KEYTRUDA for head and neck cancer 


About head and neck cancer

If you have been diagnosed with head or neck cancer, or you know somebody who has, you’re probably looking for reliable information about the disease and its treatments. This section will help to answer many of your questions.

Types of head and neck cancer

How head and neck cancers are named depends on where the cancer first starts. Cancer can also start in the brain, eye, oesophagus, thyroid gland, skin, scalp or the bones or muscles of the head and neck, however these cancers are not known as head and neck cancers. The following are types of head and neck cancers.

  • Oral cancer describes cancer that affects your lips, gums, cheek lining, floor of your mouth, roof of the mouth (hard palate), your tongue or the muscles on the base of your tongue that extend down into your throat.
  • Nasopharyngeal cancer refers to cancer in the upper region of the throat behind the nose, but before your mouth joins the throat.
  • Oropharyngeal cancer is cancer that begins in the middle region of the throat, roughly behind your mouth.
  • Hypopharyngeal cancer describes cancer in the lower region of your throat, behind your voice box (larynx).
  • Laryngeal cancer means cancer that affects your voice box (larynx).
  • Salivary gland cancer affects any or all of your salivary glands – there are three large salivary glands and hundreds of smaller ones.
  • Nasal cancer begins in any of the cells lining the large, hollow space (nasal cavity) inside the nose that warms, moistens and filters the air you breathe.
  • Paranasal sinus cancer affects any or all of the small, air-filled spaces (paranasal sinuses) that surround the nasal cavity.
  • Metastatic head and neck cancer refers to cancer that has spread from where it started to another part of your body.
  • Recurrent head and neck cancer means cancer that has come back after previous treatment.

Incidence of head and neck cancer

Head and neck cancer represents the sixth leading cancer by incidence worldwide. Nearly all the cases of head and neck malignancies (95%) are represented by squamous cell carcinoma arising in the oral cavity and pharynx.

What are the symptoms?

  • Pain in the area
  • Swelling in the area
  • A hoarse voice
  • Difficulty swallowing
  • Bad breath

How is it diagnosed?

If your doctor suspects head or neck cancer, these tests may be required:

  • Physical examination
    Diagnosis usually begins with an examination of your mouth, throat, nose, neck, ears and eyes.
  • Nasendoscopy
    A nasendoscope is an examination device that allows closer inspection of the nose and throat area. It involves a thin flexible tube with a light and camera on the end that is passed through your nostril.
  • Biopsy
    The nasendoscope can be used to take a tissue sample (biopsy) of unusual looking areas.
  • Laryngoscopy
    A laryngoscope is a device that allows your doctor to look at your larynx and pharynx, then take a biopsy if necessary. In this procedure, a tube with a light and camera on it is inserted into your mouth and throat.
  • Imaging tests
    An X-ray scan, CT scan, MRI scan, PET scan or ultrasound may be required as part of the diagnostic process.

Treatment for head and neck cancer

  • Tumour surgery
    Surgery aims to remove cancerous tissue in a way that preserves the functions of your head and neck, such as breathing, swallowing and talking. Surgical procedures and recovery times will differ depending on the location and extent of your cancer.
  • Lymph node removal
    Depending on the extent of your cancer, your surgeon may remove some lymph nodes. This operation is called a lymphadenectomy. There is a possibility it will affect the movement and appearance of your neck or shoulder.
  • Radiotherapy
    Also known as radiation therapy, radiotherapy is used to kill or harm cancer cells. It is carefully targeted to do as little harm as possible to healthy tissue.
  • Chemotherapy
    Chemotherapy involves the use of drugs to kill or slow the growth of cancer cells in the body. It is usually given by injection into a vein (intravenously) at treatment sessions over several weeks. Chemotherapy affects all rapidly dividing cells, so there can be uncomfortable side effects.
  • Targeted therapies
    Targeted therapies are newer treatments that attack specific molecules within cells to help prevent cell growth. Compared to chemotherapy, they have fewer side effects.
  • Immuno-oncology treatment
    KEYTRUDA is an immuno-oncology treatment for advanced and reoccurring head and neck cancer. It may be used when platinum and cetuximab-based* therapies didn’t work, or are no longer working.

