From the Guidelines
Keytruda (pembrolizumab) can be a risk factor for developing aspergillus infections, particularly in patients with other predisposing factors for fungal infections, such as underlying lung disease, prior steroid use, or concurrent immunosuppressive treatments. Keytruda is an immune checkpoint inhibitor that works by enhancing the immune system's ability to fight cancer, but this immunomodulatory effect can sometimes impair the body's defense against certain infections. Patients receiving Keytruda may experience immune-related adverse events, including a potentially reduced ability to fight fungal pathogens like Aspergillus 1. The risk of aspergillosis may increase with longer duration of Keytruda therapy or higher doses.
Risk Factors and Prevention
Patients on Keytruda should be monitored for symptoms of fungal infection including persistent cough, fever, chest pain, or shortness of breath. If aspergillosis is suspected, prompt diagnostic workup and antifungal treatment should be initiated while decisions about continuing or pausing Keytruda therapy are made in consultation with both oncology and infectious disease specialists. According to the practice guidelines for the diagnosis and management of aspergillosis, patients at risk for mold infections should be managed with reasonable precautions to reduce mold exposure, including the avoidance of gardening, spreading mulch, or close exposure to construction or renovation 1.
Treatment and Management
The treatment of aspergillosis typically involves antifungal medications, such as voriconazole, liposomal amphotericin B, or posaconazole, and may require surgical intervention in certain cases 1. The choice of treatment depends on the severity and location of the infection, as well as the patient's underlying health status. It is essential to note that the effectiveness of masks (surgical or N95) to protect against mold infections associated with these exposures is unknown, and therefore, other preventive measures should be prioritized.
Conclusion is not allowed, so the answer will be ended here.
From the Research
Risk Factors for Aspergillosis
- Immunocompromised patients are at high risk of developing aspergillosis, including those with malignancies, undergoing intensive immunosuppressive therapy regimens, or receiving allogeneic haematopoietic stem cell or organ transplantation 2, 3
- Rheumatology patients, particularly those receiving high dose intravenous immunosuppressive agents, are also at increased risk of invasive Aspergillus spp infection 4
- Patients in an intensive care unit setting, even if not classically defined as immunocompromised, can also develop invasive aspergillosis 5
Association with Keytruda (Pembrolizumab)
- The use of immune checkpoint inhibitors, including Keytruda (pembrolizumab), has been associated with immunerelated adverse effects and may require immunosuppressive therapy 6
- Prolonged immunosuppressive therapies, which may be necessary for patients taking Keytruda, can increase the risk of fungal diseases, including aspergillosis 6
Treatment and Prevention
- Early initiation of effective systemic antifungal treatment is essential for a successful clinical outcome in patients with invasive aspergillosis 3
- Voriconazole is currently the gold standard of systemic antifungal treatment, but combination therapy with voriconazole and an echinocandin may become the standard of care in high-risk patients 5
- Prophylactic systemic antifungal treatment with posaconazole or voriconazole may be suitable for prevention of invasive aspergillosis in high-risk patients 3