Treatment Name: Pembrolizumab (Keytruda®) + Carboplatin + Pemetrexed (Alimta®)
How does pembrolizumab + carboplatin + pemetrexed work?
Pembrolizumab is designed to block the signals that tumor cells use to suppress the immune system and prevent the immune system from attacking lung cancer cells. This is commonly called immunotherapy.
Carboplatin and pemetrexed are chemotherapy drugs designed to slow the growth of and kill cancer cells by altering (changing) cancer cell DNA.
Goals of therapy:
Pembrolizumab + carboplatin + pemetrexed are given to shrink lung cancer tumors and decrease symptoms of lung cancer. This combination of drugs is not commonly given with the goal of cure.
Cycles 1 through 4
- Pembrolizumab intravenous (I.V.) infusion over 30 minutes on Day 1
- Pemetrexed I.V. infusion over ten minutes on Day 1
- Carboplatin I.V. infusion over 15-60 minutes on Day 1 (most commonly over 30 minutes)
Following Cycle 4
- Pembrolizumab I.V. infusion over 30 minutes every 21 days for 24 months
Note: in some cases, your doctor may decide to continue therapy with pemetrexed until it not longer works or until unacceptable side effects occur.
Estimated total infusion time for this treatment:
- Up to two hours for Day 1 of each cycle when pembrolizumab, carboplatin, and pemetrexted are all given; as short as one hour on Day 1 when only pembrolizumab is given
- Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time
Pembrolizumab + carboplatin + pemetrexed is usually given in an outpatient infusion center, allowing the person to go home afterwards.
Pembrolizumab + carboplatin + pemetrexed is repeated every 21 days. This is known as one Cycle. Each cycle may be repeated up to four times. After four cycles of pembrolizumab + carboplatin + pemetrexed are given, pembrolizumab alone is given for up to two years. Total duration of therapy may last up to 28 months, depending upon response, tolerability, and number of cycles prescribed.
Click here for the common pembrolizumab + carboplatin + pemetrexed starting doses.
In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported pembrolizumab + carboplatin + pemetrexed side effects are shown here:
- Fatigue (64%)
- Nausea (58%)
- Low red blood cells [Anemia] (32%)
- Vomiting (27%)
- Rash (27%)
- Diarrhea (20%)
- Decreased appetite (19%)
- Constipation (19%)
- Altered taste (17%)
- Decreased thyroid function (15%)
- Hair loss (14%)
- Fluid retention in arms and legs (12%)
- Itching (12%)
- Increased saliva production (12%)
- Dizziness (10%)
- Low blood potassium levels (10%)
- Low white blood cells [neutropenia] (8%)
- Increased thyroid function (8%)
- Low platelets (6%)
- Mouth sores (5%)
- Lung injury (5%)
- Low blood calcium (5%)
- Infusion reaction (4%)
- Skin infection (4%)
- Kidney injury (3%)
- Neutropenic fever (2%)
- Heart attack (2%)
- Pneumonia (2%)
- Severe skin rash (2%)
On average, 10% of patients discontinue treatment due to unacceptable side effects.
How often is monitoring needed?
Labs (blood tests) may be checked before treatment then every three weeks. Labs often include: Complete Blood Count (CBC) and Comprehensive Metabolic Panel (CMP), plus any others your doctor may order. Thyroid Function Tests may be checked before the first two treatments, then every 12 weeks thereafter.
How often is imaging needed?
Imaging may be checked before treatment, every six weeks for the first 18 weeks, then every nine weeks for the next 34 weeks, and then every 12 weeks thereafter. Imaging may include: X-rays, magnetic resonance imaging (MRI), or computerized tomography (CT) scans.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue pembrolizumab + carboplatin + pemetrexed as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy.
- Serious immune reactions may occur. The most common organs affected are the lungs, intestines, liver, thyroid, kidneys, and pituitary gland, but may affect others as well. If immune reactions occur, corticosteroids may be given and pembrolizumab treatment may need to be interrupted or discontinued
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil®, Motrin®) or naproxen (Aleve®) can affect your body’s ability to get rid of (eliminate) pemetrexed. Avoid NSAIDs starting 2 to 5 days prior to each treatment and for at least two days after receiving pemetrexed
- An intramuscular (I.M.) injection of Vitamin B-12 is recommended beginning one week prior to the first dose of pemetrexed to avoid possible toxicity. Injections are often given every 9 weeks (or 3 cycles) until therapy with pemetrexed is complete
- Starting one week prior to your first dose of pemetrexed, folic acid should be taken by mouth every day to avoid possible toxicity. Folic acid should be taken daily until 21 days after the last dose of pemetrexed
- Remember to take the dexamethasone tablets twice daily for three days prior to treatment with pemetrexed. This drug helps prevent skin reactions. If you forget, be sure to alert the doctor, nurse, or pharmacist at the infusion center. An intravenous dose of dexamethasone may be given if you forget a dose(s) at home. On occasion, your doctor may decide to give intravenous dexamethasone at the infusion center instead of oral dexamethasone at home
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for NSCLC. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Pembrolizumab (Keytruda®) + Carboplatin + Pemetrexed (Alimta®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Pembrolizumab (Keytruda®) + Carboplatin + Pemetrexed (Alimta®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Pembrolizumab (Keytruda®) + Carboplatin + Pemetrexed (Alimta®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with Pembrolizumab (Keytruda®) + Carboplatin + Pemetrexed (Alimta®)