What are the precautions for Pembrolizumab?

During treatment with Pembrolizumab, attention should be paid to the occurrence of serious and fatal immune-mediated adverse reactions, infusion-related reactions, complications of allogeneic HSCT, combined medication, embryo-fetal toxicity and other events. If discomfort occurs, promptly communicate with the doctor.

1. Serious and fatal immune-mediated adverse reactions:

Immune-mediated adverse reactions may be serious or fatal, may occur in any organ system or tissue, and may affect more than one body system simultaneously. After starting treatment withPD-1/PD-L1 blocking antibodies, immune-mediated adverse reactions may occur at any time, such as immune-mediated pneumonia, colitis, hepatitis, thyroid disease, etc. Discontinue or permanently discontinue treatment depending on the severity. With pembrolizumab, if interruption or discontinuation is necessary, administer systemic corticosteroid therapy (1-2 mg/kg/day prednisone or equivalent) until improvement to grade 1 or less.

2. Infusion-related reactions:

Pembrolizumab can cause serious or life-threatening infusion-related reactions, including hypersensitivity reactions and anaphylaxis. Monitor patients for signs and symptoms of infusion-related reactions, including chills, wheezing, pruritus, flushing, rash, hypotension, hypoxemia, and pyrexia. For mild (Grade 1) or moderate (Grade 2) infusion-related reactions, interrupt or slow down the infusion rate. For serious (Grade 3) or life-threatening (Grade 4) infusion-related reactions, the infusion should be discontinued and pembrolizumab should be permanently discontinued.

3. AllogeneicComplications of HSCT:

Patients who receive allogeneic hematopoietic stem cell transplantation (HSCT) before or after receivingPD-1/PD-L1 blocking antibody therapy may develop fatal and other serious complications. Transplant-related complications include hyperacute graft-versus-host disease (GVHD), acute GVHD, chronic GVHD, hepatic veno-occlusive disease (VOD) after reduced-intensity conditioning, and steroid-requiring febrile syndrome (without a clear infectious cause). These complications may occur despite therapeutic intervention between PD-1/PD-L1 blockade and allogeneic HSCT.

4. Combined medication:

In two randomized trials in patients with multiple myeloma, addition to thalidomide analogues plus dexamethasone (no indication for PD-1 or PD-L1 blocking antibodies)Pembrolizumab, resulting in increased mortality. The use of PD-1 or PD-L1 blocking antibodies in combination with thalidomide analogues plus dexamethasone is not recommended outside of controlled trials in patients with multiple myeloma.

5. Embryo-Fetotoxicity: According to the mechanism of action of pembrolizumab, pregnant women taking this drug will cause harm to the fetus. Animal models link thePD-1/PD-L1 signaling pathway to pregnancy maintenance by inducing maternal immune tolerance to fetal tissue. Inform women of the potential risk to the fetus. Advise females of reproductive potential to use effective contraception during treatment with pembrolizumab and for 4 months after the last dose.