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Drug overview for KEYTRUDA (pembrolizumab):
Generic name: PEMBROLIZUMAB (PEM-broe-LIZ-ue-mab)
Drug class: Antineoplastic - Anti-Programmed Death-(PD-1/L1) MC Antibody
Therapeutic class: Antineoplastics
Pembrolizumab, a humanized anti-programmed-death receptor-1 (anti-PD-1) monoclonal antibody, is an antineoplastic agent.
No enhanced Uses information available for this drug.
Generic name: PEMBROLIZUMAB (PEM-broe-LIZ-ue-mab)
Drug class: Antineoplastic - Anti-Programmed Death-(PD-1/L1) MC Antibody
Therapeutic class: Antineoplastics
Pembrolizumab, a humanized anti-programmed-death receptor-1 (anti-PD-1) monoclonal antibody, is an antineoplastic agent.
No enhanced Uses information available for this drug.
DRUG IMAGES
KEYTRUDA 100 MG/4 ML VIAL
The following indications for KEYTRUDA (pembrolizumab) have been approved by the FDA:
Indications:
Adjuvant treatment of melanoma
Biliary tract malignancy
Carcinoma of cervix
Early-stage triple-negative breast cancer
EGFR negative, ALK negative, non-small cell lung cancer
Endometrial carcinoma
Hodgkin's lymphoma
Invasive bladder cancer
Liver cell carcinoma
Malignant melanoma
Malignant mesothelioma of pleura
Merkel cell carcinoma
Microsatellite instability-high colorectal cancer
Microsatellite instability-high solid malignant tumor
Mismatch repair deficient endometrial cancer
Mismatch repair proficient endometrial cancer
Non-muscle invasive bladder cancer with carcinoma in situ
Non-small cell lung cancer
PD-L1 expressing epithelial ovarian carcinoma
PD-L1 expressing fallopian tube carcinoma
PD-L1 expressing triple-negative breast cancer
PD-L1 positive adenocarcinoma of gastroesophageal junction
PD-L1 positive cervical cancer
PD-L1 positive esophageal carcinoma
PD-L1 positive non-small cell lung cancer
PD-L1 positive squamous cell carcinoma of esophagus
PD-L1 positive squamous cell carcinoma of head and neck
PD-L1 positive, EGFR-negative, ALK-negative metastatic non-small cell lung cancer
PD-L1+, HER2-negative gastric or gastroesophageal junction adenocarcinoma
PD-L1+, HER2-positive gastric or gastroesophageal junction adenocarcinoma
Primary mediastinal large B-cell lymphoma
Renal cell carcinoma
Squamous cell carcinoma of head and neck
Squamous cell carcinoma of lung
Squamous cell carcinoma of skin
Transitional cell carcinoma of the urinary tract
Tumor mutational burden-high solid malignant tumor
Professional Synonyms:
Anemia lymphatica
Biliary cancer
Biliary malignancy
Carcinoma of fallopian tube w/ PD-L1 expression
Carcinoma of kidney
Cervical carcinoma cancer
Cervical carcinoma
Cutaneous neuroendocrine carcinoma
Cutaneous squamous cell carcinoma
DMMR cancer
DMMR colorectal cancer
DMMR endometrial cancer
DMMR solid malignant tumor
Early-stage hormone receptor (ER/PR)-negative, HER2-negative breast cancer
Early-stage hormone receptor-negative, HER2-negative breast cancer
Early-stage HR-negative, HER2-negative breast cancer
Early-stage TNBC
EGFR-negative, ALK mut (-) non-small cell lung cancer
EGFR-negative, ALK-negative, NSCLC
Epidermoid carcinoma of lung
Epidermoid carcinoma of the head and neck
Gallbladder or bile duct cancer
Grawitz tumor
Hepatocarcinoma
Hepatocellular carcinoma
Hodgkin's disease
Hormone receptor (HR)-negative, HER2-negative, PD-L1 expressing breast cancer
HR negative, HER2 negative, PD-L1 positive breast cancer
Hypernephroid carcinoma
Hypernephroma
Invasive malignancy of bladder
Kidney adenocarcinoma
Malignant neoplasm of gallbladder or bile ducts
Malignant tumor of gallbladder or bile ducts
Melanoblastoma
Melanocarcinoma
Melanoma
Melanosarcoma
Melanotic carcinoma
Mismatch repair deficient colorectal cancer
Mismatch repair deficient solid malignant tumor
MSI-H cancer
MSI-H colorectal cancer
MSI-H solid malignant tumor
Muscle invasive bladder cancer
Nephroid carcinoma
Neuroendocrine carcinoma of the skin
Ovarian epithelial cancer with PD-L1 expression
PD-L1 expressing epithelial ovarian carcer
PD-L1 expressing malignant tumor of fallopian tube
PD-L1 expressing non-small cell lung cancer
PD-L1 expressing, EGFR mutation negative, ALK mutation negative metastatic NSCLC
PD-L1 ovarian carcinoma
PD-L1 positive adenocarcinoma of cardioesophageal junction
PD-L1 positive esophageal squamous cell carcinoma
PD-L1 positive metastatic non-small cell lung cancer with no EGFR or ALK mutations
PD-L1 positive NSCLC
PD-L1 positive SCC of esophagus
PD-L1 positive, EGFR-negative, ALK-negative NSCLC
PD-L1+ SCC of esophagus
PDCD1L1 positive non-small cell lung cancer
PMMR endometrial cancer
Programmed cell death 1 ligand 1 positive gastroesophageal adenocarcinoma
Programmed cell death 1 ligand 1 positive NSCLC
Programmed death ligand 1 positive adenocarcinoma of gastroesophageal junction
Programmed death ligand 1 positive non-small cell lung cancer
Renal adenocarcinoma
Renal carcinoma
Renal cell adenocarcinoma
SCC of lung
Skin squamous cell carcinoma (SCC)
Solid malignant tumor with >=10 mutations/megabase (mut/Mb)
Squamous cell lung carcinoma
Squamous non-small cell lung cancer
Squamous NSCLC
TMB-H solid malignant tumor
Trabecular cell carcinoma of skin
Urothelial carcinoma
Indications:
Adjuvant treatment of melanoma
Biliary tract malignancy
Carcinoma of cervix
Early-stage triple-negative breast cancer
EGFR negative, ALK negative, non-small cell lung cancer
Endometrial carcinoma
Hodgkin's lymphoma
Invasive bladder cancer
Liver cell carcinoma
Malignant melanoma
Malignant mesothelioma of pleura
Merkel cell carcinoma
Microsatellite instability-high colorectal cancer
Microsatellite instability-high solid malignant tumor
Mismatch repair deficient endometrial cancer
Mismatch repair proficient endometrial cancer
Non-muscle invasive bladder cancer with carcinoma in situ
Non-small cell lung cancer
PD-L1 expressing epithelial ovarian carcinoma
PD-L1 expressing fallopian tube carcinoma
PD-L1 expressing triple-negative breast cancer
PD-L1 positive adenocarcinoma of gastroesophageal junction
PD-L1 positive cervical cancer
PD-L1 positive esophageal carcinoma
PD-L1 positive non-small cell lung cancer
PD-L1 positive squamous cell carcinoma of esophagus
PD-L1 positive squamous cell carcinoma of head and neck
PD-L1 positive, EGFR-negative, ALK-negative metastatic non-small cell lung cancer
PD-L1+, HER2-negative gastric or gastroesophageal junction adenocarcinoma
PD-L1+, HER2-positive gastric or gastroesophageal junction adenocarcinoma
Primary mediastinal large B-cell lymphoma
Renal cell carcinoma
Squamous cell carcinoma of head and neck
Squamous cell carcinoma of lung
Squamous cell carcinoma of skin
Transitional cell carcinoma of the urinary tract
Tumor mutational burden-high solid malignant tumor
Professional Synonyms:
Anemia lymphatica
Biliary cancer
Biliary malignancy
Carcinoma of fallopian tube w/ PD-L1 expression
Carcinoma of kidney
Cervical carcinoma cancer
Cervical carcinoma
Cutaneous neuroendocrine carcinoma
Cutaneous squamous cell carcinoma
DMMR cancer
DMMR colorectal cancer
DMMR endometrial cancer
DMMR solid malignant tumor
Early-stage hormone receptor (ER/PR)-negative, HER2-negative breast cancer
Early-stage hormone receptor-negative, HER2-negative breast cancer
Early-stage HR-negative, HER2-negative breast cancer
Early-stage TNBC
EGFR-negative, ALK mut (-) non-small cell lung cancer
EGFR-negative, ALK-negative, NSCLC
Epidermoid carcinoma of lung
Epidermoid carcinoma of the head and neck
Gallbladder or bile duct cancer
Grawitz tumor
Hepatocarcinoma
Hepatocellular carcinoma
Hodgkin's disease
Hormone receptor (HR)-negative, HER2-negative, PD-L1 expressing breast cancer
HR negative, HER2 negative, PD-L1 positive breast cancer
Hypernephroid carcinoma
Hypernephroma
Invasive malignancy of bladder
Kidney adenocarcinoma
Malignant neoplasm of gallbladder or bile ducts
Malignant tumor of gallbladder or bile ducts
Melanoblastoma
Melanocarcinoma
Melanoma
Melanosarcoma
Melanotic carcinoma
Mismatch repair deficient colorectal cancer
Mismatch repair deficient solid malignant tumor
MSI-H cancer
MSI-H colorectal cancer
MSI-H solid malignant tumor
Muscle invasive bladder cancer
Nephroid carcinoma
Neuroendocrine carcinoma of the skin
Ovarian epithelial cancer with PD-L1 expression
PD-L1 expressing epithelial ovarian carcer
PD-L1 expressing malignant tumor of fallopian tube
PD-L1 expressing non-small cell lung cancer
PD-L1 expressing, EGFR mutation negative, ALK mutation negative metastatic NSCLC
PD-L1 ovarian carcinoma
PD-L1 positive adenocarcinoma of cardioesophageal junction
PD-L1 positive esophageal squamous cell carcinoma
PD-L1 positive metastatic non-small cell lung cancer with no EGFR or ALK mutations
PD-L1 positive NSCLC
PD-L1 positive SCC of esophagus
PD-L1 positive, EGFR-negative, ALK-negative NSCLC
PD-L1+ SCC of esophagus
PDCD1L1 positive non-small cell lung cancer
PMMR endometrial cancer
Programmed cell death 1 ligand 1 positive gastroesophageal adenocarcinoma
Programmed cell death 1 ligand 1 positive NSCLC
Programmed death ligand 1 positive adenocarcinoma of gastroesophageal junction
Programmed death ligand 1 positive non-small cell lung cancer
Renal adenocarcinoma
Renal carcinoma
Renal cell adenocarcinoma
SCC of lung
Skin squamous cell carcinoma (SCC)
Solid malignant tumor with >=10 mutations/megabase (mut/Mb)
Squamous cell lung carcinoma
Squamous non-small cell lung cancer
Squamous NSCLC
TMB-H solid malignant tumor
Trabecular cell carcinoma of skin
Urothelial carcinoma
The following dosing information is available for KEYTRUDA (pembrolizumab):
No dosage reduction for pembrolizumab is recommended; however, if immune-mediated adverse reactions occur, temporary or permanent discontinuance of pembrolizumab may be required based on severity of the reaction.
In general, pembrolizumab should be temporarily withheld in patients with severe (grade 3) immune-mediated adverse reactions, and should be permanently discontinued in patients experiencing life-threatening (grade 4) immune-mediated adverse reactions that require systemic immunosuppressive therapy. Therapy with the drug also should be permanently discontinued in patients unable to reduce corticosteroid dosage to <=10 mg of prednisone daily (or equivalent) within 12 weeks of initiating corticosteroids.
When adverse effects occur during concomitant use of pembrolizumab with lenvatinib, modification of the dosage of one or both agents is recommended. Temporary or permanent discontinuance of pembrolizumab may be required based on the severity of the reaction. Refer to the lenvatinib prescribing information for additional dosage modifications.
Hematologic Toxicity: If grade 4 hematologic toxicity occurs in patients with cHL or PMBCL, pembrolizumab therapy should be interrupted until the toxicity resolves to grade 0 or 1.
Immune-mediated Pneumonitis: If grade 2 immune-mediated pneumonitis occurs, pembrolizumab therapy should be interrupted until the toxicity resolves to grade 0 or 1 and the corticosteroid dosage has been tapered. Therapy with the drug should be permanently discontinued in patients who do not recover to grade 0 or 1 within 12 weeks of initiating corticosteroids or who are unable to reduce corticosteroid dosage to <=10 mg of prednisone daily (or equivalent) within 12 weeks of initiating corticosteroids.
If grade 3 or 4 immune-mediated pneumonitis occurs, pembrolizumab therapy should be permanently discontinued.
Immune-mediated GI Effects: If grade 2 or 3 immune-mediated colitis occurs, pembrolizumab therapy should be interrupted until the toxicity resolves to grade 0 or 1 and the corticosteroid dosage has been tapered. Therapy with the drug should be permanently discontinued in patients who do not recover to grade 0 or 1 within 12 weeks of initiating corticosteroids or who are unable to reduce corticosteroid dosage to <=10 mg of prednisone daily (or equivalent) within 12 weeks of initiating corticosteroids.
If grade 4 immune-mediated colitis occurs, pembrolizumab therapy should be permanently discontinued.
Immune-mediated Hepatotoxicity (Except When Used in Combination with Axitinib): For serum aminotransferase (ALT or AST) elevations exceeding 3 times and up to 8 times the upper limit of normal (ULN) or total bilirubin concentrations exceeding 1.5 times and up to 3 times the ULN in patients without liver tumor involvement experiencing hepatotoxicity, pembrolizumab therapy should be interrupted until the toxicity resolves to grade 0 or 1 and the corticosteroid dosage has been tapered. Therapy with the drug should be permanently discontinued in patients who do not recover to grade 0 or 1 within 12 weeks of initiating corticosteroids or who are unable to reduce corticosteroid dosage to <=10 mg of prednisone daily (or equivalent) within 12 weeks of initiating corticosteroids.
For ALT or AST elevations exceeding 8 times the ULN or total bilirubin concentrations exceeding 3 times the ULN in patients without liver tumor involvement experiencing hepatotoxicity, pembrolizumab therapy should be permanently discontinued.
When AST and ALT concentrations are <=ULN at baseline in patients with liver tumor involvement experiencing hepatotoxicity, temporary or permanent discontinuance of pembrolizumab may be based on recommendations for hepatotoxicity in patients without liver tumor involvement.
