Keytruda Administration via Peripheral Vein
Yes, Keytruda (pembrolizumab) can be administered via a peripheral vein as an intravenous infusion. The guidelines and evidence consistently describe pembrolizumab as being given by "intravenous infusion" without specifying that central venous access is required 1.
Route of Administration
- Pembrolizumab is administered as an intravenous infusion, with standard dosing of 200 mg every 3 weeks or 2 mg/kg every 3 weeks for most indications 1.
- The drug can also be given as 400 mg every 6 weeks, which has been shown to have equivalent pharmacokinetic exposure and clinical efficacy 2.
- There is no requirement in the guidelines for central venous access (such as a PICC line or central line) for pembrolizumab administration 1.
Practical Considerations
- Peripheral IV access is appropriate for pembrolizumab infusion, as the drug is administered as a standard intravenous infusion over approximately 30 minutes 3.
- The pharmacokinetic profile of pembrolizumab is typical of humanized monoclonal antibodies, with no special requirements for administration route beyond standard IV access 3.
- In clinical trials establishing pembrolizumab's efficacy across multiple tumor types (melanoma, hepatocellular carcinoma, colorectal cancer, bladder cancer, cutaneous squamous cell carcinoma), the drug was administered intravenously without specification of central access 4, 2, 5, 6, 3.
When Central Access May Be Preferred
- Central venous access may be considered if the patient requires multiple concurrent infusions, has poor peripheral venous access, or needs long-term vascular access for other therapies 7.
- In oncology patients receiving regular chemotherapy or blood transfusions alongside immunotherapy, multi-lumen central catheters may be more practical 7.
- However, central access is not medically necessary for pembrolizumab administration itself 1.
Common Pitfalls to Avoid
- Do not assume that all cancer immunotherapy requires central venous access—pembrolizumab is suitable for peripheral administration 1.
- Ensure adequate peripheral venous access is established before infusion to avoid extravasation, though pembrolizumab is not a vesicant 3.
- If using a multi-lumen central catheter for other therapies, pembrolizumab can be administered through a separate lumen, but this is a matter of convenience rather than necessity 7.