Talk:Pembrolizumab

note
Article abrubtly cuts off following an "a". 74.62.185.1 (talk) 09:37, 22 August 2015 (UTC)

Significant publications to include

 * On September 2014, Lancet: Anti-programmed-death-receptor-1 treatment with pembrolizumab in ipilimumab-refractory advanced melanoma: a randomised dose-comparison cohort of a phase 1 trial


 * On November 2014, Nature: PD-1 blockade induces responses by inhibiting adaptive immune resistance . The editor's summary states: "Clinical efficacy is shown to correlate with increased frequencies of pre-existing CD8+ T cells and PD-1 and PD-L1 expression at the invasive tumour margin and within tumours."

Tal Galili (talk) 17:33, 22 February 2015 (UTC)

Biomarkers depend on type of cancer
Although the 2015 FDA approval for NSCLC was for patients whose tumors express PD-L1 it seems the PD-L1 status is not a good predictor of response in HNSCC (and PD-L2 is better). Potential Biomarkers Identified for Pembrolizumab in Head and Neck Cancer.. - Rod57 (talk) 19:51, 10 July 2016 (UTC)

Any marketing applications outside USA ?
Any marketing applications (or approvals) outside USA eg EU/UK ? (Could note applications in History) - Rod57 (talk) 21:32, 9 November 2016 (UTC)

I am in Australia, and am on this page because this drug has been prescribed for me for the treatment of metastatic uretereal/uereteric cancer. That is not on the list of targetted cancers, but then I am missing DNA-mismatch repair genes and have tested positive for microsatellite instability, so perhaps that is why I qualify. According to my oncologist, this drug has only been approved for circumstances such as mine in the past few months (mid 2019). I am not a doctor, but I am a well-informed patient, and can provide extra info if you feel it's worthwhile.

Note that in Australia this is a PBS listed drug, and thus the cost to me is only $37 per injection.

Also ... the list of "adverse reactions" is quite formidable, with reasonably high percentages. This conflicts with what my oncologist told me, which was that 90% of patients experience no side-effects, and those that do generally have very mild ones. — Preceding unsigned comment added by 2001:8003:E448:D401:DCA2:2C2C:BD81:7810 (talk) 04:23, 11 September 2019 (UTC) EDIT. Pembro has completely destroyed my thyroid, so I am on thyroxine for the rest of my life. My (new) onco tells me that this is a very very common side effect. — Preceding unsigned comment added by 2001:8003:e422:3c01:19af:35a7:ac40:b179 (talk) 12:59, 27 July 2021 (UTC)

Medical Letter 2017
http://secure.medicalletter.org/article-share?a=1513b&p=tml&title=Pembrolizumab%20%28Keytruda%29%20for%20First-%20Line%20Treatment%20of%20Metastatic%20NSCLC Pembrolizumab (Keytruda) for First- Line Treatment of Metastatic NSCLC Medical Letter Issue 1513 January 30, 2017 The FDA has approved the immune checkpoint inhibitor pembrolizumab (Keytruda – Merck), a programmed death receptor-1 (PD-1) inhibitor, for first-line treatment of patients with metastatic non-small cell lung cancer (NSCLC) that highly expresses programmed death-ligand 1 (PD-L1) and has no epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) translocations.... --Nbauman (talk) 18:47, 25 January 2017 (UTC)

Additions - re KEYNOTE trial results
User: Aglo123, about this, the problems with that edit were that it contained content that violated WP:PROMO (not to mention WP:OR) by calling the study a "landmark", and it introduced extensive comment based on a primary source, to the medical use section. (See WP:MEDRS)

You then made another series of edits here where you changed the section name in a way that doesn't follow WP:MEDMOS, and you restored the content based on the primary source, albeit this time without "landmark", which was in improvement, and you also added it under "research" which was a dramatic improvement. I saw that you left a note on my Talk page here; we discuss article content at article Talk pages, so that everybody watching can participate.