In patients with liver tumor involvement and baseline ALT or AST concentrations exceeding 1 time and up to 3 times the ULN who experience increases in ALT or AST concentrations exceeding 5 times and up to 10 times the ULN, pembrolizumab therapy should be interrupted until hepatotoxicity resolves to grade 0 or 1 or the AST and ALT concentrations return to baseline. Therapy with the drug should be permanently discontinued in patients who do not recover to grade 0 or 1 within 12 weeks of initiating corticosteroids or who are unable to reduce corticosteroid dosage to <=10 mg of prednisone daily (or equivalent) within 12 weeks of initiating corticosteroids.
In patients with liver tumor involvement and baseline ALT or AST concentrations exceeding 3 times and up to 5 times the ULN who experience increases in ALT or AST concentrations exceeding 8 times and up to 10 times the ULN, pembrolizumab therapy should be interrupted until hepatotoxicity resolves to grade 0 or 1 or the AST and ALT concentrations return to baseline. Therapy with the drug should be permanently discontinued in patients who do not recover to grade 0 or 1 within 12 weeks of initiating corticosteroids or who are unable to reduce corticosteroid dosage to <=10 mg of prednisone daily (or equivalent) within 12 weeks of initiating corticosteroids.
For ALT or AST concentrations exceeding 10 times the ULN in patients with liver tumor involvement, pembrolizumab therapy should be permanently discontinued.
For total bilirubin concentrations exceeding 3 times the ULN in patients with liver tumor involvement, pembrolizumab therapy should be permanently discontinued.
Hepatotoxicity When Used in Combination with Axitinib for RCC: For treatment of liver enzyme elevations in patients experiencing adverse hepatotoxic effects from pembrolizumab therapy in combination with axitinib, consider corticosteroid therapy.
For ALT or AST concentrations that are >=3 times but less than 10 times the ULN in patients receiving pembrolizumab with concomitant axitinib and without concurrent total bilirubin concentrations of at least 2 times the ULN, pembrolizumab and axitinib therapy should be interrupted until the toxicity resolves to grade 0 or 1. A single-agent rechallenge or sequential rechallenge with both drugs may be considered after resolution of toxicity. If therapy with axitinib is rechallenged, consider dosage reduction according to the axitinib prescribing information.
For ALT or AST concentrations exceeding 3 times the ULN with concurrent total bilirubin concentrations >=2 times ULN, pembrolizumab and axitinib should both be permanently discontinued.
For ALT or AST concentrations >=10 times the ULN, pembrolizumab and axitinib should both be permanently discontinued.
Immune-mediated Endocrine Effects: If grade 3 or 4 immune-mediated endocrinopathies occur, pembrolizumab therapy should be interrupted until the patient is clinically stable or the drug should be permanently discontinued.
Immune-mediated Renal Effects: If grade 2 or 3 immune-mediated nephritis occurs with increased serum creatinine concentrations, pembrolizumab therapy should be interrupted until the toxicity resolves to grade 0 or 1 and the corticosteroid dosage has been tapered. Therapy with the drug should be permanently discontinued in patients who do not recover to grade 0 or 1 within 12 weeks of initiating corticosteroids or who are unable to reduce the corticosteroid dosage to <=10 mg of prednisone daily (or equivalent) within 12 weeks of initiating corticosteroids.
If grade 4 immune-mediated nephritis occurs with increased serum creatinine concentrations, pembrolizumab therapy should be permanently discontinued.
Immune-mediated Dermatologic Effects: If Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), or drug rash with eosinophilia and systemic symptoms (DRESS) is suspected, pembrolizumab therapy should be interrupted until the toxicity resolves to grade 0 or 1 and the corticosteroid dosage has been tapered. Therapy with the drug should be permanently discontinued in patients who do not recover to grade 0 or 1 within 12 weeks of initiating corticosteroids or who are unable to reduce corticosteroid dosage to <=10 mg of prednisone daily (or equivalent) within 12 weeks of initiating corticosteroid therapy.
If SJS, TEN, or DRESS is confirmed, pembrolizumab therapy should be permanently discontinued.
Immune-mediated Cardiac Effects: If grade 2--4 immune-mediated myocarditis occurs, pembrolizumab therapy should be permanently discontinued.
Immune-mediated Neurologic Effects: If grade 2 immune-mediated neurologic toxicity occurs, pembrolizumab therapy should be interrupted until the toxicity resolves to grade 0 or 1 and the corticosteroid dosage has been tapered. Therapy with the drug should be permanently discontinued in patients who do not recover to grade 0 or 1 within 12 weeks of initiating corticosteroids or who are unable to reduce corticosteroid dosage to <=10 mg of prednisone daily (or equivalent) within 12 weeks of initiating corticosteroid therapy.
If grade 3 or 4 immune-mediated neurologic toxicity occurs, pembrolizumab therapy should be permanently discontinued.
Infusion-related Reactions: If grade 1 or 2 infusion-related reactions occur, the infusion should be interrupted or the infusion rate should be slowed.
If grade 3 or 4 infusion-related reactions occur, pembrolizumab therapy should be permanently discontinued.
In general, pembrolizumab should be temporarily withheld in patients with severe (grade 3) immune-mediated adverse reactions, and should be permanently discontinued in patients experiencing life-threatening (grade 4) immune-mediated adverse reactions that require systemic immunosuppressive therapy. Therapy with the drug also should be permanently discontinued in patients unable to reduce corticosteroid dosage to <=10 mg of prednisone daily (or equivalent) within 12 weeks of initiating corticosteroids.
When adverse effects occur during concomitant use of pembrolizumab with lenvatinib, modification of the dosage of one or both agents is recommended. Temporary or permanent discontinuance of pembrolizumab may be required based on the severity of the reaction. Refer to the lenvatinib prescribing information for additional dosage modifications.
Hematologic Toxicity: If grade 4 hematologic toxicity occurs in patients with cHL or PMBCL, pembrolizumab therapy should be interrupted until the toxicity resolves to grade 0 or 1.
Immune-mediated Pneumonitis: If grade 2 immune-mediated pneumonitis occurs, pembrolizumab therapy should be interrupted until the toxicity resolves to grade 0 or 1 and the corticosteroid dosage has been tapered. Therapy with the drug should be permanently discontinued in patients who do not recover to grade 0 or 1 within 12 weeks of initiating corticosteroids or who are unable to reduce corticosteroid dosage to <=10 mg of prednisone daily (or equivalent) within 12 weeks of initiating corticosteroids.
If grade 3 or 4 immune-mediated pneumonitis occurs, pembrolizumab therapy should be permanently discontinued.
Immune-mediated GI Effects: If grade 2 or 3 immune-mediated colitis occurs, pembrolizumab therapy should be interrupted until the toxicity resolves to grade 0 or 1 and the corticosteroid dosage has been tapered. Therapy with the drug should be permanently discontinued in patients who do not recover to grade 0 or 1 within 12 weeks of initiating corticosteroids or who are unable to reduce corticosteroid dosage to <=10 mg of prednisone daily (or equivalent) within 12 weeks of initiating corticosteroids.
If grade 4 immune-mediated colitis occurs, pembrolizumab therapy should be permanently discontinued.
Immune-mediated Hepatotoxicity (Except When Used in Combination with Axitinib): For serum aminotransferase (ALT or AST) elevations exceeding 3 times and up to 8 times the upper limit of normal (ULN) or total bilirubin concentrations exceeding 1.5 times and up to 3 times the ULN in patients without liver tumor involvement experiencing hepatotoxicity, pembrolizumab therapy should be interrupted until the toxicity resolves to grade 0 or 1 and the corticosteroid dosage has been tapered. Therapy with the drug should be permanently discontinued in patients who do not recover to grade 0 or 1 within 12 weeks of initiating corticosteroids or who are unable to reduce corticosteroid dosage to <=10 mg of prednisone daily (or equivalent) within 12 weeks of initiating corticosteroids.
For ALT or AST elevations exceeding 8 times the ULN or total bilirubin concentrations exceeding 3 times the ULN in patients without liver tumor involvement experiencing hepatotoxicity, pembrolizumab therapy should be permanently discontinued.
When AST and ALT concentrations are <=ULN at baseline in patients with liver tumor involvement experiencing hepatotoxicity, temporary or permanent discontinuance of pembrolizumab may be based on recommendations for hepatotoxicity in patients without liver tumor involvement.
In patients with liver tumor involvement and baseline ALT or AST concentrations exceeding 1 time and up to 3 times the ULN who experience increases in ALT or AST concentrations exceeding 5 times and up to 10 times the ULN, pembrolizumab therapy should be interrupted until hepatotoxicity resolves to grade 0 or 1 or the AST and ALT concentrations return to baseline. Therapy with the drug should be permanently discontinued in patients who do not recover to grade 0 or 1 within 12 weeks of initiating corticosteroids or who are unable to reduce corticosteroid dosage to <=10 mg of prednisone daily (or equivalent) within 12 weeks of initiating corticosteroids.
In patients with liver tumor involvement and baseline ALT or AST concentrations exceeding 3 times and up to 5 times the ULN who experience increases in ALT or AST concentrations exceeding 8 times and up to 10 times the ULN, pembrolizumab therapy should be interrupted until hepatotoxicity resolves to grade 0 or 1 or the AST and ALT concentrations return to baseline. Therapy with the drug should be permanently discontinued in patients who do not recover to grade 0 or 1 within 12 weeks of initiating corticosteroids or who are unable to reduce corticosteroid dosage to <=10 mg of prednisone daily (or equivalent) within 12 weeks of initiating corticosteroids.
For ALT or AST concentrations exceeding 10 times the ULN in patients with liver tumor involvement, pembrolizumab therapy should be permanently discontinued.
For total bilirubin concentrations exceeding 3 times the ULN in patients with liver tumor involvement, pembrolizumab therapy should be permanently discontinued.
Hepatotoxicity When Used in Combination with Axitinib for RCC: For treatment of liver enzyme elevations in patients experiencing adverse hepatotoxic effects from pembrolizumab therapy in combination with axitinib, consider corticosteroid therapy.
For ALT or AST concentrations that are >=3 times but less than 10 times the ULN in patients receiving pembrolizumab with concomitant axitinib and without concurrent total bilirubin concentrations of at least 2 times the ULN, pembrolizumab and axitinib therapy should be interrupted until the toxicity resolves to grade 0 or 1. A single-agent rechallenge or sequential rechallenge with both drugs may be considered after resolution of toxicity. If therapy with axitinib is rechallenged, consider dosage reduction according to the axitinib prescribing information.
For ALT or AST concentrations exceeding 3 times the ULN with concurrent total bilirubin concentrations >=2 times ULN, pembrolizumab and axitinib should both be permanently discontinued.
For ALT or AST concentrations >=10 times the ULN, pembrolizumab and axitinib should both be permanently discontinued.
Immune-mediated Endocrine Effects: If grade 3 or 4 immune-mediated endocrinopathies occur, pembrolizumab therapy should be interrupted until the patient is clinically stable or the drug should be permanently discontinued.
Immune-mediated Renal Effects: If grade 2 or 3 immune-mediated nephritis occurs with increased serum creatinine concentrations, pembrolizumab therapy should be interrupted until the toxicity resolves to grade 0 or 1 and the corticosteroid dosage has been tapered. Therapy with the drug should be permanently discontinued in patients who do not recover to grade 0 or 1 within 12 weeks of initiating corticosteroids or who are unable to reduce the corticosteroid dosage to <=10 mg of prednisone daily (or equivalent) within 12 weeks of initiating corticosteroids.
If grade 4 immune-mediated nephritis occurs with increased serum creatinine concentrations, pembrolizumab therapy should be permanently discontinued.
Immune-mediated Dermatologic Effects: If Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), or drug rash with eosinophilia and systemic symptoms (DRESS) is suspected, pembrolizumab therapy should be interrupted until the toxicity resolves to grade 0 or 1 and the corticosteroid dosage has been tapered. Therapy with the drug should be permanently discontinued in patients who do not recover to grade 0 or 1 within 12 weeks of initiating corticosteroids or who are unable to reduce corticosteroid dosage to <=10 mg of prednisone daily (or equivalent) within 12 weeks of initiating corticosteroid therapy.
If SJS, TEN, or DRESS is confirmed, pembrolizumab therapy should be permanently discontinued.
Immune-mediated Cardiac Effects: If grade 2--4 immune-mediated myocarditis occurs, pembrolizumab therapy should be permanently discontinued.
Immune-mediated Neurologic Effects: If grade 2 immune-mediated neurologic toxicity occurs, pembrolizumab therapy should be interrupted until the toxicity resolves to grade 0 or 1 and the corticosteroid dosage has been tapered. Therapy with the drug should be permanently discontinued in patients who do not recover to grade 0 or 1 within 12 weeks of initiating corticosteroids or who are unable to reduce corticosteroid dosage to <=10 mg of prednisone daily (or equivalent) within 12 weeks of initiating corticosteroid therapy.
If grade 3 or 4 immune-mediated neurologic toxicity occurs, pembrolizumab therapy should be permanently discontinued.
Infusion-related Reactions: If grade 1 or 2 infusion-related reactions occur, the infusion should be interrupted or the infusion rate should be slowed.
If grade 3 or 4 infusion-related reactions occur, pembrolizumab therapy should be permanently discontinued.
Pembrolizumab is commercially available as an injection concentrate, which must be diluted prior to IV administration. The commercially available injection concentrate should be inspected visually for particulate matter and discoloration prior to dilution and administration. The solution should be clear to slightly opalescent and colorless to slightly yellow, and should not be used if visible particles are present.
The commercially available pembrolizumab injection concentrate contains no preservatives and is intended for single use only; any unused portions should be discarded. Store vials of injection concentrate under refrigeration (2-8degreesC) in the original carton to protect from light. Do not shake or freeze.
The commercially available pembrolizumab injection concentrate contains no preservatives and is intended for single use only; any unused portions should be discarded. Store vials of injection concentrate under refrigeration (2-8degreesC) in the original carton to protect from light. Do not shake or freeze.
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| KEYTRUDA 100 MG/4 ML VIAL | Maintenance | Adults infuse 200 mg over 30 minute(s) by intravenous route every 3 weeks |
No generic dosing information available.
The following drug interaction information is available for KEYTRUDA (pembrolizumab):
There are 4 contraindications.
These drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.
| Drug Interaction | Drug Names |
|---|---|
| Efalizumab; Natalizumab/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Natalizumab,(1-3) efalizumab,(4) immunosuppressives, and immunomodulators all suppress the immune system. CLINICAL EFFECTS: Concurrent use of natalizumab(1-3) or efalizumab(4) with immunosuppressives or immunomodulators may result in an increased risk of infections, including progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV). PREDISPOSING FACTORS: Previous JCV infection, longer duration of natalizumab treatment - especially if greater than 2 years, and prior or concomitant treatment with immunosuppressant medication are all independent risk factors which increase the risk for PML.(1,5) The FDA has estimated PML incidence stratified by risk factors: If anti-JCV antibody positive, no prior immunosuppressant use and natalizumab treatment less than 25 months, incidence <1/1,000. If anti-JCV antibody positive, history of prior immunosuppressant use and natalizumab treatment less than 25 months, incidence 2/1,000 If anti-JCV antibody positive, no prior immunosuppressant use and natalizumab treatment 25-48 months, incidence 4/1,000 If anti-JCV antibody positive, history of prior immunosuppressant use and natalizumab treatment 25-48 months, incidence 11/1,000. PATIENT MANAGEMENT: The US manufacturer of natalizumab states patients with Crohn's disease should not receive concurrent immunosuppressants, with the exception of limited overlap of corticosteroids, due to the increased risk for PML. For new natalizumab patients currently receiving chronic oral corticosteroids for Crohn's Disease, begin corticosteroid taper when therapeutic response to natalizumab has occurred. If corticosteroids cannot be discontinued within six months of starting natalizumab, discontinue natalizumab.(3) The US manufacturer of natalizumab states that natalizumab should not ordinarily be used in multiple sclerosis patients receiving immunosuppressants or immunomodulators due to the increased risk for PML. Immunosuppressives include, but are not limited to azathioprine, cyclophosphamide, cyclosporine, mercaptopurine, methotrexate, mitoxantrone, mycophenolate, and corticosteroids.(3,6) The UK manufacturer of natalizumab states that concurrent use with immunosuppressives or antineoplastic agents is contraindicated.(1) The Canadian manufacturer of natalizumab states that natalizumab should not be used with immunosuppressive or immunomodulatory agents.(2) The US manufacturer of certolizumab states that concurrent therapy with natalizumab is not recommended.(7) DISCUSSION: Progressive multifocal leukoencephalopathy has been reported in patients receiving concurrent natalizumab were recently or concomitantly taking immunomodulators or immunosuppressants.(1-5,8,9) In a retrospective cohort study of multiple sclerosis patients newly initiated on a disease-modifying therapy, use of high-efficacy agents (alemtuzumab, natalizumab, or ocrelizumab) resulted in the same risk of overall infections as moderate-efficacy agents, but there was an elevated risk of serious infections (adjusted hazard ratio [aHR] = 1.24, 95% confidence interval (CI) = 1.06-1.44) and UTIs (aHR = 1.21, 95% CI = 1.14-1.30).(10) |
TYRUKO, TYSABRI |
| Live Vaccines; Live BCG/Selected Immunosuppressive Agents SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: A variety of disease modifying agents suppress the immune system. Immunocompromised patients may be at increased risk for uninhibited replication after administration of live, attenuated vaccines or intravesicular BCG. Immune response to vaccines may be decreased during periods of immunocompromise.(1) CLINICAL EFFECTS: The expected serum antibody response may not be obtained and/or the vaccine may result in illness.(1) After instillation of intravesicular BCG, immunosuppression may interfere with local immune response, or increase the severity of mycobacterial infection following inadvertent systemic exposure.(2) PREDISPOSING FACTORS: Immunosuppressive diseases (e.g. hematologic malignancies, HIV disease), treatments (e.g. radiation) and drugs may all increase the magnitude of immunodeficiency. PATIENT MANAGEMENT: The Centers for Disease Control(CDC) Advisory Committee on Immunization Practices (ACIP) states that live-virus and live, attenuated vaccines should not be administered to patients who are immunocompromised. The magnitude of immunocompromise and associated risks should be determined by a physician.(1) For patients scheduled to receive chemotherapy, vaccination should ideally precede the initiation of chemotherapy by 14 days. Patients vaccinated while on immunosuppressive therapy or in the 2 weeks prior to starting therapy should be considered unimmunized and should be revaccinated at least 3 months after discontinuation of therapy.(1) Patients who receive anti-B cell therapies should not receive live vaccines for at least 6 months after such therapies due to a prolonged duration of immunosuppression. An exception is the Zoster vaccine, which can be given at least 1 month after receipt of anti-B cell therapies.(1) The US manufacturer of abatacept states live vaccines should not be given during or for up to 3 months after discontinuation of abatacept.(2) The US manufacturer of live BCG for intravesicular treatment of bladder cancer states use is contraindicated in immunosuppressed patients.(3) The US manufacturer of daclizumab states live vaccines are not recommended during and for up to 4 months after discontinuation of treatment.(4) The US manufacturer of guselkumab states that live vaccines should be avoided during treatment with guselkumab.(5) The US manufacturer of inebilizumab-cdon states that live vaccines are not recommended during treatment and after discontinuation until B-cell repletion. Administer all live vaccinations at least 4 weeks prior to initiation of inebilizumab-cdon.(6) The US manufacturer of ocrelizumab states that live vaccines are not recommended during treatment and until B-cell repletion occurs after discontinuation of therapy. Administer all live vaccines at least 4 weeks prior to initiation of ocrelizumab.(7) The US manufacturer of ozanimod states that live vaccines should be avoided during and for up to 3 months after discontinuation of ozanimod.(8) The US manufacturer of siponimod states that live vaccines are not recommended during treatment and for up to 4 weeks after discontinuation of treatment.(9) The US manufacturer of ustekinumab states BCG vaccines should not be given in the year prior to, during, or the year after ustekinumab therapy.(10) The US manufacturer of satralizumab-mwge states that live vaccines are not recommended during treatment and should be administered at least four weeks prior to initiation of satralizumab-mwge.(11) The US manufacturer of ublituximab-xiiy states that live vaccines are not recommended during treatment and until B-cell recovery. Live vaccines should be administered at least 4 weeks prior to initiation of ublituximab-xiiy.(12) The US manufacturer of etrasimod states that live vaccines should be avoided during and for 5 weeks after treatment. Live vaccines should be administered at least 4 weeks prior to initiation of etrasimod.(13) The US manufacturer of emapalumab-lzsg states that live vaccines should not be administered to patients receiving emapalumab-lzsg and for at least 4 weeks after the last dose of emapalumab-lzsg. The safety of immunization with live vaccines during or following emapalumab-lzsg therapy has not been studied.(14) The US manufacturer of sibeprenlimab-szsi states live vaccines should not be given within 30 days prior to initiation or during treatment with sibeprenlimab-szsi.(15) DISCUSSION: Killed or inactivated vaccines do not pose a danger to immunocompromised patients.(1) Patients with a history of leukemia who are in remission and have not received chemotherapy for at least 3 months are not considered to be immunocompromised.(1) |
ACAM2000 (NATIONAL STOCKPILE), ADENOVIRUS TYPE 4, ADENOVIRUS TYPE 4 AND TYPE 7, ADENOVIRUS TYPE 7, BCG (TICE STRAIN), BCG VACCINE (TICE STRAIN), DENGVAXIA, ERVEBO (NATIONAL STOCKPILE), FLUMIST 2025-2026, FLUMIST HOME 2025-2026, M-M-R II VACCINE, PRIORIX, PROQUAD, ROTARIX, ROTATEQ, STAMARIL, VARIVAX VACCINE, VAXCHORA ACTIVE COMPONENT, VAXCHORA VACCINE, VIVOTIF, YF-VAX |
| Talimogene laherparepvec/Selected Immunosuppressants SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Talimogene laherparepvec is a live, attenuated herpes simplex virus.(1) CLINICAL EFFECTS: Concurrent use of talimogene laherparepvec in patients receiving immunosuppressive therapy may cause a life-threatening disseminated herpetic infection.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Talimogene laherparepvec is contraindicated in immunosuppressed patients.(1) The magnitude of immunocompromise and associated risks due to immunosuppressant drugs should be determined by a physician. DISCUSSION: Concurrent use of talimogene laherparepvec in patients receiving immunosuppressive therapy may cause a life-threatening disseminated herpetic infection.(1) |
IMLYGIC |
| Nadofaragene Firadenovec/Selected Immunosuppressants SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Nadofaragene firadenovec may contain low levels of replication-competent adenovirus.(1) CLINICAL EFFECTS: Concurrent use of nadofaragene firadenovec in patients receiving immunosuppressive therapy may cause disseminated adenovirus infection.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Individuals who are immunosuppressed or immune-deficient should not receive nadofaragene firadenovec.(1) DISCUSSION: Nadofaragene firadenovec is a non-replicating adenoviral vector-based gene therapy but may contain low levels of replication-competent adenovirus. Immunocompromised persons, including those receiving immunosuppressant therapy, may be at risk for disseminated adenovirus infection.(1) |
ADSTILADRIN |
There are 22 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| Deferiprone/Selected Myelosuppressive Agents SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Concurrent use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis may increase the frequency or risk for severe toxicity.(1) CLINICAL EFFECTS: Concurrent use of deferiprone and myelosuppressive agents may result in severe neutropenia or agranulocytosis, which may be fatal. PREDISPOSING FACTORS: Agranulocytosis may be less common in patients receiving deferiprone for thalassemia, and more common in patients treated for other systemic iron overload conditions (e.g. myelodysplastic syndromes, sickle cell disease).(2,3) Inadequate monitoring appears to increase the risk for severe outcomes. Manufacturer post market surveillance found that in all fatal cases of agranulocytosis reported between 1999 and 2005, data on weekly white blood count (WBC) monitoring was missing. In three fatal cases, deferiprone was continued for two to seven days after the detection of neutropenia or agranulocytosis.(2) PATIENT MANAGEMENT: If possible, discontinue one of the drugs associated with risk for neutropenia or agranulocytosis. If alternative therapy is not available, documentation and adherence to the deferiprone monitoring protocol is essential. Baseline absolute neutrophil count (ANC) must be at least 1,500/uL prior to starting deferiprone. Monitor ANC weekly during therapy. If infection develops, interrupt deferiprone therapy and monitor ANC more frequently. If ANC is less than 1,500/uL but greater than 500/uL, discontinue deferiprone and any other drugs possibly associated with neutropenia. Initiate ANC and platelet counts daily until recovery (i.e. ANC at least 1,500/uL). If ANC is less than 500/uL, discontinue deferiprone, evaluate patient and hospitalize if appropriate. Do not resume deferiprone unless potential benefits outweigh potential risks.(1) DISCUSSION: Drugs linked to this monograph have an FDA Boxed Warning for risk of neutropenia, agranulocytosis, or pancytopenia, or have > 5% risk for neutropenia and/or warnings describing risk for myelosuppression in manufacturer prescribing information.(1-25) In pooled clinical studies submitted to the FDA, 6.1% of deferiprone patients met criteria for neutropenia and 1.7% of patients developed agranulocytosis.(1) The time to onset of agranulocytosis was highly variable with a range of 65 days to 9.2 years (median, 161 days).(3) |
DEFERIPRONE, DEFERIPRONE (3 TIMES A DAY), FERRIPROX, FERRIPROX (2 TIMES A DAY), FERRIPROX (3 TIMES A DAY) |
| Tofacitinib/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Concurrent use of tofacitinib and azathioprine, other biologic disease-modifying antirheumatic drugs (DMARDs), or potent immunosuppressants may result in additive or synergistic effects on the immune system.(1) CLINICAL EFFECTS: Concurrent use of tofacitinib and azathioprine, other biologic DMARDs, or potent immunosuppressants use may increase the risk of serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Tofacitinib should not be used concurrently with azathioprine, other biologic DMARDs, or cyclosporine.(1) Patient should be monitored for decreases in lymphocytes and neutrophils. Therapy should be adjusted based on the indication. - For all indications: If absolute neutrophil count (ANC) or lymphocyte count is less than 500 cells/mm3, discontinue tofacitinib. - For rheumatoid arthritis or psoriatic arthritis and absolute neutrophil count (ANC) 500 to 1000 cells/mm3: interrupt dosing. When ANC is greater than 1000 cells/mm3, resume Xeljanz 5 mg twice daily or Xeljanz XR 11 mg once daily. - For ulcerative colitis and ANC 500 to 1000 cells/mm3: -If taking Xeljanz 10 mg twice daily, decrease to 5 mg twice daily. When ANC is greater than 1000 cells/mm3, increase to 10 mg twice daily based on clinical response. -If taking Xeljanz 5 mg twice daily, interrupt dosing. When ANC is greater than 1000 cells/mm3, resume 5 mg twice daily. -If taking Xeljanz XR 22 mg once daily, decrease to 11 mg once daily. When ANC is greater than 1000 cells/mm3, increase to 22 mg once daily based on clinical response. -If taking Xeljanz XR 11 mg once daily, interrupt dosing. When ANC is greater than 1000 cells/mm3, resume 11 mg once daily. - For polyarticular course juvenile idiopathic arthritis (pcJIA) and ANC 500 to 1000 cells/mm3: interrupt dosing until ANC is greater than 1000 cells/mm3.(1) DISCUSSION: Concurrent use of tofacitinib and azathioprine, other biologic DMARDs, or potent immunosuppressants may increase the risk of infection.(1) Serious infections due to bacterial, mycobacterial, invasive fungal, viral, or other opportunistic pathogens have been reported in patients receiving tofacitinib. Some patients presented with disseminated disease and were often taking concomitant immunomodulating agents. In the ulcerative colitis population, a greater risk of serious infections was seen with a higher tofacitinib dose. In 7 placebo-controlled rheumatoid arthritis trials (0-3 months exposure), the overall frequency of infections was 20% in the tofacitinib 5 mg twice daily group and 22% in the tofacitinib 10 mg twice daily group compared to 18% in the placebo group. Serious infections were reported in 11 patients (1.7 events per 100 patient-years) with a rate difference between treatment groups of 1.1 (-0.4, 2.5) events per 100 patient-years for both tofacitinib 5 mg twice daily and 10 mg twice daily. During 0-12 months exposure, serious infections were reported in 34 patients (2.7 events per 100 patient years) in the tofacitinib 5 mg twice daily group and 33 patients (2.7 events per 100 patient years) in the tofacitinib 10 mg twice daily group.(1) |
TOFACITINIB CITRATE, TOFACITINIB CITRATE ER, XELJANZ, XELJANZ XR |