*Cetuximab is not funded in New Zealand

Questions to ask your doctor about head and neck cancer

About KEYTRUDA

How to access KEYTRUDA


NZ-KEY-00181

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Important Safety Information About KEYTRUDA® (pembrolizumab)

KEYTRUDA contains the active substance called pembrolizumab and is a medicine that may treat certain cancers by working with your immune system. KEYTRUDA can cause your immune system to attack normal organs and tissues in any area of your body and can affect the way they work. These problems can sometimes become severe or life-threatening and can lead to death. These problems may happen any time during treatment or even after your treatment has ended.

Before you receive KEYTRUDA, tell your doctor if you have immune system problems such as Crohn’s disease, ulcerative colitis, or lupus; have had an organ transplant or plan to have or have had a bone marrow (stem cell) transplant that used donor stem cells (allogeneic); have lung or breathing problems; have liver problems; or have any other medical problems.

If you are pregnant or plan to become pregnant, tell your doctor. KEYTRUDA can harm your unborn baby. If you are able to become pregnant, your doctor will give you a pregnancy test before you start treatment. Use effective birth control during treatment and for at least 4 months after the final dose of KEYTRUDA. Tell your doctor right away if you think you may be pregnant, or you become pregnant during treatment with KEYTRUDA.

If you are breastfeeding or plan to breastfeed, tell your doctor. It is not known if KEYTRUDA passes into your breast milk. Do not breastfeed during treatment with KEYTRUDA and for 4 months after your final dose of KEYTRUDA.

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Your doctor will give you KEYTRUDA through an IV for about 30 minutes. Most people get KEYTRUDA every 3 weeks or every 6 weeks, depending on the dose you are given. Your doctor will decide how many treatments you need.

What are the possible side effects of KEYTRUDA?

KEYTRUDA can cause your immune system to attack normal organs and tissues in any area of your body and can affect the way they work. These problems can sometimes become severe or life-threatening and can lead to death. These problems may happen any time during treatment or even after your treatment has ended.

Side effects may occur with KEYTRUDA. Serious side effects include: lung problems (or pneumonitis); intestinal problems (or colitis) that can lead to tears or holes in your intestine; liver problems (or hepatitis); hormone gland problems (especially the thyroid, pituitary, adrenal glands, and pancreas); kidney problems (including nephritis and kidney failure); skin problems; problems in other organs; infusion (IV) reactions that can sometimes be severe and life-threatening; rejection of a transplanted organ; and complications in people with a bone marrow transplant that uses donor stem cells (allogeneic). Getting medical treatment right away may help keep these problems from becoming more serious. Your doctor will check you for these problems during treatment with KEYTRUDA. Your doctor may treat you with corticosteroid or hormone replacement medicines and delay or completely stop treatment with KEYTRUDA if you have severe side effects.

Common side effects in people who received KEYTRUDA include feeling tired; pain, including pain in muscles, bones, or joints and stomach area (abdominal) pain; decreased appetite; itching; diarrhoea; nausea; rash; fever; cough; shortness of breath; and constipation.

Common side effects reported in more than 1 in 5 people when KEYTRUDA was given in combination with certain chemotherapy medicines: hair loss, feeling tired, diarrhoea, decreased white blood cell count, joint pain, rash. Less common side effects can happen.

Call or see your doctor right away if you develop any symptoms of the following problems or these symptoms get worse:

Lung problems (pneumonitis). Symptoms of pneumonitis may include shortness of breath, chest pain, or new or worse cough.

Intestinal problems (colitis) that can lead to tears or holes in your intestine. Signs and symptoms of colitis may include diarrhoea or more bowel movements than usual; stools that are black, tarry, sticky, or have blood or mucus; or severe stomach-area (abdomen) pain or tenderness.

Liver problems, including hepatitis. Signs and symptoms of liver problems may include yellowing of your skin or the whites of your eyes, nausea or vomiting, pain on the right side of your stomach area (abdomen), dark urine, or bleeding or bruising more easily than normal.

