotherapy, is indicated for the first-line treatment of metastatic non-squamous non-small cell lung carcinoma in adults whose tumours have no EGFR or ALK positive mutations. KEYTRUDA, in combination with carboplatin and either paclitaxel or nab-paclitaxel, is indicated for the first-line treatment of metastatic squamous non-small cell lung carcinoma in adults. KEYTRUDA as monotherapy is indicated for the treatment of locally advanced or metastatic non-small cell lung carcinoma in adults whose tumours express PD-L1 with a ≥ 1% TPS and who have received at least one prior chemotherapy regimen. Patients with EGFR or ALK positive tumour mutations should also have received targeted therapy before receiving KEYTRUDA. Malignant pleural mesothelioma (MPM) KEYTRUDA, in combination with pemetrexed and platinum chemotherapy, is indicated for the first-line treatment of adults with unresectable non-epithelioid malignant pleural mesothelioma. Classical Hodgkin lymphoma (cHL) KEYTRUDA as monotherapy is indicated for the treatment of adult and paediatric patients aged 3 years and older with relapsed or refractory classical Hodgkin lymphoma who have failed autologous stem cell transplant (ASCT) or following at least two prior therapies when ASCT is not a treatment option. Urothelial carcinoma KEYTRUDA, in combination with enfortumab vedotin, as neoadjuvant treatment and then continued after radical cystectomy as adjuvant treatment, is indicated for the treatment of adults with resectable muscle invasive bladder cancer (MIBC). KEYTRUDA, in combination with enfortumab vedotin, is indicated for the first-line treatment of unresectable or metastatic urothelial carcinoma in adults. KEYTRUDA as monotherapy is indicated for the treatment of locally advanced or metastatic urothelial carcinoma in adults who have received prior platinum-containing chemotherapy (see section 5.1). KEYTRUDA as monotherapy is indicated for the treatment of locally advanced or metastatic urothelial carcinoma in adults who are not eligible for cisplatin-containing chemotherapy and whose tumours express PD-L1 with a combined positive score (CPS) ≥ 10 (see section 5.1). Head and neck squamous cell carcinoma (HNSCC) KEYTRUDA as monotherapy is indicated for the treatment of resectable locally advanced head and neck squamous cell carcinoma as neoadjuvant treatment, continued as adjuvant treatment in combination with radiation therapy with or without concomitant cisplatin and then as monotherapy in adults whose tumours express PD-L1 with a CPS ≥ 1. KEYTRUDA, as monotherapy or in combination with platinum and 5-fluorouracil (5-FU) chemotherapy, is indicated for the first-line treatment of metastatic or unresectable recurrent head and neck squamous cell carcinoma in adults whose tumours express PD-L1 with a CPS ≥ 1 (see section 5.1). KEYTRUDA as monotherapy is indicated for the treatment of recurrent or metastatic head and neck squamous cell carcinoma in adults whose tumours express PD-L1 with a ≥ 50% TPS and progressing on or after platinum-containing chemotherapy (see section 5.1). Renal cell carcinoma (RCC) KEYTRUDA, in combination with axitinib, is indicated for the first-line treatment of advanced renal cell carcinoma in adults (see section 5.1). KEYTRUDA, in combination with lenvatinib, is indicated for the first-line treatment of advanced renal cell carcinoma in adults (see section 5.1). KEYTRUDA as monotherapy is indicated for the adjuvant treatment of adults with renal cell carcinoma at increased risk of recurrence following nephrectomy, or following nephrectomy and resection of metastatic lesions (for selection criteria, see section 5.1). Microsatellite instability high (MSI-H) or mismatch repair deficient (dMMR) cancers Colorectal cancer (CRC) KEYTRUDA as monotherapy is indicated for adults with MSI-H or dMMR colorectal cancer in the following settings: - first-line treatment of metastatic colorectal cancer; - treatment of unresectable or metastatic colorectal cancer after previous fluoropyrimidine-based combination therapy. Non-colorectal cancers