| Clozapine/Selected Myelosuppressive Agents SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Clozapine and other myelosuppressive agents may be associated with neutropenia or agranulocytosis.(2) CLINICAL EFFECTS: Moderate neutropenia, even if due to combination therapy, may require abrupt discontinuation of clozapine resulting in decompensation of the patient's psychiatric disorder (e.g. schizophrenia). The disease treated by the myelosuppressive agent may be compromised if myelosuppression requires dose reduction, delay, or discontinuation of the myelosuppressive agent. Undetected severe neutropenia or agranulocytosis may be fatal. PREDISPOSING FACTORS: Low white blood counts prior to initiation of the myelosuppressive agent may increase risk for clinically significant neutropenia. PATIENT MANAGEMENT: If a patient stabilized on clozapine therapy requires treatment with a myelosuppressive agent, the clozapine prescriber should consult with prescriber of the myelosuppressive agent (e.g. oncologist) to discuss treatment and monitoring options.(2) More frequent absolute neutrophil count (ANC) monitoring or treatment alternatives secondary to neutropenic episodes may need to be considered. The U.S. Food and Drug Administration (FDA) recommends that prescribers monitor patients' ANC according to the monitoring frequencies described in the prescribing information. Severe neutropenia remains a serious, potentially fatal risk that is greatest in the first several months of clozapine treatment. ANC monitoring can help identify neutropenia early to allow for timely intervention.(1-2) Australia, Canada, and U.K.: Clozapine is only available through a restricted distribution system which requires documentation of the ANC prior to dispensing. For most clozapine patients, clozapine treatment must be interrupted for a suspected clozapine-induced ANC < 1000 cells/microliter. For patients with benign ethnic neutropenia (BEN), treatment must be interrupted for suspected clozapine-induced neutropenia < 500 cells/microliter.(2) DISCUSSION: Concurrent use of clozapine and selected myelosuppressive agents may require more frequent ANC monitoring or consideration of treatment alternatives secondary to neutropenic episodes. Agents linked to this interaction generally have > 5% risk for neutropenia and/or warnings describing risk for myelosuppression in manufacturer prescribing information.(3-26) |
CLOZAPINE, CLOZAPINE ODT, CLOZARIL, VERSACLOZ |
| Selected Multiple Sclerosis Agents/Immunosuppressants; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Ocrelizumab or ofatumumab in combination with immunosuppressives and immune-modulators all suppress the immune system.(1,2) CLINICAL EFFECTS: Concurrent use of ocrelizumab or ofatumumab with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1,2) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: The ocrelizumab US prescribing information states: - Ocrelizumab and other immune-modulating or immunosuppressive therapies, (including immunosuppressant doses of corticosteroids) are expected to increase the risk of immunosuppression, and the risk of additive immune system effects must be considered if these therapies are coadministered with ocrelizumab. When switching from drugs with prolonged immune effects, such as daclizumab, fingolimod, natalizumab, teriflunomide, or mitoxantrone, the duration and mode of action of these drugs must be considered to avoid unintended additive immunosuppressive effects when initiating ocrelizumab.(1) The ofatumumab US prescribing information states: - Ofatumumab and other immunosuppressive therapies (including systemic corticosteroids) may have the potential for increased immunosuppressive effects and increase the risk of infection. When switching between therapies, the duration and mechanism of action of each therapy should be considered due to the potential for additive immunosuppressive effects. Ofatumumab for MS therapy has not been studied in combination with other MS agents that suppress the immune system.(2) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1,2) In a retrospective cohort study of multiple sclerosis patients newly initiated on a disease-modifying therapy, use of high-efficacy agents (alemtuzumab, natalizumab, or ocrelizumab) resulted in the same risk of overall infections as moderate-efficacy agents, but there was an elevated risk of serious infections (adjusted hazard ratio [aHR] = 1.24, 95% confidence interval (CI) = 1.06-1.44) and UTIs (aHR = 1.21, 95% CI = 1.14-1.30).(3) |
KESIMPTA PEN, OCREVUS, OCREVUS ZUNOVO |
| PD-1 and PD-L1 Blocking Antibodies/Thalidomide Analogues SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: The mechanism of this interaction is not known. CLINICAL EFFECTS: Concurrent use of a thalidomide analogue with dexamethasone and a PD-1 or PD-L1 blocking antibody may increase the risk of mortality. PREDISPOSING FACTORS: Concurrent use of dexamethasone may increase the risk of venous thromboembolism (VTE), ischemic heart disease including myocardial infarction, and stroke. PATIENT MANAGEMENT: Concurrent administration of a thalidomide analogue plus dexamethasone with a PD-1 or PD-L1 blocking antibody is not recommended outside of controlled clinical trials. DISCUSSION: Two randomized clinical trials in multiple myeloma patients showed an increase in mortality associated with the concurrent use of pembrolizumab, a thalidomide analogue, and dexamethasone. In the first clinical trial, patients were randomized to receive pomalidomide, dexamethasone, and pembrolizumab. In this trial, the relative risk of death was increased by more than 50% in the experimental arm containing pembrolizumab and the hazard ratio for overall survival was 1.61. Causes of death in the experimental arm included myocarditis, Stevens-Johnson syndrome, myocardial infarction, pericardial hemorrhage, cardiac failure, respiratory tract infection, neutropenia sepsis, sepsis, multiple organ dysfunction, and respiratory failure. In the second clinical trial, patients were randomized to receive lenalidomide, dexamethasone, and pembrolizumab. In this trial, the relative risk of death was increased by more than 100% in the experimental arm containing pembrolizumab and the hazard ratio for overall survival was 2.06. Causes of death in the experimental arm included intestinal ischemia, cardio-respiratory arrest, pulmonary embolism, cardiac arrest, pneumonia, sudden death, myocarditis, large intestinal perforation, and cardiac failure. PD-1 and PD-L1 blocking antibodies linked to this monograph include atezolizumab, avelumab, cemiplimab, cosibelimab, dostarlimab, durvalumab, nivolumab, pembrolizumab, penpulimab, retifanlimab, sintilimab, sugemalimab, and toripalimab. |
LENALIDOMIDE, POMALIDOMIDE, POMALYST, REVLIMID, THALOMID |
| Upadacitinib/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Upadacitinib, immunosuppressives, and immunomodulators all suppress the immune system. CLINICAL EFFECTS: Concurrent use of upadacitinib with immunosuppressives or immunomodulators may result in an increased risk of serious infections. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of upadacitinib states that concurrent use of upadacitinib with immunosuppressives or immunomodulators is not recommended. DISCUSSION: Serious infections have been reported in patients receiving upadacitinib. Reported infections included pneumonia, cellulitis, tuberculosis, multidermatomal herpes zoster, oral/esophageal candidiasis, cryptococcosis. Reports of viral reactivation, including herpes virus reactivation and hepatitis B reactivation, were reported in clinical studies with upadacitinib.(1) |
RINVOQ, RINVOQ LQ |
| Inebilizumab/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Inebilizumab, immunosuppressives, and immunomodulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of inebilizumab with immunosuppressive or immunomodulating agents may result in myelosuppression including neutropenia resulting in an increased risk for serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of inebilizumab states that the concurrent use of inebilizumab with immunosuppressive agents, including systemic corticosteroids, may increase the risk of infection. If concurrent therapy is warranted, consider the risk of additive immune suppression and monitor based on prescribing information for both agents.(1) DISCUSSION: Inebilizumab has not been studied in combination with other immunosuppressants. If concurrent therapy is warranted, consider the potential for increased immunosuppressive risks from both agents. The most common infections reported by inebilizumab treated patients in the randomized and open-label clinical trial periods included urinary tract infections (20%), nasopharyngitis (13%), upper respiratory tract infections (8%), and influenza (7%). Although there been no cases of Hepatitis B virus reactivation or progressive multifocal leukoencephalopathy reported in patients taking inebilizumab, these infections have been observed in patients taking other B-cell-depleting antibodies.(1) |
UPLIZNA |
| Baricitinib/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Concurrent use of baricitinib with other biologic disease-modifying antirheumatic drugs (DMARDs) or potent immunosuppressants such as azathioprine or cyclosporine may result in additive or synergistic effects on the immune system. CLINICAL EFFECTS: Concurrent use of baricitinib with other biologic DMARDs or potent immunosuppressants such as azathioprine or cyclosporine may increase the risk of serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of baricitinib states that concurrent use of baricitinib with biologic DMARDs or potent immunosuppressants is not recommended.(1) DISCUSSION: Most patients who developed serious infections while being treated with baricitinib were on concomitant immunosuppressants like methotrexate and corticosteroids. The combination of baricitinib with other biologic DMARDs has not been studied.(1) |
OLUMIANT |
| Leflunomide; Teriflunomide/Selected Immunosuppressants SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Concurrent use of leflunomide or teriflunomide and potent immunosuppressants may result in additive or synergistic effects on the immune system.(1,2) Leflunomide is a prodrug and is converted to its active metabolite teriflunomide.(1) CLINICAL EFFECTS: Concurrent use of leflunomide or teriflunomide with immunosuppressants may result in an increased risk of serious infections, including opportunistic infections, especially Pneumocystis jiroveci pneumonia, tuberculosis (including extra-pulmonary tuberculosis), and aspergillosis. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: If leflunomide or teriflunomide is used concurrently with immunosuppressive agents, chronic CBC monitoring should be performed more frequently, every month instead of every 6 to 8 weeks. If bone marrow suppression or a serious infection occurs, leflunomide or teriflunomide should be stopped and rapid drug elimination procedure should be performed.(1,2) DISCUSSION: Pancytopenia, agranulocytosis and thrombocytopenia have been reported in patients receiving leflunomide or teriflunomide alone, but most frequently in patients taking concurrent immunosuppressants.(1,2) Severe and potentially fatal infections, including sepsis, have been reported in patients receiving leflunomide or teriflunomide, especially Pneumocystis jiroveci pneumonia and aspergillosis. Tuberculosis has also been reported.(1,2) |
ARAVA, AUBAGIO, LEFLUNICLO, LEFLUNOMIDE, TERIFLUNOMIDE |
| Ponesimod/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Ponesimod in combination with immunosuppressives and immune-modulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of ponesimod with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection, cryptococcal infection, or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: The ponesimod US prescribing information states ponesimod has not been studied in combination with anti-neoplastic, immune-modulating, or immunosuppressive therapies. Caution should be used during concomitant administration because of the risk of additive immune effects during therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, the half-life and mode of action of these drugs must be considered in order to avoid unintended additive immunosuppressive effects. Initiating treatment with ponesimod after alemtuzumab is not recommended. However, ponesimod can generally be started immediately after discontinuation of beta interferon or glatiramer acetate.(1) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections, cryptococcal meningitis, disseminated cryptococcal infections, and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1) |
PONVORY |
| Sodium Iodide I 131/Myelosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Sodium iodide I 131 can cause depression of the hematopoetic system. Myelosuppressives and immunomodulators also suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of sodium iodide I 131 with agents that cause bone marrow depression, including myelosuppressives or immunomodulators, may result in an enhanced risk of hematologic disorders, including anemia, blood dyscrasias, bone marrow depression, leukopenia, and thrombocytopenia. Bone marrow depression may increase the risk of serious infections and bleeding.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of sodium iodide I 131 states that concurrent use with bone marrow depressants may enhance the depression of the hematopoetic system caused by large doses of sodium iodide I 131.(1) Sodium iodide I 131 causes a dose-dependent bone marrow suppression, including neutropenia or thrombocytopenia, in the 3 to 5 weeks following administration. Patients may be at increased risk of infections or bleeding during this time. Monitor complete blood counts within one month of therapy. If results indicate leukopenia or thrombocytopenia, dosimetry should be used to determine a safe sodium iodide I 131 activity.(1) DISCUSSION: Hematologic disorders including death have been reported with sodium iodide I 131. The most common hematologic disorders reported include anemia, blood dyscrasias, bone marrow depression, leukopenia, and thrombocytopenia.(1) |
HICON, SODIUM IODIDE I-131 |
| Fingolimod/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Fingolimod in combination with immunosuppressives and immune-modulators all suppress the immune system.(1-3) CLINICAL EFFECTS: Concurrent use of fingolimod with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1-3) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: Recommendations for fingolimod regarding this interaction differ between regulatory approving agencies. The fingolimod US prescribing information states: - Antineoplastic, immune-modulating, or immunosuppressive therapies, (including corticosteroids) are expected to increase the risk of immunosuppression, and the risk of additive immune system effects must be considered if these therapies are coadministered with fingolimod. When switching from drugs with prolonged immune effects, such as natalizumab, teriflunomide or mitoxantrone, the duration and mode of action of these drugs must be considered to avoid unintended additive immunosuppressive effects when initiating fingolimod.(1) The fingolimod Canadian prescribing information states: - Concurrent use with immunosuppressive or immunomodulatory agents is contraindicated due to the risk of additive immune system effects. However, co-administration of a short course of corticosteroids (up to 5 days) did not increase the overall rate of infection in patients participating Phase III clinical trials.(2) The fingolimod UK specific product characteristics states: - Fingolimod is contraindicated in patients currently receiving immunosuppressive therapies or those immunocompromised by prior therapies. When switching patients from another disease modifying therapy to Gilenya, the half-life and mode of action of the other therapy must be considered in order to avoid an additive immune effect whilst at the same time minimizing the risk of disease activation.(3) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1-3) |
FINGOLIMOD, GILENYA, TASCENSO ODT |
| Ozanimod/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Ozanimod in combination with immunosuppressives and immune-modulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of ozanimod with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: The ozanimod US prescribing information state this information regarding this interaction: -Ozanimod has not been studied in combination with anti-neoplastic, immune-modulating, or immunosuppressive therapies. Caution should be used during concomitant administration because of the risk of additive immune effects during therapy and in the week following administration. When switching from drugs with prolonged immune effects, the half-life and mode of action of these drugs must be considered in order to avoid unintended additive immunosuppressive effects. Initiating treatment with ozanimod after alemtuzumab is not recommended. However, ozanimod can generally be started immediately after discontinuation of beta interferon or glatiramer acetate.(1) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1) |
ZEPOSIA |
| Siponimod/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Siponimod in combination with immunosuppressives and immune-modulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of siponimod with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: The siponimod US prescribing information state this information regarding this interaction: -Siponimod has not been studied in combination with anti-neoplastic, immune-modulating, or immunosuppressive therapies. Caution should be used during concomitant administration because of the risk of additive immune effects during therapy and in the week following administration. When switching from drugs with prolonged immune effects, the half-life and mode of action of these drugs must be considered in order to avoid unintended additive immunosuppressive effects. Initiating treatment with siponimod after alemtuzumab is not recommended. However, siponimod can generally be started immediately after discontinuation of beta interferon or glatiramer acetate.(1) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1) |
