Pembrolizumab plus chemotherapy in metastatic non-small cell lung cancer

Metastatic non-small cell lung cancer has spread beyond its original lung site. Pembrolizumab helps the immune system recognise and respond to cancer by changing an immune checkpoint signal. Chemotherapy reaches cancer cells through the bloodstream and may be given in cycles, with rest periods between treatments. The exact medicines, schedule and number of cycles depend on the cancer subtype, test results, general health and previous treatment.

Treatment is monitored through appointments, blood tests and scans. Common effects can include tiredness, nausea, reduced appetite, hair changes and lower blood-cell counts. Pembrolizumab can also cause immune-related inflammation affecting organs such as the lungs, bowel, liver, thyroid or skin.

Bring a complete list of medicines, supplements and allergies. Tell the oncology team about lung disease, autoimmune conditions, transplants, infections and any steroid or immune-suppressing treatment. Keep a record of fever, breathing changes, bowel symptoms, rashes and energy levels. Do not start a new medicine or supplement without checking its compatibility.

Your team may discuss biomarker testing and other options, such as [Immunotherapy](/treatments/systemic-therapy/immunotherapy/) or [Targeted Therapy](/treatments/systemic-therapy/targeted-therapy/), when tumour features make them relevant. Local treatment such as [Stereotactic Body Radiotherapy](/treatments/radiation-oncology/stereotactic-body-radiotherapy/) may be considered for selected sites.

Contact your cancer team promptly for a fever, new or worsening cough, shortness of breath, chest pain, severe diarrhoea, blood in the stool, yellowing of the skin, a widespread rash, confusion, marked weakness or very little urine. These symptoms can signal infection, low blood counts or immune-related inflammation and should not wait for the next routine visit. Seek emergency care for severe breathing difficulty, fainting, sudden weakness or uncontrolled bleeding.

Ask which chemotherapy medicines are planned, how treatment response will be checked, which symptoms need a same-day call, and whether your other medicines need adjustment. Ask what happens if side effects delay a cycle or require corticosteroid treatment.