Primary literature describing dose rounding for Keytruda (pembrolizumab) primarily focuses on cost savings (see Tables 1,2), generally finding that practical dose down-rounding procedures can significantly reduce cost. Tangentially-related data from studies comparing weight-based vs. fixed dose administration has found that both strategies may offer overall comparable benefits, while weight-based dosing may be associated with some cost savings.
A 2022 review explored the dosing and schedule optimization of immune checkpoint-targeted antibodies, particularly anti-cytotoxic T-lymphocyte-associated protein 4 (anti-CTLA-4) and anti-programmed cell death protein/ligand 1 (anti-PD-1/PD-L1) monoclonal antibodies, which have become pivotal in cancer immunotherapy. These therapeutic antibodies, including ipilimumab, nivolumab, pembrolizumab, atezolizumab, and others, were developed with dosing regimens largely guided by conventional models from chemotherapy, emphasizing fixed intervals or weight-based calculations. Development trials identified no dose-limiting toxicities for most PD-1/PD-L1 inhibitors, allowing fixed dosing options to evolve from weight-based regimens, despite notable economic and clinical implications. Fixed-dose regimens, such as pembrolizumab at 200 mg every three weeks or nivolumab at 480 mg every four weeks, were standardized based on average patient weights during trials, often leading to overexposure in low...
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A search of the published medical literature revealed
3 studies investigating the researchable question:
What literature is available for dose rounding of Keytruda (pembrolizumab)?
Level of evidence
C - Multiple studies with limitations or conflicting results
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[1] Maritaz C, Broutin S, Chaput N, Marabelle A, Paci A. Immune checkpoint-targeted antibodies: a room for dose and schedule optimization?. J Hematol Oncol. 2022;15(1):6. Published 2022 Jan 15. doi:10.1186/s13045-021-01182-3
[2] Patel A, Akhade A, Parikh P, et al. Pembrolizumab weight based dosing – A call for policy change. Indian J Med Paediatr Oncol. 2022;43(3):306–310. doi:10.1055/s-0042-1742651
[3] Patail NK, Sher AF, Wu S. Improving tolerability of pembrolizumab with weight based dosing: A meta-analysis. JCO. 2021;39(15_suppl):2639-2639. doi:10.1200/JCO.2021.39.15_suppl.2639
[4] Ch...