MAYZENT |
| Cladribine Oral/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Cladribine in combination with immunosuppressives and immune-modulators all suppress the immune system.(1-2) CLINICAL EFFECTS: Concurrent use of cladribine with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1-2) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: Recommendations for cladribine regarding this interaction differ between regulatory approving agencies. The cladribine US prescribing information states: -Concomitant use with myelosuppressive or other immunosuppressive drugs is not recommended. Acute short-term therapy with corticosteroids can be administered. In patients who have previously been treated with immunomodulatory or immunosuppressive drugs, consider potential additive effect, the mode of action, and duration of effect of the other drugs prior to initiation of cladribine.(1) The cladribine Canadian prescribing information states: -Use of cladribine in immunocompromised patients is contraindicated because of a risk of additive effects on the immune system. Acute short-term therapy with corticosteroids can be administered during cladribine treatment.(2) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1-2) |
CLADRIBINE, MAVENCLAD |
| IgG Antibodies and Derivatives/Efgartigimod-alfa SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: The neonatal Fc receptor (FcRn) prevents catabolism and mediates recycling of IgG and albumin, which leads to their long persistence in the body.(1,2) Efgartigimod-alfa binds to FcRn and may decrease systemic exposure of other ligands of FcRn, like immunoglobulins and IgG-based antibodies.(3) CLINICAL EFFECTS: The effectiveness of medicines that bind to FcRn may be decreased.(3) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The manufacturer of efgartigimod-alfa states that efgartigimod-alfa should not be combined with long-term use of FcRn-binding medications. If the medication is essential for the patient, efgartigimod-alfa should be discontinued.(3) DISCUSSION: Clinical drug interaction studies with efgartigimod-alfa have not been performed. Efgartigimod-alfa may decrease concentrations of compounds that bind to the human FcRn.(3) |
VYVGART, VYVGART HYTRULO |
| Anifrolumab/Biologic Therapies SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Concurrent use of anifrolumab with other biologic therapies may result in additive or synergistic effects on the immune system.(1) CLINICAL EFFECTS: Concurrent use of anifrolumab with other biologic therapies may increase the risk of serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The concurrent use of anifrolumab with other biologic therapies is not recommended.(1) DISCUSSION: The combination of anifrolumab with other biologic therapies has not been studied and is not recommended.(1) |
SAPHNELO, SAPHNELO PEN |
| Ritlecitinib/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Ritlecitinib, immunosuppressives, and immunomodulators all suppress the immune system. CLINICAL EFFECTS: Concurrent use of ritlecitinib with immunosuppressives or immunomodulators may result in an increased risk of serious infections. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of ritlecitinib states that concurrent use of ritlecitinib with other JAK inhibitors, biologic immunomodulators, cyclosporine or other potent immunosuppressants is not recommended.(1) DISCUSSION: Serious infections have been reported in patients receiving ritlecitinib. Reported infections included appendicitis, COVID-19 infection (including pneumonia), and sepsis. Reports of viral reactivation, including herpes virus reactivation was reported in clinical studies with ritlecitinib.(1) |
LITFULO |
| Etrasimod/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Etrasimod causes reversible sequestration of lymphocytes in lymphoid tissues, resulting in a mean 55% decrease in peripheral blood lymphocyte count at 52 weeks.(1) Other immunosuppressives and immune-modulators also suppress the immune system. CLINICAL EFFECTS: Concurrent use of etrasimod with immunosuppressive or immune-modulating agents may result in an increased risk of serious and fatal infections, such as disseminated herpetic infection, cryptococcal infection, or progressive multifocal leukoencephalopathy (PML).(1) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications increases the risk of adverse effects. PATIENT MANAGEMENT: The etrasimod US prescribing information states etrasimod has not been studied in combination with anti-neoplastic, immune-modulating, or immunosuppressive therapies. Concomitant administration of these therapies with etrasimod should be avoided because of the risk of additive immune effects during therapy and in the weeks following administration. Etrasimod's effect on peripheral lymphocytes may persist for up to 5 weeks after discontinuation.(1) When switching from drugs with prolonged immune effects, the half-life and mode of action of these drugs must be considered in order to avoid unintended additive immunosuppressive effects.(1) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections, cryptococcal meningitis, disseminated cryptococcal infections, and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients treated with other sphingosine-1 phosphate receptor modulators.(1) |
VELSIPITY |
| Ropeginterferon alfa-2b/Slt Immunosuppress; Immunomodulator SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Ropeginterferon alfa-2b and immunosuppressives both suppress the immune system. CLINICAL EFFECTS: Concurrent use of ropeginterferon alfa-2b with immunosuppressives may result in an increased risk of serious infections. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Avoid concurrent use of myelosuppressive agents.(1-2) If concurrent use cannot be avoided, monitor for effects of excessive immunosuppression. DISCUSSION: In clinical trials, 20% of patients experienced leukopenia. Interferon alfa products may cause fatal or life-threatening infections.(1-2) |
BESREMI |
| Deuruxolitinib/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Deuruxolitinib, immunosuppressives, and immunomodulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of deuruxolitinib and potent immunosuppressants may increase the risk of serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of deuruxolitinib states that concurrent use of deuruxolitinib with other JAK inhibitors, biologic immunomodulators, cyclosporine or other potent immunosuppressants is not recommended.(1) If concurrent use cannot be avoided, patients should be monitored for signs and symptoms of infection. If a patient develops a serious or opportunistic infection, interrupt deuruxolitinib treatment until the infection is controlled. DISCUSSION: Serious infections have been reported in patients receiving treatment with deuruxolitinib.(1) |
LEQSELVI |
| IgG Antibodies and Derivatives/Nipocalimab-aahu SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: The neonatal Fc receptor (FcRn) prevents catabolism and mediates recycling of IgG and albumin, which leads to their long persistence in the body.(1,2) Nipocalimab-aahu binds to FcRn and may decrease systemic exposure of other ligands of FcRn, like immunoglobulins and IgG-based antibodies.(3) CLINICAL EFFECTS: The effectiveness of medicines that bind to FcRn may be decreased.(3) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The manufacturer of nipocalimab-aahu states that nipocalimab-aahu should not be combined with long-term use of FcRn-binding medications. If the medication is essential for the patient, nipocalimab-aahu should be discontinued.(3) DISCUSSION: Clinical drug interaction studies with nipocalimab-aahu have not been performed. Nipocalimab-aahu may decrease concentrations of compounds that bind to the human FcRn.(3) |
IMAAVY |
There are 9 moderate interactions.
The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.
| Drug Interaction | Drug Names |
|---|---|
| Ustekinumab/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Ustekinumab, immunosuppressives, and immunomodulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of ustekinumab with immunosuppressive or immunomodulating agents may result in an increased risk for serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of ustekinumab recommends caution because the concurrent use of ustekinumab with immunosuppressive agents may increase the risk of infection. If concurrent therapy is warranted, consider the risk of additive immune suppression and monitor based on prescribing information for both agents.(1) DISCUSSION: Ustekinumab has not been studied in combination with other immunosuppressants in psoriasis studies. In psoriatic arthritis studies, concomitant methotrexate use did not appear to influence the safety or efficacy of ustekinumab. In Crohn's disease and ulcerative colitis studies, concomitant use of immunosuppressants or corticosteroids did not appear to influence the safety or efficacy of ustekinumab. If concurrent therapy is warranted, consider the potential for increased immunosuppressive risks from both agents.(1) The most common infections reported by ustekinumab treated patients in the clinical trial periods included nasopharyngitis(8%) and upper respiratory tract infection(5%). Serious bacterial, mycobacterial, fungal, and viral infections were observed in patients receiving ustekinumab. Cases of interstitial pneumonia, eosinophilic pneumonia, and cryptogenic organizing pneumonia resulting in respiratory failure or prolonged hospitalization have been reported in patients receiving ustekinumab.(1) |
IMULDOSA, OTULFI, PYZCHIVA, PYZCHIVA AUTOINJECTOR, SELARSDI, STARJEMZA, STELARA, STEQEYMA, USTEKINUMAB, USTEKINUMAB-AAUZ, USTEKINUMAB-AEKN, USTEKINUMAB-TTWE, WEZLANA, YESINTEK |
| COVID-19 Vaccines/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Immunosuppressants and immunomodulators may prevent the immune system from properly responding to the COVID-19 vaccine.(1-3) CLINICAL EFFECTS: Administration of a COVID-19 vaccine with immunosuppressants or immunomodulators may interfere with vaccine-induced immune response and impair the efficacy of the vaccine. However, patients should be offered and given a COVID-19 vaccine even if the use and timing of immunosuppressive agents cannot be adjusted.(1-3) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The Centers for Disease Control and Prevention (CDC),(1) Infectious Diseases Society of America (IDSA),(2) and the American College of Rheumatology (ACR)(3) have published guidances for COVID-19 vaccination in patients on immunosuppressants. The CDC states that all immunocompromised patients over 6 months of age should receive at least 1 dose of COVID-19 vaccine if eligible. See the CDC's Interim Clinical Considerations for Use of COVID-19 Vaccines for specific recommendations based on age, vaccination history, and vaccine manufacturer.(1) The CDC advises planning for vaccination at least 2 weeks before starting or resuming immunosuppressive therapy.(1) IDSA recommends timing COVID-19 vaccination at least 2 weeks before starting or at least 3 months after completing immunosuppressive therapy.(2) The ACR states that in general, immunosuppressants and immunomodulators should be held for 1-2 weeks after each vaccine dose.(3) Patients should be offered and given a COVID-19 vaccine even if the use and timing of immunosuppressive agents cannot be adjusted, though the immune response will likely be blunted. COVID-19 vaccines should not be delayed in patients taking immunosuppressive therapies.(1-2) See below for specific recommendations for certain agents. B-cell depleting agents, including rituximab: The CDC states that the utility of B-cell quantification to guide clinical care is not known and is not recommended. Patients who receive B-cell depleting therapy on a continuing basis should receive COVID-19 vaccines about 4 weeks before the next scheduled dose. For patients who received 1 or more doses of COVID-19 vaccine during treatment with B-cell-depleting therapies that were administered over a limited period (e.g., as part of a treatment regimen for certain malignancies), revaccination may be considered according to the current CDC recommendations for unvaccinated patients. The suggested interval to start revaccination is about 6 months after completion of the B-cell-depleting therapy.(1) IDSA recommends waiting for at least 3-6 months after the last infusion of B-cell depleting therapy before administering COVID-19 vaccines.(2) The ACR recommends consulting with the rheumatologist to determine optimal timing of COVID-19 vaccination. Measuring CD19 B cells may be considered to determine need for a booster vaccine dose. If B cell levels are not measured, a supplemental vaccine dose 2-4 weeks before the next scheduled dose of rituximab is recommended.(3) Recipients of hematopoietic cell transplant or CAR-T-cell therapy who received one or more doses of COVID-19 vaccine prior to or during treatment should undergo revaccination following the current CDC recommendations for unvaccinated patients. Revaccination should start at least 3 months (12 weeks) after transplant or CAR-T-cell therapy.(1,2) The CDC includes abatacept, cyclophosphamide, and TNF-alpha and cytokine inhibitors in their general recommendation to hold therapy for at least 2 weeks following vaccination (1) while the ACR provides different recommendations:(3) *Abatacept: - Subcutaneous abatacept should be withheld for 1-2 weeks after each vaccine dose, as disease activity allows. - For intravenous abatacept, time administration so that vaccination will occur 1 week before the next abatacept infusion. *Cyclophosphamide: When feasible, administer cyclophosphamide 1 week after each COVID-19 vaccine dose. *TNF-alpha inhibitors and cytokine inhibitors: The ACR was not able to reach consensus on whether to modify dosing or timing of these agents with COVID-19 vaccination. DISCUSSION: IDSA recommendations are based on cohort and case control studies in immunocompromised patients that found low to modest vaccine effectiveness (37-61%) but lower risks of COVID-19 association hospitalization, COVID-19 related mortality, and critical illness.(2) The ACR convened a COVID-19 Vaccine Guidance Task Force to provide guidance on optimal use of COVID-19 vaccines in rheumatology patients. These recommendations are based on limited clinical evidence of COVID-19 vaccines in patients without rheumatic and musculoskeletal disorders and evidence of other vaccines in this patient population.(3) The ACR recommendation for rituximab is based on studies of humoral immunity following receipt of other vaccines. These studies have uncertain generalizability to vaccination against COVID-19, as it is unknown if efficacy is attributable to induction of host T cells versus B cell (antibody-based) immunity.(3) The ACR recommendation for mycophenolate is based on preexisting data of mycophenolate on non-COVID-19 vaccine immunogenicity. Emerging data suggests that mycophenolate may impair SARS-CoV-2 vaccine response in rheumatic and musculoskeletal disease and transplant patients.(3) The ACR recommendation for methotrexate is based on data from influenza vaccines and pneumococcal vaccines with methotrexate.(3) The ACR recommendation for JAK inhibitors is based on concerns related to the effects of JAK inhibitors on interferon signaling that may result in a diminished vaccine response.(3) The ACR recommendation for subcutaneous abatacept is based on several studies suggesting a negative effect of abatacept on vaccine immunogenicity. The first vaccine dose primes naive T cells, naive T cell priming is inhibited by CTLA-4, and abatacept is a CTLA-4Ig construct. CTLA-4 should not inhibit boosts of already primed T cells at the time of the second vaccine dose.(3) |
COMIRNATY 2025-2026 (12Y UP), COMIRNATY 2025-2026(5-11Y), MNEXSPIKE 2025-2026 (12Y UP), NUVAXOVID 2025-2026, SPIKEVAX 2025-2026 (12Y UP), SPIKEVAX 2025-2026 (6M-11Y) |
