Premedications for Pembrolizumab, Paclitaxel, and Carboplatin in Endometrial Cancer

Standard Dosing Regimen Context

The standard first-line regimen for advanced/recurrent endometrial cancer consists of carboplatin AUC 5-6 plus paclitaxel 175 mg/m² every 21 days, and pembrolizumab 200 mg IV every 3 weeks for 6 cycles, followed by pembrolizumab 400 mg IV every 6 weeks for up to 14 maintenance cycles, as recommended by the European Society for Medical Oncology 1, 2

Pembrolizumab does not require routine premedication for infusion reactions, according to the Society for Immunotherapy of Cancer 3, 4
Monitoring for immune-related adverse events is essential when administering pembrolizumab, as stated by the National Comprehensive Cancer Network 3, 4

The combination regimen of carboplatin, paclitaxel, and pembrolizumab is expected to result in grade ≥3 adverse events in approximately 63-70% of patients, with the most common toxicities being neutropenia, peripheral neuropathy, fatigue, nausea, and alopecia, as reported by the American Society of Clinical Oncology 1, 3, 4
Immune-related adverse events from pembrolizumab include hypothyroidism, rash, and less commonly colitis, hepatitis, pneumonitis, or nephritis, according to the European Society for Medical Oncology 3, 4, 5

Adequate antiemetic coverage is necessary beyond the premedication protocol, as the combination regimen produces significant nausea, and consideration of 5-HT3 antagonists and NK1 receptor antagonists is recommended, as suggested by the Multinational Association of Supportive Care in Cancer [3, 4] [3, 4]