Pembrolizumab (Keytruda) for the treatment of advanced head and neck cancer in adults who have had previous treatment

In 2018, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into whether pembrolizumab has any advantages or disadvantages compared to individual treatment for advanced squamous cell carcinoma of the head and neck with high levels of the protein PD-L1 in people who have had treatment before.

The manufacturer gave IQWiG one study involving a small number of participants (37 people) that provided at least preliminary answers to some questions. 16 people in the study had treatment with pembrolizumab, and another 21 were given methotrexate. Despite the advanced stage of the disease, all patients involved were otherwise in good general health. This is what was found:

What are the advantages of pembrolizumab?

Life expectancy: The study suggests that pembrolizumab has an advantage here: People in the pembrolizumab group passed away within 17 months on average (median value), while those in the methotrexate group already passed away after an average of only 6 months (median value).

What are the disadvantages of pembrolizumab?

Immune-mediated side effects: Immune-mediated side effects are medical conditions in which someone’s immune system attacks their own body. The study suggests that pembrolizumab has a disadvantage here. These side effects typically occurred within about 3 years and 7 months on average (median value) in people who had treatment with pembrolizumab. They occurred later in those who received methotrexate.

No difference

No difference was found regarding a number of disease-related symptoms, including:

  • Exhaustion
  • Nausea and vomiting
  • Pain
  • Shortness of breath
  • Sleep problems
  • Loss of appetite
  • Constipation
  • Diarrhea
  • Trouble swallowing
  • Abnormal sensations
  • Speech problems
  • Dental (tooth) problems
  • Trouble opening your mouth
  • Dry mouth
  • Sticky saliva
  • Coughing
  • Generally feeling ill

Health-related quality of life: No difference was found between the treatments in terms of various aspects of quality of life either, such as performing daily tasks or problems socializing.

Severe side effects and stopping treatment due to side effects: There was no difference here either.