| Sarilumab/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Sarilumab, immunosuppressives, and immunomodulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of sarilumab with immunosuppressive or immunomodulating agents may result in an increased risk for serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of sarilumab recommends caution because the concurrent use of sarilumab with immunosuppressive agents may increase the risk of infection. If concurrent therapy is warranted, consider the risk of additive immune suppression and monitor based on prescribing information for both agents.(1) DISCUSSION: Sarilumab was studied as monotherapy and in combination with methotrexate or conventional disease modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis studies. Sarilumab has not been studied with biological DMARDs and concurrent use should be avoided. If concurrent therapy is warranted, consider the potential for increased immunosuppressive risks from both agents.(1) The most common infections reported by sarilumab treated patients in the clinical trial periods included pneumonia and cellulitis. Serious bacterial, mycobacterial, fungal, and viral infections were observed in patients receiving sarilumab. Cases of tuberculosis, candidiasis, and pneumocystis with sarilumab have been reported.(1) |
KEVZARA |
| Ublituximab/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Ublituximab, immunosuppressives, and immunomodulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of ublituximab with immunosuppressive or immunomodulating agents may result in an increased risk for serious infections.(1) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: The US manufacturer of ublituximab recommends caution because the concurrent use of ublituximab with immunomodulating or immunosuppressive agents, including immunosuppressant doses of corticosteroids, may increase the risk of infection.(1) If concurrent therapy is warranted, consider the risk of additive immune suppression and monitor based on prescribing information for both agents. When switching from agents with immune effects, the half-life and mechanism of action of these drugs must be taken into consideration in order to prevent additive immunosuppressive effects.(1) DISCUSSION: The most common infections reported by ublituximab-treated patients in the clinical trial periods included upper respiratory tract infections and urinary tract infections. Serious, including life-threatening or fatal, bacterial and viral infections were observed in patients receiving ublituximab.(1) Serious and/or fatal bacterial, fungal, and new or reactivated viral infections have been associated with other anti-CD20 B-cell depleting therapies. There were no cases of progressive multifocal leukoencephalopathy (PML) reported during the clinical trials; however, there have been reports of PML during or following completion of other anti-CD20 B-cell depleting therapies.(1) |
BRIUMVI |
| Belimumab/Biologic Therapies SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Concurrent use of belimumab with other biologic therapies may result in additive or synergistic effects on the immune system.(1) CLINICAL EFFECTS: Concurrent use of belimumab with other biologic therapies may increase the risk of serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The concurrent use of belimumab with other biologic therapies should be approached with caution.(1) DISCUSSION: In a randomized, double-blind, placebo-controlled trial, more patients who received belimumab and rituximab experienced serious adverse events, serious infections, and post-injection systemic reactions (22.2%, 9%, and 13.2%, respectively) than patients who received belimumab with placebo (13.9%, 2.8%, 9.7%) or standard therapy (19.7%, 5.3%, 5.3%).(1) The combination of belimumab with other biologic therapies has not been studied and should be used cautiously.(1) |
BENLYSTA |
| IgG Antibodies and Derivatives/Rozanolixizumab-noli SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The neonatal Fc receptor (FcRn) prevents catabolism and mediates recycling of IgG and albumin, which leads to their long persistence in the body.(1,2) Rozanolixizumab-noli binds to FcRn and may decrease systemic exposure of other ligands of FcRn, like immunoglobulins and IgG-based antibodies.(3) CLINICAL EFFECTS: The effectiveness of medications that bind to FcRn may be decreased.(3) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The manufacturer of rozanolixizumab-noli states that concurrent use with medications that bind to the human neonatal Fc receptor (FcRn) should be closely monitored for reduced effectiveness of these medications. If long-term use of such medications is essential for the patient, consider discontinuing rozanolixizumab-noli and use alternative therapies.(3) DISCUSSION: Clinical drug interaction studies with rozanolixizumab-noli have not been performed. Rozanolixizumab-noli may decrease concentrations of compounds that bind to the human FcRn.(3) |
RYSTIGGO |
| Tocilizumab/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Tocilizumab, immunosuppressives, and immunomodulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of tocilizumab with immunosuppressive or immunomodulating agents may result in an increased risk for serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of tocilizumab recommends caution because the concurrent use of tocilizumab with immunosuppressive agents may increase the risk of infection. If concurrent therapy is warranted, consider the risk of additive immune suppression and monitor based on prescribing information for both agents.(1) DISCUSSION: Tocilizumab was studied as monotherapy and in combination with methotrexate, non-biologic DMARDs or corticosteroids, depending on the indication. Tocilizumab has not been studied with biological DMARDs and concurrent use should be avoided. If concurrent therapy is warranted, consider the potential for increased immunosuppressive risks from both agents.(1) The most common infections reported by tocilizumab treated patients in the clinical trial periods included pneumonia, urinary tract infection, cellulitis, herpes zoster, gastroenteritis, diverticulitis, sepsis and bacterial arthritis. Serious bacterial, mycobacterial, fungal, and viral infections were observed in patients receiving tocilizumab. Cases of tuberculosis, cryptococcus, aspergillosis, candidiasis, and pneumocystosis have been reported.(1) |
ACTEMRA, ACTEMRA ACTPEN, AVTOZMA, AVTOZMA AUTOINJECTOR, TOFIDENCE, TYENNE, TYENNE AUTOINJECTOR |
| Cladribine Oncology Inj/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Cladribine in combination with immunosuppressives and immune-modulators all suppress the immune system.(1-4) CLINICAL EFFECTS: Concurrent use of cladribine with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections.(1-4) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: Recommendations for cladribine regarding this interaction differ between regulatory approving agencies. The cladribine US, UK, and Australian prescribing information state: -Caution should be exercised if cladribine injection is administered before, after, or in conjunction with other drugs known to cause immunosuppression or myelosuppression.(1-3) The cladribine Canadian prescribing information states: -Proceed carefully in patients with severe bone marrow impairment of any etiology since further suppression of bone marrow function should be anticipated.(4) DISCUSSION: Severe bone marrow suppression, including neutropenia, anemia and thrombocytopenia, has been commonly observed in patients treated with cladribine injection, especially at high doses.(1-4) |
CLADRIBINE |
| Immune Checkpoint Inhibitors/Proton Pump Inhibitors SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The mechanism of this interaction has not been fully investigated. Proposed mechanisms include: 1. Proton pump inhibitor (PPI)-induced changes of the microbiota (dysbiosis) causing resistance to immune checkpoint inhibitors, 2. Co-administration of PPIs with corticosteroids or non steroidal anti-inflammatory drugs (NSAIDs) and immune checkpoint inhibitors resulting in poorer prognosis.(1) CLINICAL EFFECTS: PPIs may decrease the therapeutic effects of immune checkpoint inhibitors. Several observational studies have shown a reduction in progression free survival (PFS), overall survival (OS), and tumor response in patients on concurrent treatment with immune checkpoint inhibitors and PPIs.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Concurrent use of immune checkpoint inhibitors and PPIs should be approached with caution. Manufacturers of immune checkpoint inhibitors do not provide recommendations on the concurrent use of PPIs. Primary literature on the concurrent use of these agents include recommendations to evaluate the risks and benefits of PPI use and consideration of alternative therapy when possible such as histamine H2-receptor antagonists (H2RAs) or antacids.(1-3) DISCUSSION: A meta analysis of 23 studies evaluating the impact of acid suppressing therapy on the efficacy of immune checkpoint inhibitors found coadministration of a PPI decreased PFS (HR 1.34 [95% confidence interval (CI), 1.13 to 1.58]) and OS (HR 1.43 [95% CI, 1.21 to 1.69]) compared with patients not treated with PPIs. Furthermore, the meta analysis identified that H2RAs did not affect OS. These results were consistent across cancer types.(1) In another meta analysis of 22 studies (5 prospective and 17 retrospective, n=16,072) evaluating the impact of concomitant medications on survival outcomes in patients treated with systemic therapy for advanced unresectable or metastatic renal cell carcinoma, concomitant use of PPIs (n=3959) was significantly associated with worse OS in patients treated with immune checkpoint inhibitors (HR 1.22, P=0.01).(4) A retrospective analysis of 635 patients treated with immune checkpoint inhibitors found PPI use was associated with significantly decreased OS (9 vs 26.5 months), PFS (3.5 vs. 8 months), and tumor response (61% vs. 72%).(5) Analysis of retrospective data from clinical trials of atezolizumab for urothelial carcinoma and non-small-cell lung cancer, among patients using a PPI within 30 days before or after therapy initiation, OS was significantly worse for patients randomized to treatment with atezolizumab than for patients randomized to chemotherapy.(6,7) A retrospective study of 381 patients treated with immune checkpoint inhibitors found use of acid-suppression therapy (n=168 PPIs, n=37 potassium competitive acid blocker, n=13 H2RAs) was associated with significantly shorter PFS and OS (2.9 vs. 6.2 months and 12.3 vs. 24 months, respectively) compared with patients who did not use acid-suppression therapy. However, when stratified by concomitant use of corticosteroids or NSAIDs, use of acid-suppression therapy was not associated with worse progression-free or overall survival.(8) In a retrospective cohort study of patients with advanced non-small-cell lung cancer treated with pembrolizumab, exposure to PPIs was associated with worse OS (HR, 1.13; 95% CI, 1.10-1.17).(9) Analysis of US and Japanese adverse drug event reporting system databases found administration of immune checkpoint inhibitors and PPIs was associated with an increased risk of adverse events including acute kidney injury (10) and congenital, familial and genetic disorders.(11) In a meta analysis of 14 observational studies, the risk of immune checkpoint inhibitor related AKI (ICI-AKI) in cancer patients concurrently using PPIs was found to be significantly higher (pooled OR of 1.84 [95% CI 1.16-2.90]) in comparison to the overall incidence of AKI from all-causes (1.57 [95% CI 1.02-2.40]).(12) In contrast to these findings, other studies have not found a negative effect on PFS or OS when patients are co-administered PPIs and immune checkpoint inhibitors. In a retrospective study of 159 patients treated with ipilimumab, coadministration of PPIs was associated with increased odds of experiencing a partial or complete response to ipilimumab (OR 3.73 [95% CI, 1.26 to 11.04]).(13) In another retrospective study of 233 patients who received nivolumab or pembrolizumab, use of PPI had no effect on OS (HR 1.2 [95% CI, 0.8-1.9]) or PFS (HR 1.1 [95% CI, 0.8 to 1.5]).(14) A nested case-control study of patients (n=38,930) with cancer who were new PPI or immune checkpoint inhibitor users and had no history of AKI before cohort entry, found the risk of AKI in patients treated with both PPIs and immune checkpoint inhibitors was not higher than then additional or multiplication of the risks in those who were treated with PPIs or immune checkpoint inhibitors alone. The study reinforces the association between PPIs and immune checkpoint inhibitors use and the increased risk of AKI and the need for careful monitoring and evaluation of kidney function when treated with both medicines.(15) |
ACIPHEX, ACIPHEX SPRINKLE, DEXILANT, DEXLANSOPRAZOLE DR, ESOMEPRAZOLE MAGNESIUM, ESOMEPRAZOLE SODIUM, KONVOMEP, LANSOPRAZOL-AMOXICIL-CLARITHRO, LANSOPRAZOLE, NAPROXEN-ESOMEPRAZOLE MAG, NEXIUM, OMECLAMOX-PAK, OMEPRAZOLE, OMEPRAZOLE-SODIUM BICARBONATE, PANTOPRAZOLE SODIUM, PANTOPRAZOLE SODIUM-0.9% NACL, PREVACID, PRILOSEC, PROTONIX, PROTONIX IV, RABEPRAZOLE SODIUM, TALICIA, VOQUEZNA, VOQUEZNA DUAL PAK, VOQUEZNA TRIPLE PAK, YOSPRALA |
The following contraindication information is available for KEYTRUDA (pembrolizumab):
Drug contraindication overview.
*None.
*None.
There are 1 contraindications.
Absolute contraindication.
| Contraindication List |
|---|
| Lactation |
There are 1 severe contraindications.
Adequate patient monitoring is recommended for safer drug use.
| Severe List |
|---|
| Pregnancy |
There are 5 moderate contraindications.
Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.
| Moderate List |
|---|
| Hyperglycemia |
| Hyperthyroidism |
| Hypothyroidism |
| Kidney disease with reduction in glomerular filtration rate (GFr) |
| Myasthenia gravis |
The following adverse reaction information is available for KEYTRUDA (pembrolizumab):
Adverse reaction overview.
Adverse effects reported in >=20% of patients in clinical studies receiving single-agent pembrolizumab include fatigue, musculoskeletal pain, rash, diarrhea, pyrexia, cough, decreased appetite, pruritus, dyspnea, constipation, pain, abdominal pain, nausea, and hypothyroidism. Adverse effects reported in >=20% of patients in clinical studies receiving pembrolizumab in combination with chemotherapy or chemoradiotherapy include fatigue/asthenia, nausea, constipation, diarrhea, decreased appetite, rash, vomiting, cough, dyspnea, pyrexia, alopecia, peripheral neuropathy, mucosal inflammation, stomatitis, headache, weight loss, abdominal pain, arthralgia, myalgia, insomnia, palmar-plantar erythrodysesthesia, urinary tract infection, and hypothyroidism. Adverse effects reported in >=20% of patients in clinical studies receiving pembrolizumab in combination with chemotherapy plus bevacizumab include peripheral neuropathy, alopecia, anemia, fatigue/asthenia, nausea, neutropenia, diarrhea, hypertension, thrombocytopenia, constipation, arthralgia, vomiting, urinary tract infection, rash, leukopenia, hypothyroidism, and decreased appetite.
Adverse effects reported in >=20% of patients in clinical studies receiving pembrolizumab in combination with axitinib include diarrhea, fatigue/asthenia, hypertension, hepatotoxicity, hypothyroidism, decreased appetite, palmar-plantar erythrodysesthesia, nausea, stomatitis/mucosal inflammation, dysphonia, rash, cough, and constipation. Adverse effects reported in >=20% of patients in clinical studies receiving pembrolizumab in combination with lenvatinib include hypothyroidism, hypertension, fatigue, diarrhea, musculoskeletal disorders, nausea, decreased appetite, vomiting, stomatitis, weight loss, abdominal pain, urinary tract infection, proteinuria, constipation, headache, hemorrhagic events, palmar-plantar erythrodysesthesia, dysphonia, rash, hepatotoxicity, and acute kidney injury. Adverse effects reported in >=20% of patients in clinical studies receiving pembrolizumab in combination with enfortumab vedotin include rash, peripheral neuropathy, fatigue, pruritus, diarrhea, alopecia, weight loss, decreased appetite, dry eyes, nausea, constipation, dysgeusia, and urinary tract infection.
Adverse effects reported in >=20% of patients in clinical studies receiving single-agent pembrolizumab include fatigue, musculoskeletal pain, rash, diarrhea, pyrexia, cough, decreased appetite, pruritus, dyspnea, constipation, pain, abdominal pain, nausea, and hypothyroidism. Adverse effects reported in >=20% of patients in clinical studies receiving pembrolizumab in combination with chemotherapy or chemoradiotherapy include fatigue/asthenia, nausea, constipation, diarrhea, decreased appetite, rash, vomiting, cough, dyspnea, pyrexia, alopecia, peripheral neuropathy, mucosal inflammation, stomatitis, headache, weight loss, abdominal pain, arthralgia, myalgia, insomnia, palmar-plantar erythrodysesthesia, urinary tract infection, and hypothyroidism. Adverse effects reported in >=20% of patients in clinical studies receiving pembrolizumab in combination with chemotherapy plus bevacizumab include peripheral neuropathy, alopecia, anemia, fatigue/asthenia, nausea, neutropenia, diarrhea, hypertension, thrombocytopenia, constipation, arthralgia, vomiting, urinary tract infection, rash, leukopenia, hypothyroidism, and decreased appetite.
