It is used to treat up to a dozen different tumors. We talk about pembrolizumab, a humanized monoclonal antibody that binds to programmed cell death receptor-1 (PD-1) and that works by increasing the immune system's ability to detect and fight tumor cells.
In 2015 it achieved the first indication from the European Medicines Agency (EMA): it was for melanoma, and since then, nine years later, this drug brings together a total of 17 indications in Spain approved and financed by the National System of Health. The last nine in December of last year, becoming the immunotherapy treatment for cancer with the most indications financed by the National Health System currently. But how is that possible?
The diagnosis and treatment of cancer has been transformed in recent years thanks to advances in knowledge of the biology and molecular bases of tumors, and the availability of drugs directed against specific alterations present in some patients. And this transformation sets up a new perspective in the management of cancer patients, which is known as Precision Medicine, in which specific information about a person's tumor is used to facilitate diagnosis, plan treatment, determine what it could be. effective or give a forecast.
Pembralizumab acts by binding to the PD-1 receptor present in some tumors
Thanks to her, many of Classifications of various types of tumors are now based on the identification of these molecular alterations., establishing groups or subgroups of neoplasms that share clinical, evolutionary and prognostic characteristics or that can be treated with targeted drugs. These molecular alterations are known as biomarkers.
«Based on the biomarkers that accompany the conventional diagnosis Based on microscope observation of a patient's biopsies, we can, in 2024, make decisions about what treatment or follow-up is most appropriate for each patient.», explains Federico Rojo, director of the Department of Pathological Anatomy and head of the Molecular Pathology Unit of the Jiménez Díaz Foundation, in Madrid. “In fact, thanks to this evolution of diagnosis and the incorporation of biomarkers, we now know that cancer actually encompasses hundreds of different entities or diseases, which require a differential therapeutic approach in each case,” he continues.
Testing on new tumors
The secret of the success of this immunotherapy, as explained by Joaquín Mateos, medical director of MSD Spain, (the laboratory that markets it), “is the result of the research work that we have been carrying out to expand both the types of cancer in which this therapy can suppose an alternative, such as the stages of the disease in which to apply it. In this sense, detecting cancer at an earlier stage can give patients a greater chance of long-term survival. In fact, We are investigating pembrolizumab in early stages of the disease in approximately 20 ongoing registration studies, in multiple types of cancer. “This demonstrates our commitment to providing more alternatives to patients.” Among them, he specifies, the most advanced are in lung cancer in earlier stages, in gynecological tumors and also in urothelial tumors “which are an unmet need in our country.”
The complete list of tumors against which it acts
►For clear cell renal cancer after nephrectomy.
►As monotherapy or with first-line chemotherapy in unresectable metastatic or recurrent head and neck squamous cell cancer.
►As first line in PD-L1 metastatic non-small cell lung cancer (NSCLC).
►With chemotherapy, against recurrent unresectable or metastatic triple negative breast cancer in PD-L1 tumors.
►With pemetrexed and chemo in the first line of metastatic NSCLC in non-EGFR or ALK tumors.
►With carboplatin and paclitaxel or nabpaclitaxel in first-line PD-L1-negative metastatic NSCLC.
►In first line for metastatic NSCLC in PD-L1 tumors without EGFR or ALK mutations.
►First line for metastatic colorectal cancer (CRC) with microsatellite instability.
►With chemo with or without bevacizumab in persistent, recurrent or metastatic PD-L1 cervical cancer.
►With chemo for advanced or early-stage triple negative breast cancer.
►With first-line chemo for unresectable or metastatic HER-2 negative esophageal or gastroesophageal cancer.
►With lenvatinib for advanced or recurrent endometrial cancer.
►In MSI-H or dMMR tumors in unresectable or metastatic gastric, small intestine or biliary cancer.
►In MSI-H or dMMR tumors in advanced endometrial cancer.
►In MSI-H or dMMR tumors in unresectable or metastatic CRC.
►For treatment from 12 years of age in advanced melanoma.