From the FDA Drug Label
Infections Upper respiratory tract infection‡41 12.4 Urinary tract infection11 0 3 0.7 Pneumonia8 Herpes virus infection (9%) Pneumonitis Febrile neutropenia Sepsis Herpes zoster
The infections associated with Keytruda (pembrolizumab) therapy are:
- Upper respiratory tract infection
- Urinary tract infection
- Pneumonia
- Herpes virus infection
- Pneumonitis
- Febrile neutropenia
- Sepsis
- Herpes zoster 1 1
From the Research
Keytruda (pembrolizumab) can increase your risk of various infections, particularly respiratory infections like pneumonia, urinary tract infections, and skin infections, due to its immune checkpoint inhibitor mechanism of action. As an immune checkpoint inhibitor, Keytruda works by removing the brakes on your immune system to help it fight cancer, but this can also reduce your body's ability to fight infections 2. You're particularly at risk for opportunistic infections, which typically only affect people with weakened immune systems, may also occur, including fungal infections like candidiasis or aspergillosis. Reactivation of dormant infections such as tuberculosis, hepatitis B, or herpes is another concern.
Some of the key infections associated with Keytruda therapy include:
- Respiratory infections like pneumonia
- Urinary tract infections
- Skin infections
- Opportunistic infections, such as fungal infections like candidiasis or aspergillosis
- Reactivation of dormant infections, such as tuberculosis, hepatitis B, or herpes
While on Keytruda, you should monitor for signs of infection, including:
- Fever
- Cough
- Burning during urination
- Skin redness or warmth
- Report these symptoms to your healthcare provider immediately. Maintaining good hygiene practices, avoiding people who are sick, and staying up-to-date with recommended vaccinations (though live vaccines should be avoided during treatment) can help reduce your infection risk 3. Your doctor may perform regular blood tests to monitor your white blood cell counts and overall immune function during treatment.
In cases of severe immune-mediated pneumonitis, treatment with infliximab, an anti-TNF-α antibody, may be beneficial, as it has been shown to rapidly improve respiratory status and chest CT findings in some patients 4. However, the current guidelines do not recommend repeated administration of infliximab for immune-mediated pneumonitis, and more research is needed to determine the optimal treatment approach.