Pembrolizumab

Pembrolizumab, sold under the brand name Keytruda, is a humanized monoclonal antibody, more specifically a PD-1 inhibitor, used in cancer immunotherapy to treat many types of cancer. It is administered by slow intravenous injection. Common side effects include fatigue, musculoskeletal pain, decreased appetite, itchy skin, diarrhea, nausea, rash, fever, cough, difficulty breathing, constipation, pain, and abdominal pain. It is an IgG4 isotype antibody that blocks a protective mechanism of cancer cells, allowing the immune system to destroy them. It targets the programmed cell death protein 1 (PD-1) receptor of lymphocytes. Pembrolizumab was approved for medical use in the United States in 2014. It is on the World Health Organization's List of Essential Medicines. A fixed-dose combination of pembrolizumab and berahyaluronidase alfa, (Keytruda Qlex) was approved for medical use in the United States in September 2025.

Medical uses

In the United States, pembrolizumab is indicated for the treatment of melanoma, non-small-cell lung cancer, malignant pleural mesothelioma, head and neck squamous-cell cancer, classical Hodgkin lymphoma, primary mediastinal large B-cell lymphoma, urothelial cancer, microsatellite instability-high or mismatch repair deficient cancer, microsatellite instability-high or mismatch repair deficient colorectal cancer, gastric cancer, esophageal cancer, cervical cancer, hepatocellular carcinoma, biliary tract cancer, Merkel-cell carcinoma, renal cell carcinoma, endometrial carcinoma, tumor mutational burden-high cancer, cutaneous squamous cell carcinoma, and triple-negative breast cancer. As of 2019, pembrolizumab is used via intravenous infusion to treat inoperable or metastatic melanoma, metastatic non-small cell lung cancer (NSCLC) in certain situations, as a first-line treatment for metastatic bladder cancer in people who cannot receive cisplatin-based chemotherapy and have high levels of PD-L1, as a second-line treatment for head and neck squamous cell carcinoma (HNSCC), after platinum-based chemotherapy, for the treatment of people with refractory classic Hodgkin lymphoma, and recurrent locally advanced or metastatic esophageal squamous cell carcinoma. For non-small cell lung cancer, pembrolizumab is used in combination with chemotherapy (for all PD-L1, a PD-1 receptor ligand, levels) or by itself as a first-line treatment if the cancer expresses (≥ 1%) PD-L1 and the cancer has no mutations in EGFR or in ALK; if chemotherapy has already been administered, then pembrolizumab can be used as a second-line treatment, but if the cancer has EGFR or ALK mutations, agents targeting those mutations should be used first. Assessment of PD-L1 expression must be conducted with a validated and approved companion diagnostic.

In 2017, the US Food and Drug Administration (FDA) approved pembrolizumab for any unresectable or metastatic solid tumor with certain genetic anomalies (mismatch repair deficiency or microsatellite instability). This was the first time the FDA approved a cancer drug based on tumor genetics rather than tissue type or tumor site; therefore, pembrolizumab is a so-called tissue-agnostic drug. In the European Union, pembrolizumab is indicated for:

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