Things To Think About
Scalp cooling only blocks certain drugs and does not work for everyone. You might still have hair thinning, or lose your hair completely. You can’t tell whether it will work for you until you try it.
You spend longer at hospital having your treatment if you have scalp cooling. You need to wear the cap before, during and after you have the chemotherapy drugs into your bloodstream.
The time varies depending on the drug and type of cold cap system your hospital has. For the Paxman scalp cooling system you might wear the cap:
- before treatment or about 30 to 45 minutes depending on your hair type
- during treatment for as long as it takes to recieve your chemotherapy drugs
- after treatment for a minimum of 30 to 90 minutes depending on the drugs you have had
Your nurse might ask you to dampen or wet your hair before you put on the cap or cooling system. This is to improve contact between the scalp and cap and lowers the temperature of the skin on your scalp.
You also have a small amount of conditioner added to help in removing the cap after you have finished treatment.
Research suggests that scalp cooling with Afro Caribbean hair is not as successful. So your nurse might recommend you have longer periods of scalp cooling if this applies to you.
Keytruda For Cervical Cancer
Keytruda is FDA-approved to treat cervical cancer. This form of cancer develops in the cervix, which separates a womans uterus and vagina.
Keytruda is used to treat cervical cancer that has high levels of the immune system protein called PD-L1.
Its given in combination with chemotherapy, with or without bevacizumab , to treat cancer thats either:
- persistent
- recurrent
- metastatic
Keytruda is used by itself to treat recurrent or metastatic cervical cancer that has worsened either during or after chemotherapy.
Keytrudas effectiveness for cervical cancer
In one clinical study, Keytruda was effective in treating cervical cancer. In one study:
- 11.7% of people taking Keytruda had their cancer partially go away
- 2.6% of people taking Keytruda had their cancer completely go away
- of people whose cancer either partially or completely went away, 91% kept these results for at least 6 months
Legal Action Against Keytruda
Merck has received significant legal flak over the way that they handled the clinical trials for Keytruda. These trials were extensive and comprehensive, and they involved hundreds of different cancer patients who wanted to try a novel drug that might improve their condition. However, according to the Center for Responsible Science , Merck didn’t properly inform their trial participants of the potential dangers of the drug.
Instead of targeting Merck directly, CRS has filed a lawsuit against the FDA for allowing these unsafe trials to occur. This mass lawsuit was filed in 2017 on behalf of a number of plaintiffs who were adversely affected by these drug trials, and one of the plaintiffs included the father of 24-year-old Max Vokhgelt, who died two days after trying an experimental cancer therapy. In the case of Mr. Vokhgelt, investigators discovered that certain toxicity issues can only be determined by testing on humans, and Max was tested for toxicity without his informed consent. Therefore, he was exposed to types of drugs that were more toxic than he could have expected, and his father believes that it was these toxicity tests that led to his death.
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Other Points Of Interest
The impact of the role of PD-1 in immunotherapy is profound and those responsible for its discovery are potential winners of the Nobel Prize in Physiology and Medicine in the near future.
The efficacy of Keytruda in metastatic melanoma has helped transform the landscape of the pharmaceutical industry and now most large pharmaceutical companies have similar, anti PD-1 products, and are investing in developing new and improved drugs to gain the competitive edge. The immunotherapy market is tipped to be worth more than US$100 billion by 2020.
What Are The Side Effects Of Immunotherapy
- The side effects of immunotherapy can be different from those associated with standard treatments.
- One study found that fatigue was the most common side effect, along with fever, chills, nausea, and reactions at the site of the infusion.
Medically reviewed by Gordon Freeman, PhD
New drugs that stimulate the patients immune system to attack tumors have achieved some dramatic and long-lasting benefits in several forms of cancer. A few drugs are already approved for wide use and many more are in the research pipeline. Because these immunotherapy agents work differently than chemotherapy, the side effects of immunotherapy can be different from those associated with standard treatments.
One of cancer cells survival strategies is to hide from immune soldier T-cells and exploit natural checkpoint proteins that suppress T-cell activity. Some immunotherapy agents disable these checkpoints, removing the brakes so T-cells can mount a stronger immune attack on cancer cells. In this way, the drugs dont directly assault the cells instead, they free the patients own defensive forces to destroy cancers.
But its a two-edged sword. Freed from checkpoint restraint, the surging immune response can overshoot its target and attack healthy tissues and organs, similar to an autoimmune disorder.
