KEYTRUDA for non-small cell lung cancer (NSCLC)


Treating lung cancer

Treatment depends on the type of lung cancer you have and how far it has progressed, as well as your age and general state of health. Here’s a summary of treatments cancer specialists use today:

Surgery

Surgery may be appropriate in early stage non-small cell lung cancer (NSCLC). Careful checking is required to ensure there will be enough healthy lung tissue left after surgery.

During the operation the surgeon removes the lung cancer and a margin of healthy tissue around it. The surgeon may also remove lymph nodes from the chest, so that they can be checked for signs of cancer. Procedures to remove lung cancer include:

  • Wedge resection – removal of a small section of lung that contains the tumour, as well as a margin of healthy tissue
  • Segmental resection – removal of a larger portion of lung, but not an entire lobe
  • Lobectomy – removal of the entire lobe of one lung
  • Pneumonectomy – removal of an entire lung

Like any surgery, lung cancer surgery can come with the risk of bleeding and infection. You may expect to feel short of breath after lung surgery. If a portion of the lung was removed, physiotherapy can help to improve breathing as the remaining lung tissue adapts over time.

Chemotherapy

Chemotherapy (chemo) involves using drugs that kill cancer cells. These drugs can be given through a vein in the arm (intravenously) or taken orally (by mouth). Chemotherapy is usually delivered as a series of treatments, with breaks for recovery in between.

Chemotherapy can sometimes be used before surgery, to shrink cancers and make them easier to remove. It is also often used after surgery, with the goal of killing any cancer cells remaining.

For advanced cancer, chemotherapy can be used to relieve pain and other debilitating symptoms.

Radiation therapy

Radiation therapy uses high-powered energy beams, from sources such as X-rays and protons, to target cancer cells. It can be directed at cancer from outside the body (external beam radiation) or it can be positioned inside the body near the cancer (brachytherapy), using a needle or catheter (small plastic tube).

Like chemotherapy, radiation therapy can be used after surgery to kill remaining cancer cells. It can also be used instead of surgery, for lung cancers that can’t be operated on. For advanced lung cancer, radiation therapy may be used to reduce pain and other symptoms.

For very small lung cancer lesions, stereotactic body radiotherapy could be an option. This type of radiation therapy aims many beams of radiation from different angles at the lung cancer.

Personalised drug therapy

Recent advances in lung cancer treatment target specific abnormalities in cancer cells. Some of these treatments are used alone or in combination with chemotherapy drugs.

Immunotherapies, such as KEYTRUDA, are being used to treat advanced non-small cell lung cancer, by helping the immune system to detect and fight cancer cells.

KEYTRUDA may be used as a first treatment option when lung cancer has spread (advanced NSCLC), tests positive for PD-L1 and does not have an abnormal EGFR or ALK gene. More about KEYTRUDA >>

  • PD-L1 = programmed death ligand
  • EGFR = epidermal growth factor receptor
  • ALK = anaplastic lymphoma kinase

Palliative care

You might think of palliative care as ‘end of life’ care, but its true definition is much broader. Palliative care is about providing relief of suffering and improvement of quality of life for you and your family. It should be provided alongside any surgical or medical treatment you are receiving.

Your doctor may introduce you to a palliative care team soon after your diagnosis, to ensure you're comfortable during and after your cancer treatment.

Palliative care for lung cancer can involve:

  • Relief from your symptoms and side effects, such as nausea, pain, fatigue, or shortness of breath
  • Emotional and spiritual support
  • Support for your friends and family, who will be worried about you

How KEYTRUDA works

Questions to ask your doctor about lung cancer

Who can you talk to?

NZ-KEY-00183

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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 the 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)

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. 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 diarrhoea, 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. 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 and urothelial carcinoma 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 29 July 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 is a prescription medicine used to treat:
  • a kind of skin cancer called melanoma
  • a kind of lung cancer called non-small cell lung cancer
  • a kind of cancer called classical Hodgkin lymphoma
  • a kind of cancer called urothelial carcinoma, including bladder cancer
  • a kind of head and neck cancer called head and neck squamous cell carcinoma
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.

Copyright © 2019 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-00178 TAPS NA11321 First issued November 2017 essence MSD9245 Updated: December 2019.