Hormone gland problems (especially the thyroid, pituitary, adrenal glands, and pancreas). Signs and symptoms that your hormone glands are not working properly may include rapid heartbeat, weight loss or weight gain, increased sweating, feeling more hungry or thirsty, urinating more often than usual, hair loss, feeling cold, constipation, your voice gets deeper, muscle aches, dizziness or fainting, or headaches that will not go away or unusual headache.

Kidney problems, including nephritis and kidney failure. Signs of kidney problems may include change in the amount or color of your urine.

Skin problems. Signs of skin problems may include rash, itching, blisters, peeling or skin sores, or painful sores or ulcers in your mouth or in your nose, throat, or genital area.

Problems in other organs. Signs and symptoms of these problems may include changes in eyesight; severe or persistent muscle or joint pains; severe muscle weakness; low red blood cells (anemia); swollen lymph nodes, rash or tender lumps on skin, cough, shortness of breath, vision changes, or eye pain (sarcoidosis); confusion, fever, muscle weakness, balance problems, nausea, vomiting, stiff neck, memory problems, or seizures (encephalitis); and shortness of breath, irregular heartbeat, feeling tired, or chest pain (myocarditis).

Infusion (IV) reactions that can sometimes be severe and life-threatening. Signs and symptoms of infusion reactions may include chills or shaking, shortness of breath or wheezing, itching or rash, flushing, dizziness, fever, or feeling like passing out.

Rejection of a transplanted organ. People who have had an organ transplant may have an increased risk of organ transplant rejection if they are treated with KEYTRUDA.

Complications, including graft-versus-host disease (GVHD), in people who have received a bone marrow (stem cell) transplant that uses donor stem cells (allogeneic). These complications can be severe and can lead to death. These complications may happen if you underwent transplantation either before or after being treated with KEYTRUDA. Your doctor will monitor you for the following signs and symptoms: skin rash, liver inflammation, abdominal pain, and diarrhoea.

Getting medical treatment right away may help keep these problems from becoming more serious. Your doctor will check you for these problems during treatment with KEYTRUDA. Your doctor may treat you with corticosteroid or hormone replacement medicines. Your doctor may also need to delay or completely stop treatment with KEYTRUDA if you have severe side effects.

Based on US Consumer SSI & NZ CMI and Data sheet prepared 29 July 2019.


KEYTRUDA (pembrolizumab) 50mg powder for infusion

KEYTRUDA (pembrolizumab) 100 mg/4 mL (25 mg/mL) concentrate for solution for infusion

KEYTRUDA is a Prescription Only Medicine

Use: KEYTRUDA is used
  • in the treatment of melanoma which cannot be removed by surgery alone or when it has spread to multiple sites in the body
  • in treatment of melanoma after surgery to help prevent the cancer from coming back
  • in the treatment of a kind of lung cancer called non-small cell lung cancer (NSCLC)
  • in the treatment of classical Hodgkin Lymphoma (cHL)
  • in the treatment of urothelial carcinoma, including bladder cancer
  • in the treatment of a kind of head and neck cancer called head and neck squamous cell carcinoma (HNSCC)
  • in the treatment of a kind of cancer in adults and children that can occur in any part of the body and is shown by a laboratory test to be microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR).

Side effects: Immune-mediated side effects including inflammation of the lungs, colon, liver, kidneys, pituitary gland, brain, eye, muscles, nervous system, pancreas, and heart, thyroid disorders, type 1 diabetes mellitus, adrenal insufficiency. Severe skin reactions including Steven-Johnson syndrome and toxic epidermal necrolysis. Severe infusion reactions including hypersensitivity and anaphylaxis. Transplant recipients: rejection of a transplanted organ, graft-versus-host-disease (in people with a bone marrow transplant using donor cells). Very common side effects include diarrhea, nausea, itching, rash, joint pain, back pain, feeling tired, cough, patches of discoloured skin, stomach pain, decreased levels of sodium in blood. Hair loss, tiredness, diarrhoea, a decrease in white-blood cell count, joint pain, and rash, were reported when given in combination with chemotherapy. Common side effects in children include fever, vomiting, fatigue, constipation stomach pain and nausea. It is not known if KEYTRUDA is safe and effective in children with MSI-H or dMMR cancer of the brain or spinal cord (central nervous system cancers). You may experience more than one side effect at the same time.