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How Is It Determined Whether A Patient Is A Candidate For Targeted Therapy
For some types of cancer, most patients with that cancer will have an appropriate target for a particular targeted therapy and, thus, will be candidates to be treated with that therapy. CML is an example: most patients have the BCR-ABL fusion gene. For other cancer types, however, a patients tumor tissue must be tested to determine whether or not an appropriate target is present. The use of a targeted therapy may be restricted to patients whose tumor has a specific genemutation that codes for the target patients who do not have the mutation would not be candidates because the therapy would have nothing to target.
Sometimes, a patient is a candidate for a targeted therapy only if he or she meets specific criteria . These criteria are set by the FDA when it approves a specific targeted therapy.
Side Effects In Children
The side effects of Keytruda seen in children are similar to those seen in adults. However, in a small clinical study, children who took Keytruda had higher rates of certain side effects than did adults using the drug.
Side effects of Keytruda that were more common in children than in adults included:
- fatigue
- elevated liver enzymes
If you have questions or concerns about side effects in children using Keytruda, talk with your pharmacist or your childs doctor.
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Pregnancy And Breastfeeding While Taking Keytruda
You shouldnt use Keytruda while pregnant or breastfeeding.
Keytruda hasnt been studied during pregnancy. But based on how the drug works, Keytruda may cause harm to infants born to pregnant females* who used the drug during pregnancy.
For this reason, you should use birth control while taking Keytruda if you or your partner can become pregnant. And you should continue to use birth control for at least 4 months after your last dose.
It isnt known if Keytruda can pass into breast milk. To be safe, you shouldnt breastfeed while using Keytruda and for at least 4 months after your last dose.
Before starting Keytruda treatment, tell your doctor if youre pregnant or planning to become pregnant. Also tell them if youre breastfeeding or planning to breastfeed. They can discuss your options with you.
* In this article, we use the term female to refer to someones sex assigned at birth. For information about the difference between sex and gender, see this article.
How Effective Is Keytruda
Keytruda also known as pembrolizumab is a medicine to treat cancer which mainly focuses on the effectively reducing the development and spread of cells that spread the disease in the body.
Keytruda or pembrolizumab is to effectively treat all these conditions:
- Keytruda or pembrolizumab is used to effectively treat Hodgkin lymphoma in children and adults
- Keytruda or pembrolizumab is used to effectively treat a kind of cancer that after lab testing proves to be mismatch repair deficiency or instability high solid tumor
- Neck and head cancer which spreads to other parts or returns after the treatment
- Treatment of non small cell lung cancer
- Effective treatment of melanoma which has spread to all other parts of the body and also cannot be removed surgically
- Treatment of urinary or bladder tract cancer which spreads to other parts of the body and not possible to remove through surgical procedures
The FDA approved keytruda or pembrolizumab for the treatment of lung cancer or neck and head cancer on accelerated basis. In laboratory, tumors have responded to Keytruda. However, it is not proved that keytruda or pembrolizumab can lengthen survival time or improve symptoms.
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Keytruda 25 Mg/ml Concentrate For Solution For Infusion
This information is intended for use by health professionals
KEYTRUDA® 25 mg/mL concentrate for solution for infusion.
One vial of 4 mL of concentrate contains 100 mg of pembrolizumab.
Each mL of concentrate contains 25 mg of pembrolizumab.
Pembrolizumab is a humanised monoclonal anti-programmed cell death-1 antibody produced in Chinese hamster ovary cells by recombinant DNA technology.
For the full list of excipients, see section 6.1.
Concentrate for solution for infusion.
Clear to slightly opalescent, colourless to slightly yellow solution, pH 5.2 5.8.
Melanoma
KEYTRUDA as monotherapy is indicated for the treatment of advanced melanoma in adults.
KEYTRUDA as monotherapy is indicated for the adjuvant treatment of adults with Stage III melanoma and lymph node involvement who have undergone complete resection .
Non-small cell lung carcinoma
KEYTRUDA as monotherapy is indicated for the first-line treatment of metastatic non-small cell lung carcinoma in adults whose tumours express PD-L1 with a 50% tumour proportion score with no EGFR or ALK positive tumour mutations.
KEYTRUDA, in combination with pemetrexed and platinum chemotherapy, is indicated for the first-line treatment of metastatic non-squamous non-small cell lung carcinoma in adults whose tumours have no EGFR or ALK positive mutations.
