Are there circumstances where you would recommend every 6 week dosing schedule for pembrolizumab monotherapy?

Topics: Gynecologic Cancers • Gastrointestinal Cancers • Melanoma/Skin Cancer • Thoracic Malignancies • Medical Oncology • Immunotherapy • NCI-CCC Tumor Board Question • Yale • COVID-19 • NCI-CCC Thoracic Tumor Board Question

I am considering every 6 week pembrolizumab dosing in patients >70 years old in whom I want to reduce clinic visits for, especially in the context of the COVID-19 pandemic. This schedule was approved in Europe based on modeling/simulation (https://ascopubs.org/doi/abs/10.1200/JCO.2018.36.15_suppl.3062), but the FDA rejected the every 6 week dosing in February 2020.

Answer from: Medical Oncologist at Academic Institution

FDA approval for q 6 week dosing of pembrolizumab is awaited but has yet to occur; this would represent a welcome change for our patients, as just happened with the recent approval of q 4 week dosing of atezolizumab. Without FDA approval we are not using pembrolizumab 6 week dosing at this time, an...

Answer from: Medical Oncologist at Community Practice

Based on exposure-response evaluation using modeling and simulation data (ASCO 2018), I feel comfortable spacing out treatment to every 6 weeks in the current COVID crisis, particularly in elderly patients who have been on the agent for a while with excellent response and minimal disease burden. Ho...

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Answer from: Medical Oncologist at Academic Institution

I still favor 3-weekly pembrolizumab in the following situations: 1. During the induction of chemo-immunotherapy. 2. In maintenance phase with pemetrexed-pembrolizumab combination for adenocarcinoma. 3. When there is a concern of toxicity and I need to follow closely. 6-weekly 400 mg pem...

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