Pembrolizumab

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Background

  • Monoclonal antibody to programmed cell death 1 (PD-1)
  • Increases anti-tumour T-cell response by blocking interaction between PD-1 on T-cells and PD-L1 on cancer cells
  • Indications include melanoma and non-small cell lung cancer

Safety

Adverse Effects

  • Immune-related adverse events are common

Immune-Mediated Pneumonitis

  • Pneumonitis in a life-threatening side effect occuring in 1-5% of treated patients1
  • Slightly more frequent in patients with known asthma or COPD, or who have received chest radiation
  • Median time to onset is 2.8 months
  • Most cases are mild to moderate, though there has been at least one death
  • Pattern on radiography is of ILD (mostly organizing pneumonia, but occasionally NSIP), hypersensitivity pneumonitis, or ground-glass opacities2
  • May be managed with prednisone

Infections

References

  1. ^  Vincent Leroy, Carole Templier, Jean-Baptiste Faivre, Arnaud Scherpereel, Clement Fournier, Laurent Mortier, Lidwine Wemeau-Stervinou. Pembrolizumab-induced pneumonitis. ERJ Open Research. 2017;3(2):00081-2016. doi:10.1183/23120541.00081-2016.
  2. ^  Myriam Delaunay, Grégoire Prévot, Samia Collot, Laurent Guilleminault, Alain Didier, Julien Mazières. Management of pulmonary toxicity associated with immune checkpoint inhibitors. European Respiratory Review. 2019;28(154):190012. doi:10.1183/16000617.0012-2019.