Classical Hodgkin lymphoma
Urothelial carcinoma
Head and neck squamous cell carcinoma
Renal cell carcinoma
Colorectal cancer
Oesophageal carcinoma
PD-L1 testing
Posology
Elderly
What Is Targeted Therapy Exactly
When cancer spreads and becomes life threatening, drugs known as targeted therapies may be an option for some patients. Targeted therapy can stop cancer from growing and spreading at least for a while.
Oncologists prescribe target therapy to treat some skin cancers. It may be prescribed to treat melanoma, the most-serious skin cancer, when it spreads. Targeted therapy can also treat basal cell carcinoma , the most-common skin cancer. It may be prescribed when BCC has spread and surgery or radiation treatments can no longer treat it.
Some patients with dermatofibrosarcoma protuberans , a rare type of skin cancer, also receive targeted therapy.
Targeted therapy can give cancer patients remissions that last for months and sometimes years.
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Keytruda For Liver Cancer
Keytruda is FDA-approved to treat hepatocellular carcinoma.* This type of cancer is the most common form of liver cancer.
Keytruda is approved to treat hepatocellular carcinoma in people whove taken the cancer drug sorafenib in the past for this condition.
* For this use, Keytruda received from the FDA. Accelerated approval is based on information from early clinical trials. The FDAs decision for full approval will be made after additional clinical trials are completed.
Keytrudas effectiveness for liver cancer
In a clinical study, Keytruda was effective in treating liver cancer in people whose cancer either worsened or came back after treatment with sorafenib . And Keytruda was effective for this use in people who couldnt tolerate Nexavars side effects.
In the study:
- 16% of people taking Keytruda had their cancer partially go away
- 1% of people taking Keytruda had their cancer completely go away
- of people whose cancer either partially or completely went away, 89% kept these results for at least 6 months
- of people whose cancer either partially or completely went away, 56% kept these results for at least 12 months
Managing And Relieving Skin Problems
Rashes, dry skin, and nail and hair reactions are rarely severe. But they can cause major discomfort. Patients may even want to stop cancer treatment because of these reactions. It is important to talk with your health care team about what to expect. Also tell your doctor as soon as you start feeling or seeing any side effects. There are early and effective treatments for these reactions.
The following suggestions may help avoid reactions and help relieve them if they do happen:
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What Else Contributes To Hair Loss
There are a number of non-cancer related medications that are associated with hair loss that might accentuate the effects of chemotherapy drugs if used in combination.
Some of these include retinoids , anti-thyroid medications, L-Dopa , amphetamines, non-steroidal anti-inflammatory medications, and several antidepressants such as tricyclic antidepressants and Wellbutrin .
In addition to medications, illness, surgery, or dietary changes may lead to hair loss.
Thyroid disease may cause hair loss and may occur with cancer treatment .
How Are Targets For Targeted Cancer Therapies Identified
The development of targeted therapies requires the identification of good targetsthat is, targets that play a key role in cancer cell growth and survival.
One approach to identify potential targets is to compare the amounts of individual proteins in cancer cells with those in normal cells. Proteins that are present in cancer cells but not normal cells or that are more abundant in cancer cells would be potential targets, especially if they are known to be involved in cell growth or survival. An example of such a differentially expressed target is the human epidermal growth factor receptor 2protein . HER-2 is expressed at high levels on the surface of some cancer cells. Several targeted therapies are directed against HER-2, including trastuzumab , which is approved to treat certain breast and stomach cancers that overexpress HER-2.
Another approach to identify potential targets is to determine whether cancer cells produce mutant proteins that drive cancer progression. For example, the cell growth signaling protein BRAF is present in an altered form in many melanomas. Vemurafenib targets this mutant form of the BRAF protein and is approved to treat patients with inoperable or metastatic melanoma that contains this altered BRAF protein.
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Common And Serious Side Effects
One study found that fatigue was the most common side effect, along with:
- Fever
- Nausea
- Reactions at the site of infusion
Immunotherapy drugs such as ipilimumab, which targets the CTLA-4 checkpoint, and PD1/L1 checkpoint blockers like nivolumab and pembrolizumab are approved for melanoma, lung, and kidney cancer. Patients who receive these therapies need to be monitored for potentially more serious adverse effects such as:
- Pneumonitis
- Colitis
- Hepatitis and pancreatitis
- Skin rashes
- Endocrine disorders including thyroid abnormalities and adrenal insufficiency
Fortunately, the vast majority of such reactions can be controlled with immune suppressive drugs such as corticosteroids and antihistamines that tamp down the inflammatory overreaction.
Side effects are best treated when diagnosed early. Patients are always asked to report anything that seems unusual to their care team who can determine if its related to their immunotherapy treatment.