Potential Adverse Reactions of Keytruda and Strategies for Their Management
Keytruda, a groundbreaking biologic, is a member of the programmed cell death protein 1 (PD-1) inhibitor drug class. Approved for use in certain conditions such as classical Hodgkin lymphoma, primary mediastinal large B-cell lymphoma, and melanoma in patients 12 years and older, this immune checkpoint inhibitor has shown promising results in the treatment of various pediatric cancers. However, it's essential to understand the potential side effects associated with Keytruda, especially in the long term.
Common short- to mid-term side effects reported in clinical data include fatigue, itchy skin (pruritus), rash, diarrhea, nausea, fever, and serious immune-mediated toxicities such as pneumonitis and colitis. These side effects can occur during treatment or within about 90 days after the last dose.
Long-term immune-related adverse events can occur due to the mechanism of action of immunotherapy, where the immune system attacks normal organs. While specific pediatric long-term data are limited, potential long-term risks may include developmental delays, organ dysfunction, and a potential increased risk of secondary cancers or cancer recurrence later in life.
Because Keytruda and similar immunotherapies are relatively new, long-term animal studies on carcinogenic potential have not been fully evaluated, and comprehensive monitoring of late effects is ongoing.
It's important to note that the side effects of Keytruda can vary depending on whether it is used in combination with other drugs to treat the condition. Also, the side effects of Keytruda aren't known to vary depending on the type of cancer it's treating, such as lung cancer.
In addition to the common side effects, Keytruda may cause severe side effects such as severe infusion reactions, immune system reactions involving inflammation, eye-related side effects, severe skin reactions, confusion, and allergic reactions.
Before starting Keytruda, it's crucial to discuss your health history with your doctor, including any prior stem cell transplant, use of certain drugs for multiple myeloma, allergic reaction to the drug or any of its ingredients, pregnancy, and breastfeeding.
If you experience any eye or vision problems after starting Keytruda, do not wait to see if your symptoms get better. It's important to call your doctor right away or get emergency medical care. Hair loss could be a sign that Keytruda is causing inflammation of the thyroid gland, and other symptoms of thyroid gland inflammation include weight loss or gain, increased sweating or feeling cold, mood changes, heart rate changes, diarrhea, and constipation.
In summary, while Keytruda is generally tolerated, the potential long-term side effects in children with skin cancer, lymphoma, or solid tumors include immune-related toxicities and general risks typical of pediatric oncology therapies. Long-term follow-up in pediatric patients is essential to better define these risks.
Table:
| Aspect | Known/Reported Effects in Children | |-------------------------------|---------------------------------------------------------------| | Common side effects | Fatigue, rash, pruritus, diarrhea, nausea, fever | | Serious immune toxicities | Pneumonitis, colitis, immune-mediated adverse reactions | | Long-term data availability | Limited; no conclusive carcinogenicity studies in animals | | Potential long-term risks | Developmental delays, organ dysfunction, secondary cancers | | Approved pediatric indications| Relapsed/refractory classical Hodgkin lymphoma, PMBCL, melanoma (12+) |
- The long-term immune-related adverse events in children treated with Keytruda can include developmental delays and organ dysfunction, as well as a potential increased risk of secondary cancers or cancer recurrence later in life.
- Deciders considering Keytruda for the treatment of pediatric cancers like skin cancer, lymphoma, or solid tumors should be aware of the potential long-term side effects, which are still being defined through long-term follow-up studies.
- In addition to the common side effects such as fatigue, rash, pruritus, diarrhea, nausea, and fever, Keytruda can also cause serious immune-mediated side effects like pneumonitis, colitis, and other immune-related toxicities.
- It's essential to discuss health history with a doctor before starting Keytruda, including any allergic reactions to the drug or its ingredients, pregnancy, and breastfeeding, as these factors can influence the potential side effects.
- In the long term, comprehensive monitoring of late effects in Keytruda and similar immunotherapies is ongoing, as there are limited data available due to the relatively short history of these treatments, and carcinogenicity studies in animals have not been fully evaluated.