All medicines have risks and benefits. Talk to your doctor to see if KEYTRUDA is right for you. KEYTRUDA is a funded medicine for melanoma patients – restrictions apply. KEYTRUDA is an unfunded medicine for treatment of melanoma after surgery, NSCLC, HNSCC, cHL, urothelial carcinoma and MSI-H/dMMR cancer patients. Ask your health professional the cost of the medicine and any other medical fees that may apply. Use only as directed and if symptoms continue or you have side effects, see your doctor, pharmacist, or health professional.

Based on data sheet prepared 28 November 2019. Marketed by: Merck Sharp & Dohme (New Zealand) Limited, Newmarket, Auckland. For additional product information, consult the Consumer Medicine Information (CMI), available on request, phone 0800 500 673 or refer to the Medsafe website medsafe.govt.nz.

See full indications

KEYTRUDA (pembrolizumab) 50mg powder for infusion

KEYTRUDA (pembrolizumab) 100 mg/4 mL (25 mg/mL) concentrate for solution for infusion

KEYTRUDA is a Prescription Only Medicine and is used:

  • in the treatment of melanoma which cannot be removed by surgery alone or when it has spread to multiple sites in the body
  • in treatment of melanoma after surgery to help prevent the cancer from coming back.
  • in the treatment of a kind of lung cancer called non-small cell lung cancer (NSCLC)
  • in the treatment of classical Hodgkin Lymphoma (cHL)
  • in the treatment of urothelial carcinoma, including bladder cancer
  • in the treatment of a kind of head and neck cancer called head and neck squamous cell carcinoma (HNSCC)
  • in the treatment of a kind of cancer in adults and children that can occur in any part of the body and is shown by a laboratory test to be microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR).
  • It is not known if KEYTRUDA is safe and effective in children with MSI-H or dMMR cancer of the brain or spinal cord (central nervous system cancers).

KEYTRUDA contains the active substance called pembrolizumab and is a medicine that may treat certain cancers by working with your immune system. KEYTRUDA can cause your immune system to attack normal organs and tissues in any area of your body and can affect the way they work. These problems can sometimes become severe or life-threatening and can lead to death. These problems may happen any time during treatment or even after your treatment has ended.

Before you receive KEYTRUDA, tell your doctor if you have immune system problems such as Crohn’s disease, ulcerative colitis, or lupus; have had an organ transplant or plan to have or have had a bone marrow (stem cell) transplant that used donor stem cells (allogeneic); have lung or breathing problems; have liver problems; or have any other medical problems. If you are pregnant or plan to become pregnant, tell your doctor. KEYTRUDA can harm your unborn baby. If you are able to become pregnant, your doctor will give you a pregnancy test before you start treatment. Use effective birth control during treatment and for at least 4 months after the final dose of KEYTRUDA. Tell your doctor right away if you think you may be pregnant, or you become pregnant during treatment with KEYTRUDA. If you are breastfeeding or plan to breastfeed, tell your doctor. It is not known if KEYTRUDA passes into your breast milk. Do not breastfeed during treatment with KEYTRUDA and for 4 months after your final dose of KEYTRUDA. Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Your doctor will give you KEYTRUDA through an IV for about 30 minutes. Most people get KEYTRUDA every 3 weeks or every 6 weeks, depending on the dose you are given. Your doctor will decide how many treatments you need.

What are the possible side effects of KEYTRUDA?

KEYTRUDA can cause your immune system to attack normal organs and tissues in any area of your body and can affect the way they work. These problems can sometimes become severe or life-threatening and can lead to death. These problems may happen any time during treatment or even after your treatment has ended.

Side effects may occur with KEYTRUDA. Serious side effects include: lung problems (or pneumonitis); intestinal problems (or colitis) that can lead to tears or holes in your intestine; liver problems (or hepatitis); hormone gland problems (especially the thyroid, pituitary, adrenal glands, and pancreas); kidney problems (including nephritis and kidney failure); skin problems; problems in other organs; infusion (IV) reactions that can sometimes be severe and life-threatening; rejection of a transplanted organ; and complications in people with a bone marrow transplant that uses donor stem cells (allogeneic). Getting medical treatment right away may help keep these problems from becoming more serious. Your doctor will check you for these problems during treatment with KEYTRUDA. Your doctor may treat you with corticosteroid or hormone replacement medicines and delay or completely stop treatment with KEYTRUDA if you have severe side effects.