I will check now to see if there are any reviews that discuss the recent clinical trial results. Jytdog (talk) 18:28, 16 March 2017 (UTC)
 * OK, I just checked pubmed and there is nothing on this yet. as i am sure you know, checkpoint inhibitors is a field that is very closely watched and it will surely be discussed in a review very soon. There is WP:NODEADLINE here and it is important that we get the views of independent experts in the field on this study.  It ~could~ be game changing, as some of the media hype around the publication of the NEJM article said.  Let's see the more measured response of the field. Jytdog (talk) 18:44, 16 March 2017 (UTC)


 * I fixed the things you said were wrong (put it in the research section so it is irrelevant whether it is primary research or not, removed inadvertant language that may make it seem biased)...If something changes when they review it, then someone will edit it to reflect that. Furthermore, my additional edits changing the title to "pharmacokinetics" was because the contents contained only pharmacokinetic parameters, and was misrepresented by its title, MEDMOS says NOTHING about not being able to use pharmacokinetics as a header on it (especially when the contents only cover ADME). This is a very poorly written article in my opinion and I am just trying to clean it up as a drug expert and I apologize that you seem to have a problem with that. Aglo123 (talk) 20:34, 16 March 2017 (UTC)
 * No problem whatsoever with improvements! If the pharmacology section's incompleteness bothers you please feel free to expand it.  btw while we pretty much require high quality secondary sources for WP:Biomedical information, we allow primary sources for purely pk things like receptor binding affinities.  Sometimes primary sources are the only place to find that info.  Otherwise we look for high quality secondary sources everywhere else. Please make sure that everything you add to WP summarizes reliable sources.  Thanks. Jytdog (talk) 20:55, 16 March 2017 (UTC)
 * I will, sorry I feel like I was being a jerk but I was just upset. Thank you. Aglo123 (talk) 20:58, 16 March 2017 (UTC)
 * thanks for your nice note! things can get hot here sometimes, everybody knows that. the key thing is recovery and that was beautiful. Jytdog (talk) 21:02, 16 March 2017 (UTC)

new
FDA approves first cancer treatment for any solid tumor with a specific genetic feature  — Preceding unsigned comment added by 184.100.32.150 (talk) 17:49, 31 May 2017 (UTC)
 * Had already been added to the article. Jytdog (talk) 03:17, 1 June 2017 (UTC)

Re data
Reporting facts is well within WP guidelines. Secondly this data is simply *amazing*. Although the complete response rate is low (15-25% overall) the fact that there were complete responses is incredible. Saying that this sort of information should not be included does not make sense to me.

It is to be hoped that this pathway can be further exploited and the response rate improved further. The word on the ground is that this drug *may* work for any type of tumour. But that is only a speculation and a hope and certainly not something that should be in WP at the moment. The sooner we find out which cancers it works for and does not work for the better for everyone. What is certain in that we seem to have found a biochemical target for multiple types of cancer that were considered suitable only for palliative care and that additional drugs are in the pipeline. Virion123 (talk) 12:46, 14 June 2017 (UTC)


 * Yes it is clear that it doesn't make sense to you. I have been trying to help you understand Wikipedia, and you don't want to hear it. This level of data is UNDUE and not our practice, especially not based only on a recent primary source. You can look at article after article about drugs and you will not find this level of detail about clinical trial outcomes; we generally do not report them at all (nor mention the trial or its publication) unless the trial was really significant like SELECT. You can ask at WT:PHARM or WP:MED ]and folks will tell you the same thing. We are not a newspaper. Jytdog (talk) 21:00, 14 June 2017 (UTC)


 * Dear Editor Jytdog. Concerning an edit war. The correct proceedure is to take the discussion to the talk page in the first instance. Not to start an edit war. You seem to know a number of WP policies. This is one of them that was designed to head off an edit war.
 * Although your knowledge of WP policies is very likely far better than mine, yours of the Five Pillars seems deficient. Wikipedia:Five pillars: Editors should treat each other with respect and civility. Disagreements will always occur. You just don't like anyone disagreeing with you. You behave in an a rude and abrupt fashion when they do disagree with you. There is ample evidence of this in your record.
 * Concerning significance. On this point you have to be joking. This is an amazing breakthrough. I am not an author of this paper or in anyway connected with it but IMHO it is still an incredible discovery.
 * You say that WP does not bother with this level of detail. Two planes hit the Twin Towers. Should WP refer to this as a number of planes hit the Twin Towers or is that level of detail too much? Virion123 (talk) 09:46, 15 June 2017 (UTC)