Adverse effects reported in >=20% of patients in clinical studies receiving pembrolizumab in combination with axitinib include diarrhea, fatigue/asthenia, hypertension, hepatotoxicity, hypothyroidism, decreased appetite, palmar-plantar erythrodysesthesia, nausea, stomatitis/mucosal inflammation, dysphonia, rash, cough, and constipation. Adverse effects reported in >=20% of patients in clinical studies receiving pembrolizumab in combination with lenvatinib include hypothyroidism, hypertension, fatigue, diarrhea, musculoskeletal disorders, nausea, decreased appetite, vomiting, stomatitis, weight loss, abdominal pain, urinary tract infection, proteinuria, constipation, headache, hemorrhagic events, palmar-plantar erythrodysesthesia, dysphonia, rash, hepatotoxicity, and acute kidney injury. Adverse effects reported in >=20% of patients in clinical studies receiving pembrolizumab in combination with enfortumab vedotin include rash, peripheral neuropathy, fatigue, pruritus, diarrhea, alopecia, weight loss, decreased appetite, dry eyes, nausea, constipation, dysgeusia, and urinary tract infection.
There are 81 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Anemia Cellulitis Hypothyroidism Lymphopenia |
Abnormal hepatic function tests Acute cognitive impairment Acute kidney injury Acute myocardial infarction Bacterial sepsis Colitis Hyperbilirubinemia Hyperthyroidism Hypokalemia Hyponatremia Hypophysitis Increased alanine transaminase Increased aspartate transaminase Interstitial pneumonitis Neutropenic disorder Pericardial effusion Pericardial tamponade Pericarditis Sinus tachycardia Supraventricular tachycardia Thrombocytopenic disorder Tumor flare reaction |
| Rare/Very Rare |
|---|
|
Acute respiratory failure Acute thromboembolic stroke Adrenocortical insufficiency Anaphylaxis Aplastic anemia Atrial fibrillation Autoimmune hemolytic anemia Autoimmune hepatitis Bullous pemphigoid Cardiac arrest Diabetes mellitus DRESS syndrome Encephalitis Exfoliative dermatitis Exocrine pancreatic insufficiency Graft-versus-host disease Guillain-barre syndrome Hematuria Hemolytic anemia Hemophagocytic lymphohistiocytosis Hemorrhage Histiocytic necrotizing lymphadenitis Hypersensitivity angiitis Hypoparathyroidism Hypotension Hypoxia Idiopathic thrombocytopenic purpura Intestinal perforation Kidney disease with reduction in glomerular filtration rate (GFr) Myasthenia gravis Myelitis Myocarditis Nephritis New fistula formation involving an internal organ Optic neuritis Organ transplant rejection Pancreatitis Pituitary insufficiency Pleural effusions Pneumonia Polymyalgia rheumatica Polymyositis Pulmonary thromboembolism Renal failure Rhabdomyolysis Sarcoidosis Sclerosing cholangitis Seizure disorder Sepsis Stevens-johnson syndrome Thyroiditis Toxic epidermal necrolysis Urosepsis Uveitis Vasculitis |
There are 54 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Acute abdominal pain Anorexia Arthralgia Constipation Cough Diarrhea Dry eye Dysgeusia Dyspnea Fatigue Fever Musculoskeletal pain Nausea Pain Pruritus of skin Skin rash |
Alopecia Back pain Chills Dizziness Elevated serum amylase Elevated serum lipase Facial edema Flushing General weakness Headache disorder Hypertension Hypertriglyceridemia Hypoalbuminemia Hypocalcemia Hypomagnesemia Hypophosphatemia Insomnia Leukopenia Maculopapular rash Myalgia Palmar-plantar erythrodysesthesia Peripheral edema Peripheral neuropathy Proteinuria Stomatitis Tachycardia Upper respiratory infection Urinary tract infection Vitiligo Voice change Vomiting Wheezing |
| Rare/Very Rare |
|---|
|
Arthritis Gastritis Hyperglycemia Iritis Muscle weakness Myositis |
The following precautions are available for KEYTRUDA (pembrolizumab):
Safety and efficacy of single-agent pembrolizumab have been established in pediatric patients with melanoma, cHL, primary mediastinal large B-cell lymphoma (PMBCL), Merkel cell carcinoma (MCC), microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) cancer, and tumor mutational burden-high (TMB-H) cancer. Safety and efficacy of pembrolizumab for the above indications in pediatric patients are supported by extrapolation of data from clinical studies evaluating pembrolizumab in adults, safety data in pediatric patients, and pharmacokinetic data indicating that age (range of 15-94 years) does not have clinically important effects on clearance of the drug. Safety and efficacy of pembrolizumab in pediatric patients have not been established in other approved indications to date.
Pediatric patients (range: 10 months-17 years of age) receiving pembrolizumab (2 mg/kg every 3 weeks) had similar plasma concentrations of pembrolizumab to those observed in adults receiving the same dosage of the drug. In KEYNOTE-051, some adverse reactions occurred at a >=10% higher incidence in pediatric patients compared to adults, including pyrexia (33%), vomiting (29%), headache (25%), abdominal pain (23%), decreased lymphocyte count (13%), and decreased white blood cell count (11%). The median duration of exposure to pembrolizumab was 2.1
months (range: 1 day to 25 months). Laboratory abnormalities that occurred at a >=10% higher incidence were leukopenia (30%), neutropenia (28%), thrombocytopenia (22%), and grade 3 anemia (17%).
Contraindicated
Severe Precaution
Management or Monitoring Precaution
Pediatric patients (range: 10 months-17 years of age) receiving pembrolizumab (2 mg/kg every 3 weeks) had similar plasma concentrations of pembrolizumab to those observed in adults receiving the same dosage of the drug. In KEYNOTE-051, some adverse reactions occurred at a >=10% higher incidence in pediatric patients compared to adults, including pyrexia (33%), vomiting (29%), headache (25%), abdominal pain (23%), decreased lymphocyte count (13%), and decreased white blood cell count (11%). The median duration of exposure to pembrolizumab was 2.1
months (range: 1 day to 25 months). Laboratory abnormalities that occurred at a >=10% higher incidence were leukopenia (30%), neutropenia (28%), thrombocytopenia (22%), and grade 3 anemia (17%).
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
There are no human data available to inform the risk of embryo-fetal toxicity. Pembrolizumab may cause fetal harm if administered to pregnant women based on its mechanism of action. Pembrolizumab has the potential to cross the placenta; advise pregnant women of the potential risk to a fetus. Pregnancy status should be verified in women of reproductive potential prior to initiation of pembrolizumab therapy.
It is not known whether pembrolizumab is distributed into human milk. The effects of pembrolizumab on nursing infants or on milk production also are unknown. Maternal immunoglobulin G (IgG) is present in human milk.
The impact of local GI exposure and minimal systemic exposure to pembrolizumab on the breast-fed infant is not known. Because of the potential for serious adverse reactions to pembrolizumab in nursing infants, women should be advised to discontinue nursing during pembrolizumab therapy and for 4 months after the last dose.
The impact of local GI exposure and minimal systemic exposure to pembrolizumab on the breast-fed infant is not known. Because of the potential for serious adverse reactions to pembrolizumab in nursing infants, women should be advised to discontinue nursing during pembrolizumab therapy and for 4 months after the last dose.
In clinical trials evaluating pembrolizumab for melanoma, NSCLC, squamous cell carcinoma of the head and neck, cHL, and urothelial carcinoma, 48% of patients were >=65 years of age and 17% were >=75 years of age. No overall differences in safety and efficacy were observed between geriatric patients and younger adults. In clinical trials evaluating pembrolizumab for cHL, 12% of patients were >=65 years of age.
Patients >=65 years of age had a higher incidence of severe adverse reactions (50%) compared to younger adults (24%). A sufficient number of patients >=65 years of age were not included in cHL studies to assess if there are differences in pembrolizumab efficacy compared to younger adults. In clinical trials evaluating pembrolizumab in patients with Stage IB (T2a >=4 cm), II, or IIIA NSCLC following complete resection and platinum-based chemotherapy, 48% of patients were >=65 years of age.
No overall differences in safety and efficacy were observed between geriatric patients and younger adults. In clinical trials evaluating pembrolizumab in combination with paclitaxel, protein-bound paclitaxel, or gemcitabine and carboplatin in patients with TNBC, 23% of patients were >=65 years of age. No overall differences in safety and efficacy were observed between geriatric patients and younger adults.
In clinical trials evaluating pembrolizumab in combination with lenvatinib in patients with endometrial carcinoma, 50% of patients were >=65 years of age. No overall differences in safety and efficacy were observed between geriatric patients and younger adults. In clinical trials evaluating pembrolizumab in combination with enfortumab vedotin in patients with locally advanced or metastatic urothelial cancer, 44% of patients were 65-74 years of age and 26% were >=75 years of age.
No overall differences in safety and efficacy were observed between patients >=65 years of age and younger adults; however, patients >=75 years of age experienced a higher incidence of fatal adverse effects compared to younger adults. The incidence of fatal adverse effects was 4% in patients <75 years of age compared to 7% in patients >=75 years of age. In clinical trials evaluating pembrolizumab in combination with axitinib for RCC, 40% of patients were >=65 years of age.
No overall differences in safety and efficacy were observed between geriatric patients and younger adults. In clinical trials evaluating pembrolizumab in combination with chemoradiotherapy (CRT) in patients with FIGO 2014 Stage III-IVA cervical cancer, 14% of patients were >=65 years of age. No overall differences in safety and efficacy were observed between geriatric patients and younger adults.
Patients >=65 years of age had a higher incidence of severe adverse reactions (50%) compared to younger adults (24%). A sufficient number of patients >=65 years of age were not included in cHL studies to assess if there are differences in pembrolizumab efficacy compared to younger adults. In clinical trials evaluating pembrolizumab in patients with Stage IB (T2a >=4 cm), II, or IIIA NSCLC following complete resection and platinum-based chemotherapy, 48% of patients were >=65 years of age.
No overall differences in safety and efficacy were observed between geriatric patients and younger adults. In clinical trials evaluating pembrolizumab in combination with paclitaxel, protein-bound paclitaxel, or gemcitabine and carboplatin in patients with TNBC, 23% of patients were >=65 years of age. No overall differences in safety and efficacy were observed between geriatric patients and younger adults.
In clinical trials evaluating pembrolizumab in combination with lenvatinib in patients with endometrial carcinoma, 50% of patients were >=65 years of age. No overall differences in safety and efficacy were observed between geriatric patients and younger adults. In clinical trials evaluating pembrolizumab in combination with enfortumab vedotin in patients with locally advanced or metastatic urothelial cancer, 44% of patients were 65-74 years of age and 26% were >=75 years of age.
No overall differences in safety and efficacy were observed between patients >=65 years of age and younger adults; however, patients >=75 years of age experienced a higher incidence of fatal adverse effects compared to younger adults. The incidence of fatal adverse effects was 4% in patients <75 years of age compared to 7% in patients >=75 years of age. In clinical trials evaluating pembrolizumab in combination with axitinib for RCC, 40% of patients were >=65 years of age.
No overall differences in safety and efficacy were observed between geriatric patients and younger adults. In clinical trials evaluating pembrolizumab in combination with chemoradiotherapy (CRT) in patients with FIGO 2014 Stage III-IVA cervical cancer, 14% of patients were >=65 years of age. No overall differences in safety and efficacy were observed between geriatric patients and younger adults.
The following prioritized warning is available for KEYTRUDA (pembrolizumab):
No warning message for this drug.
No warning message for this drug.