Common side effects in people who received KEYTRUDA include feeling tired; pain, including pain in muscles, bones, or joints and stomach area (abdominal) pain; decreased appetite; itching; diarrhea; nausea; rash; fever; cough; shortness of breath; and constipation.

Common side effects reported in more than 1 in 5 people when KEYTRUDA was given in combination with certain chemotherapy medicines: hair loss, feeling tired, diarrhea, decreased white blood cell count, joint pain, Rash. Less common side effects can happen.

Call or see your doctor right away if you develop any symptoms of the following problems or these symptoms get worse:

Lung problems (pneumonitis). Symptoms of pneumonitis may include shortness of breath, chest pain, or new or worse cough.

Intestinal problems (colitis) that can lead to tears or holes in your intestine. Signs and symptoms of colitis may include diarrhea or more bowel movements than usual; stools that are black, tarry, sticky, or have blood or mucus; or severe stomach-area (abdomen) pain or tenderness.

Liver problems, including hepatitis. Signs and symptoms of liver problems may include yellowing of your skin or the whites of your eyes, nausea or vomiting, pain on the right side of your stomach area (abdomen), dark urine, or bleeding or bruising more easily than normal.

Hormone gland problems (especially the thyroid, pituitary, adrenal glands, and pancreas). Signs and symptoms that your hormone glands are not working properly may include rapid heartbeat, weight loss or weight gain, increased sweating, feeling more hungry or thirsty, urinating more often than usual, hair loss, feeling cold, constipation, your voice gets deeper, muscle aches, dizziness or fainting, or headaches that will not go away or unusual headache.

Kidney problems, including nephritis and kidney failure. Signs of kidney problems may include change in the amount or color of your urine.

Skin problems. Signs of skin problems may include rash, itching, blisters, peeling or skin sores, or painful sores or ulcers in your mouth or in your nose, throat, or genital area.

Problems in other organs. Signs and symptoms of these problems may include changes in eyesight; severe or persistent muscle or joint pains; severe muscle weakness; low red blood cells (anemia); swollen lymph nodes, rash or tender lumps on skin, cough, shortness of breath, vision changes, or eye pain (sarcoidosis); confusion, fever, muscle weakness, balance problems, nausea, vomiting, stiff neck, memory problems, or seizures (encephalitis); and shortness of breath, irregular heartbeat, feeling tired, or chest pain (myocarditis).

Infusion (IV) reactions that can sometimes be severe and life-threatening. Signs and symptoms of infusion reactions may include chills or shaking, shortness of breath or wheezing, itching or rash, flushing, dizziness, fever, or feeling like passing out.

Rejection of a transplanted organ. People who have had an organ transplant may have an increased risk of organ transplant rejection if they are treated with KEYTRUDA.

Complications, including graft-versus-host disease (GVHD), in people who have received a bone marrow (stem cell) transplant that uses donor stem cells (allogeneic). These complications can be severe and can lead to death. These complications may happen if you underwent transplantation either before or after being treated with KEYTRUDA. Your doctor will monitor you for the following signs and symptoms: skin rash, liver inflammation, abdominal pain, and diarrhea.

Getting medical treatment right away may help keep these problems from becoming more serious. Your doctor will check you for these problems during treatment with KEYTRUDA. Your doctor may treat you with corticosteroid or hormone replacement medicines. Your doctor may also need to delay or completely stop treatment with KEYTRUDA if you have severe side effects.

KEYTRUDA is an unfunded medicine for treatment of melanoma after surgery, NSCLC, HNSCC, cHL, urothelial carcinoma and MSI-H/dMMR cancer patients

Based on US Consumer SSI & NZ CMI and Data sheet prepared 28th November 2019

Copyright © 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. All rights reserved. Merck Sharp & Dohme (New Zealand) Limited. Level 3, 123 Carlton Gore Road, Newmarket, Auckland. NZ-KEY-00266 TAPS NA 11575 First issued November 2017 essence MSD9432 Updated: January 2020.