KEYTRUDA as monotherapy is indicated for the treatment of the following MSI-H or dMMR tumours in adults with: - advanced or recurrent endometrial carcinoma, who have disease progression on or following prior treatment with a platinum-containing therapy in any setting and who are not candidates for curative surgery or radiation; - unresectable or metastatic gastric, small intestine, or biliary cancer, who have disease progression on or following at least one prior therapy. Oesophageal carcinoma KEYTRUDA, in combination with platinum and fluoropyrimidine-based chemotherapy, is indicated for the first-line treatment of locally advanced unresectable or metastatic carcinoma of the oesophagus in adults whose tumours express PD-L1 with a CPS ≥ 10 (see section 5.1). Triple-negative breast cancer (TNBC) KEYTRUDA, in combination with chemotherapy as neoadjuvant treatment, and then continued as monotherapy as adjuvant treatment after surgery, is indicated for the treatment of adults with locally advanced, or early-stage triple-negative breast cancer at high risk of recurrence (see section 5.1). KEYTRUDA, in combination with chemotherapy, is indicated for the treatment of locally recurrent unresectable or metastatic triple-negative breast cancer in adults whose tumours express PD-L1 with a CPS ≥ 10 and who have not received prior chemotherapy for metastatic disease (see section 5.1). Endometrial carcinoma (EC) KEYTRUDA, in combination with carboplatin and paclitaxel, is indicated for the first-line treatment of primary advanced or recurrent endometrial carcinoma in adults who are candidates for systemic therapy. KEYTRUDA, in combination with lenvatinib, is indicated for the treatment of advanced or recurrent endometrial carcinoma in adults who have disease progression on or following prior treatment with a platinum-containing therapy in any setting and who are not candidates for curative surgery or radiation. Cervical cancer KEYTRUDA, in combination with chemoradiotherapy (external beam radiation therapy followed by brachytherapy), is indicated for the treatment of FIGO 2014 Stage III - IVA locally advanced cervical cancer in adults who have not received prior definitive therapy. KEYTRUDA, in combination with chemotherapy with or without bevacizumab, is indicated for the treatment of persistent, recurrent, or metastatic cervical cancer in adults whose tumours express PD-L1 with a CPS ≥ 1. Gastric or gastro-oesophageal junction (GEJ) adenocarcinoma KEYTRUDA, in combination with trastuzumab, fluoropyrimidine and platinum-containing chemotherapy, is indicated for the first-line treatment of locally advanced unresectable or metastatic HER2-positive gastric or gastro-oesophageal junction adenocarcinoma in adults whose tumours express PD-L1 with a CPS ≥ 1. KEYTRUDA, in combination with fluoropyrimidine and platinum-containing chemotherapy, is indicated for the first-line treatment of locally advanced unresectable or metastatic HER2-negative gastric or gastro-oesophageal junction adenocarcinoma in adults whose tumours express PD-L1 with a CPS ≥ 1 (see section 5.1). Biliary tract carcinoma (BTC) KEYTRUDA, in combination with gemcitabine and cisplatin, is indicated for the first-line treatment of locally advanced unresectable or metastatic biliary tract carcinoma in adults. Ovarian Cancer KEYTRUDA, in combination with paclitaxel, with or without bevacizumab, is indicated for the treatment of platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal carcinoma in adults whose tumours express PD-L1 with a CPS ≥ 1 and who have received one or two prior systemic treatment regimens. KEYTRUDA as monotherapy is indicated for the treatment of adults and adolescents aged 12 years and older with relapsed or refractory classical Hodgkin lymphoma who have failed autologous stem cell transplant (ASCT) or following at least two prior therapies when ASCT is not a treatment option.

Label history

109 changes to the Keytruda label since 2016, 37 of them to the indications. Newest first, in the words of EMA's record of each procedure.

Changes