 * To make life on WP easier for both of us and hopefully others, I have listed of some of the WP guidelines that you may (or may not have read).
 * Wikipedia:Notability
 * Wikipedia:Civility
 * Wikipedia:Dispute resolution
 * Wikipedia:Negotiation
 * Wikipedia:Competence is required - Lack of technical expertise
 * Wikipedia:Tutorial/Keep in mind - Conduct
 * When you have read or indeed re read these please revert to me. Virion123 (talk) 10:05, 15 June 2017 (UTC)
 * Thank you for the Select trial reference. If the Select trial is worth mentioning then I can assure you that the trial I cited here and that you deleted is at least as important as the Select trial and is probably more so. The Select trial was hoped to show at best an incremental improvement. This latest trial is not incremental: it is a potential game changer. To compare it to other major breakthroughs in medicine, while it may not a penicillin but it is certainly a sulphomamide.Virion123 (talk) 10:11, 15 June 2017 (UTC)
 * You don't list WP:CONSENSUS there (which includes adhering to past consensus that is itself expressed in the policies and guidelines) and WP:NOT - Wikipedia is not a journal and not news. The importance of the trial is not in the details of the data, but rather what the data means. For the meaning we need MEDRS sources, which for something like this should be out shortly. Jytdog (talk) 12:58, 15 June 2017 (UTC)
 * Dear editor Jytdog the importance of the trial is in the details. This was a trial about untreatable metastatic cancer. Between 15 and 25% of these patients were cured. If that is not important I do not know what is. The details matter: it was not 100% sadly. The upside is that it was not 0% either.
 * Wikipedia:Consensus - Through discussion. This refers to discussing the matter on a talk page. For reasons known only to yourself this appears to be something that I have found that you tend to avoid. I base this statement on my experience of interacting with you and what others have written before me. It may be that you have read these pages and we can discuss this matter here further. 15:45, 15 June 2017 (UTC)
 * Local consensus at a talk page depends on the broader consensus expressed in the policies and guidelines. Jytdog (talk) 16:51, 15 June 2017 (UTC)
 * The exact issue here is your assertion that "If that is not important I do not know what is." It is because of what the data mean that you want to report them.  We need MEDRS sources to say that this is important. What are they? (btw i of course agree that this important. but that doesn't matter either - you keep personalizing this. it is not personal to you, nor to me. what matters is the work of crafting WP articles that aim at the mission per the policies and guidelines and reliable sources, not what you or i think is important) Jytdog (talk) 16:54, 15 June 2017 (UTC)
 * Dear editor Jytdog I would like to correct a statement of yours. It is not about me personalising any issue here. It is your constant lack of civility that I personalise. This last post of yours is an example of civil behavior. Thank you. I hope this is a sign of things to come.
 * From Wikipedia:Manual of Style/Medicine-related articles: "Wikipedia should concisely state facts about a subject." Virion123 (talk) 10:49, 16 June 2017 (UTC)
 * Please WP:FOC. 08:26, 17 June 2017 (UTC)
 * I found a decent secondaryish source that discussed the data, and added it in this series of diffs. Jytdog (talk) 09:12, 17 June 2017 (UTC)

(For other readers) : Virion123's original edit  - Rod57 (talk) 22:06, 30 June 2017 (UTC)

Mechanisms of resistance
How Advanced Melanoma Adapts to Immunotherapy suggests JAK1/JAK2 mutations allow melanoma to resist pembrolizumab (and presumably other anti-PD-1). - Mention here or in anti-PD-1 ? - Rod57 (talk) 21:44, 30 June 2017 (UTC)