The following icd codes are available for KEYTRUDA (pembrolizumab)'s list of indications:
| Adjuvant treatment of melanoma | |
| C43 | Malignant melanoma of skin |
| C43.0 | Malignant melanoma of lip |
| C43.1 | Malignant melanoma of eyelid, including canthus |
| C43.10 | Malignant melanoma of unspecified eyelid, including canthus |
| C43.11 | Malignant melanoma of right eyelid, including canthus |
| C43.111 | Malignant melanoma of right upper eyelid, including canthus |
| C43.112 | Malignant melanoma of right lower eyelid, including canthus |
| C43.12 | Malignant melanoma of left eyelid, including canthus |
| C43.121 | Malignant melanoma of left upper eyelid, including canthus |
| C43.122 | Malignant melanoma of left lower eyelid, including canthus |
| C43.2 | Malignant melanoma of ear and external auricular canal |
| C43.20 | Malignant melanoma of unspecified ear and external auricular canal |
| C43.21 | Malignant melanoma of right ear and external auricular canal |
| C43.22 | Malignant melanoma of left ear and external auricular canal |
| C43.3 | Malignant melanoma of other and unspecified parts of face |
| C43.30 | Malignant melanoma of unspecified part of face |
| C43.31 | Malignant melanoma of nose |
| C43.39 | Malignant melanoma of other parts of face |
| C43.4 | Malignant melanoma of scalp and neck |
| C43.5 | Malignant melanoma of trunk |
| C43.51 | Malignant melanoma of anal skin |
| C43.52 | Malignant melanoma of skin of breast |
| C43.59 | Malignant melanoma of other part of trunk |
| C43.6 | Malignant melanoma of upper limb, including shoulder |
| C43.60 | Malignant melanoma of unspecified upper limb, including shoulder |
| C43.61 | Malignant melanoma of right upper limb, including shoulder |
| C43.62 | Malignant melanoma of left upper limb, including shoulder |
| C43.7 | Malignant melanoma of lower limb, including hip |
| C43.70 | Malignant melanoma of unspecified lower limb, including hip |
| C43.71 | Malignant melanoma of right lower limb, including hip |
| C43.72 | Malignant melanoma of left lower limb, including hip |
| C43.8 | Malignant melanoma of overlapping sites of skin |
| C43.9 | Malignant melanoma of skin, unspecified |
| Biliary tract malignancy | |
| C22.1 | Intrahepatic bile duct carcinoma |
| C23 | Malignant neoplasm of gallbladder |
| C24 | Malignant neoplasm of other and unspecified parts of biliary tract |
| C24.0 | Malignant neoplasm of extrahepatic bile duct |
| C24.1 | Malignant neoplasm of ampulla of vater |
| C24.8 | Malignant neoplasm of overlapping sites of biliary tract |
| C24.9 | Malignant neoplasm of biliary tract, unspecified |
| Carcinoma of cervix | |
| C53 | Malignant neoplasm of cervix uteri |
| C53.0 | Malignant neoplasm of endocervix |
| C53.1 | Malignant neoplasm of exocervix |
| C53.8 | Malignant neoplasm of overlapping sites of cervix uteri |
| C53.9 | Malignant neoplasm of cervix uteri, unspecified |
| Early-stage triple-negative breast cancer | |
| C50 | Malignant neoplasm of breast |
| C50.01 | Malignant neoplasm of nipple and areola, female |
| C50.1 | Malignant neoplasm of central portion of breast |
| C50.11 | Malignant neoplasm of central portion of breast, female |
| C50.111 | Malignant neoplasm of central portion of right female breast |
| C50.112 | Malignant neoplasm of central portion of left female breast |
| C50.119 | Malignant neoplasm of central portion of unspecified female breast |
| C50.12 | Malignant neoplasm of central portion of breast, male |
| C50.121 | Malignant neoplasm of central portion of right male breast |
| C50.122 | Malignant neoplasm of central portion of left male breast |
| C50.129 | Malignant neoplasm of central portion of unspecified male breast |
| C50.21 | Malignant neoplasm of upper-inner quadrant of breast, female |
| C50.211 | Malignant neoplasm of upper-inner quadrant of right female breast |
| C50.212 | Malignant neoplasm of upper-inner quadrant of left female breast |
| C50.219 | Malignant neoplasm of upper-inner quadrant of unspecified female breast |
| C50.3 | Malignant neoplasm of lower-inner quadrant of breast |
| C50.31 | Malignant neoplasm of lower-inner quadrant of breast, female |
| C50.311 | Malignant neoplasm of lower-inner quadrant of right female breast |
| C50.312 | Malignant neoplasm of lower-inner quadrant of left female breast |
| C50.319 | Malignant neoplasm of lower-inner quadrant of unspecified female breast |
| C50.32 | Malignant neoplasm of lower-inner quadrant of breast, male |
| C50.321 | Malignant neoplasm of lower-inner quadrant of right male breast |
| C50.322 | Malignant neoplasm of lower-inner quadrant of left male breast |
| C50.329 | Malignant neoplasm of lower-inner quadrant of unspecified male breast |
| C50.41 | Malignant neoplasm of upper-outer quadrant of breast, female |
| C50.411 | Malignant neoplasm of upper-outer quadrant of right female breast |
| C50.412 | Malignant neoplasm of upper-outer quadrant of left female breast |
| C50.419 | Malignant neoplasm of upper-outer quadrant of unspecified female breast |
| C50.5 | Malignant neoplasm of lower-outer quadrant of breast |
| C50.51 | Malignant neoplasm of lower-outer quadrant of breast, female |
| C50.511 | Malignant neoplasm of lower-outer quadrant of right female breast |
| C50.512 | Malignant neoplasm of lower-outer quadrant of left female breast |
| C50.519 | Malignant neoplasm of lower-outer quadrant of unspecified female breast |
| C50.52 | Malignant neoplasm of lower-outer quadrant of breast, male |
| C50.521 | Malignant neoplasm of lower-outer quadrant of right male breast |
| C50.522 | Malignant neoplasm of lower-outer quadrant of left male breast |
| C50.529 | Malignant neoplasm of lower-outer quadrant of unspecified male breast |
| C50.6 | Malignant neoplasm of axillary tail of breast |
| C50.61 | Malignant neoplasm of axillary tail of breast, female |
| C50.611 | Malignant neoplasm of axillary tail of right female breast |
| C50.612 | Malignant neoplasm of axillary tail of left female breast |
| C50.619 | Malignant neoplasm of axillary tail of unspecified female breast |
| C50.62 | Malignant neoplasm of axillary tail of breast, male |
| C50.621 | Malignant neoplasm of axillary tail of right male breast |
| C50.622 | Malignant neoplasm of axillary tail of left male breast |
| C50.629 | Malignant neoplasm of axillary tail of unspecified male breast |
| C50.81 | Malignant neoplasm of overlapping sites of breast, female |
| C50.811 | Malignant neoplasm of overlapping sites of right female breast |
| C50.812 | Malignant neoplasm of overlapping sites of left female breast |
| C50.819 | Malignant neoplasm of overlapping sites of unspecified female breast |
| C50.9 | Malignant neoplasm of breast of unspecified site |
| C50.91 | Malignant neoplasm of breast of unspecified site, female |
| C50.911 | Malignant neoplasm of unspecified site of right female breast |
| C50.912 | Malignant neoplasm of unspecified site of left female breast |
| C50.919 | Malignant neoplasm of unspecified site of unspecified female breast |
| C50.92 | Malignant neoplasm of breast of unspecified site, male |
| Z17.1 | Estrogen receptor negative status [Er-] |
| EGFR negative, ALK negative, non-small cell lung cancer | |
| C34 | Malignant neoplasm of bronchus and lung |
| C34.0 | Malignant neoplasm of main bronchus |
| C34.00 | Malignant neoplasm of unspecified main bronchus |
| C34.01 | Malignant neoplasm of right main bronchus |
| C34.02 | Malignant neoplasm of left main bronchus |
| C34.1 | Malignant neoplasm of upper lobe, bronchus or lung |
| C34.10 | Malignant neoplasm of upper lobe, unspecified bronchus or lung |
| C34.11 | Malignant neoplasm of upper lobe, right bronchus or lung |
| C34.12 | Malignant neoplasm of upper lobe, left bronchus or lung |
| C34.2 | Malignant neoplasm of middle lobe, bronchus or lung |
| C34.3 | Malignant neoplasm of lower lobe, bronchus or lung |
| C34.30 | Malignant neoplasm of lower lobe, unspecified bronchus or lung |
| C34.31 | Malignant neoplasm of lower lobe, right bronchus or lung |
| C34.32 | Malignant neoplasm of lower lobe, left bronchus or lung |
| C34.8 | Malignant neoplasm of overlapping sites of bronchus and lung |
| C34.80 | Malignant neoplasm of overlapping sites of unspecified bronchus and lung |
| C34.81 | Malignant neoplasm of overlapping sites of right bronchus and lung |
| C34.82 | Malignant neoplasm of overlapping sites of left bronchus and lung |
| C34.9 | Malignant neoplasm of unspecified part of bronchus or lung |
| C34.90 | Malignant neoplasm of unspecified part of unspecified bronchus or lung |
| C34.91 | Malignant neoplasm of unspecified part of right bronchus or lung |
| C34.92 | Malignant neoplasm of unspecified part of left bronchus or lung |
| Endometrial carcinoma | |
| C54.1 | Malignant neoplasm of endometrium |
| Hodgkin's lymphoma | |
| C81 | Hodgkin lymphoma |
| C81.0 | Nodular lymphocyte predominant hodgkin lymphoma |
| C81.00 | Nodular lymphocyte predominant hodgkin lymphoma, unspecified site |
| C81.01 | Nodular lymphocyte predominant hodgkin lymphoma, lymph nodes of head, face, and neck |
| C81.02 | Nodular lymphocyte predominant hodgkin lymphoma, intrathoracic lymph nodes |
| C81.03 | Nodular lymphocyte predominant hodgkin lymphoma, intra-abdominal lymph nodes |
| C81.04 | Nodular lymphocyte predominant hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C81.05 | Nodular lymphocyte predominant hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C81.06 | Nodular lymphocyte predominant hodgkin lymphoma, intrapelvic lymph nodes |
| C81.07 | Nodular lymphocyte predominant hodgkin lymphoma, spleen |
| C81.08 | Nodular lymphocyte predominant hodgkin lymphoma, lymph nodes of multiple sites |
| C81.09 | Nodular lymphocyte predominant hodgkin lymphoma, extranodal and solid organ sites |
| C81.1 | Nodular sclerosis hodgkin lymphoma |
| C81.10 | Nodular sclerosis hodgkin lymphoma, unspecified site |
| C81.11 | Nodular sclerosis hodgkin lymphoma, lymph nodes of head, face, and neck |
| C81.12 | Nodular sclerosis hodgkin lymphoma, intrathoracic lymph nodes |
| C81.13 | Nodular sclerosis hodgkin lymphoma, intra-abdominal lymph nodes |
| C81.14 | Nodular sclerosis hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C81.15 | Nodular sclerosis hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C81.16 | Nodular sclerosis hodgkin lymphoma, intrapelvic lymph nodes |
| C81.17 | Nodular sclerosis hodgkin lymphoma, spleen |
| C81.18 | Nodular sclerosis hodgkin lymphoma, lymph nodes of multiple sites |
| C81.19 | Nodular sclerosis hodgkin lymphoma, extranodal and solid organ sites |
| C81.2 | Mixed cellularity hodgkin lymphoma |
| C81.20 | Mixed cellularity hodgkin lymphoma, unspecified site |
| C81.21 | Mixed cellularity hodgkin lymphoma, lymph nodes of head, face, and neck |
| C81.22 | Mixed cellularity hodgkin lymphoma, intrathoracic lymph nodes |
| C81.23 | Mixed cellularity hodgkin lymphoma, intra-abdominal lymph nodes |
| C81.24 | Mixed cellularity hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C81.25 | Mixed cellularity hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C81.26 | Mixed cellularity hodgkin lymphoma, intrapelvic lymph nodes |
| C81.27 | Mixed cellularity hodgkin lymphoma, spleen |
| C81.28 | Mixed cellularity hodgkin lymphoma, lymph nodes of multiple sites |
| C81.29 | Mixed cellularity hodgkin lymphoma, extranodal and solid organ sites |
| C81.3 | Lymphocyte depleted hodgkin lymphoma |
| C81.30 | Lymphocyte depleted hodgkin lymphoma, unspecified site |
| C81.31 | Lymphocyte depleted hodgkin lymphoma, lymph nodes of head, face, and neck |
| C81.32 | Lymphocyte depleted hodgkin lymphoma, intrathoracic lymph nodes |
| C81.33 | Lymphocyte depleted hodgkin lymphoma, intra-abdominal lymph nodes |
| C81.34 | Lymphocyte depleted hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C81.35 | Lymphocyte depleted hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C81.36 | Lymphocyte depleted hodgkin lymphoma, intrapelvic lymph nodes |
| C81.37 | Lymphocyte depleted hodgkin lymphoma, spleen |
| C81.38 | Lymphocyte depleted hodgkin lymphoma, lymph nodes of multiple sites |
| C81.39 | Lymphocyte depleted hodgkin lymphoma, extranodal and solid organ sites |
| C81.4 | Lymphocyte-rich hodgkin lymphoma |
| C81.40 | Lymphocyte-rich hodgkin lymphoma, unspecified site |
| C81.41 | Lymphocyte-rich hodgkin lymphoma, lymph nodes of head, face, and neck |
| C81.42 | Lymphocyte-rich hodgkin lymphoma, intrathoracic lymph nodes |
| C81.43 | Lymphocyte-rich hodgkin lymphoma, intra-abdominal lymph nodes |
| C81.44 | Lymphocyte-rich hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C81.45 | Lymphocyte-rich hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C81.46 | Lymphocyte-rich hodgkin lymphoma, intrapelvic lymph nodes |
| C81.47 | Lymphocyte-rich hodgkin lymphoma, spleen |
| C81.48 | Lymphocyte-rich hodgkin lymphoma, lymph nodes of multiple sites |
| C81.49 | Lymphocyte-rich hodgkin lymphoma, extranodal and solid organ sites |
| C81.7 | Other hodgkin lymphoma |
| C81.70 | Other hodgkin lymphoma, unspecified site |
| C81.71 | Other hodgkin lymphoma, lymph nodes of head, face, and neck |
| C81.72 | Other hodgkin lymphoma, intrathoracic lymph nodes |
| C81.73 | Other hodgkin lymphoma, intra-abdominal lymph nodes |
| C81.74 | Other hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C81.75 | Other hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C81.76 | Other hodgkin lymphoma, intrapelvic lymph nodes |
| C81.77 | Other hodgkin lymphoma, spleen |
| C81.78 | Other hodgkin lymphoma, lymph nodes of multiple sites |
| C81.79 | Other hodgkin lymphoma, extranodal and solid organ sites |
| C81.9 | Hodgkin lymphoma, unspecified |
| C81.90 | Hodgkin lymphoma, unspecified, unspecified site |
| C81.91 | Hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck |
| C81.92 | Hodgkin lymphoma, unspecified, intrathoracic lymph nodes |
| C81.93 | Hodgkin lymphoma, unspecified, intra-abdominal lymph nodes |
| C81.94 | Hodgkin lymphoma, unspecified, lymph nodes of axilla and upper limb |
| C81.95 | Hodgkin lymphoma, unspecified, lymph nodes of inguinal region and lower limb |
| C81.96 | Hodgkin lymphoma, unspecified, intrapelvic lymph nodes |
| C81.97 | Hodgkin lymphoma, unspecified, spleen |
| C81.98 | Hodgkin lymphoma, unspecified, lymph nodes of multiple sites |
| C81.99 | Hodgkin lymphoma, unspecified, extranodal and solid organ sites |
| Invasive bladder cancer | |
| C67 | Malignant neoplasm of bladder |
| C67.0 | Malignant neoplasm of trigone of bladder |
| C67.1 | Malignant neoplasm of dome of bladder |
| C67.2 | Malignant neoplasm of lateral wall of bladder |
| C67.3 | Malignant neoplasm of anterior wall of bladder |
| C67.4 | Malignant neoplasm of posterior wall of bladder |
| C67.5 | Malignant neoplasm of bladder neck |
| C67.6 | Malignant neoplasm of ureteric orifice |
| C67.7 | Malignant neoplasm of urachus |
| C67.8 | Malignant neoplasm of overlapping sites of bladder |
| C67.9 | Malignant neoplasm of bladder, unspecified |
| Liver cell carcinoma | |
| C22.0 | Liver cell carcinoma |
| Malignant melanoma | |
| C43 | Malignant melanoma of skin |
| C43.0 | Malignant melanoma of lip |
| C43.1 | Malignant melanoma of eyelid, including canthus |
| C43.10 | Malignant melanoma of unspecified eyelid, including canthus |
| C43.11 | Malignant melanoma of right eyelid, including canthus |
| C43.111 | Malignant melanoma of right upper eyelid, including canthus |
| C43.112 | Malignant melanoma of right lower eyelid, including canthus |
| C43.12 | Malignant melanoma of left eyelid, including canthus |
| C43.121 | Malignant melanoma of left upper eyelid, including canthus |
| C43.122 | Malignant melanoma of left lower eyelid, including canthus |
| C43.2 | Malignant melanoma of ear and external auricular canal |
| C43.20 | Malignant melanoma of unspecified ear and external auricular canal |
| C43.21 | Malignant melanoma of right ear and external auricular canal |
| C43.22 | Malignant melanoma of left ear and external auricular canal |
| C43.3 | Malignant melanoma of other and unspecified parts of face |
| C43.30 | Malignant melanoma of unspecified part of face |
| C43.31 | Malignant melanoma of nose |
| C43.39 | Malignant melanoma of other parts of face |
| C43.4 | Malignant melanoma of scalp and neck |
| C43.5 | Malignant melanoma of trunk |
| C43.51 | Malignant melanoma of anal skin |
| C43.52 | Malignant melanoma of skin of breast |
| C43.59 | Malignant melanoma of other part of trunk |
| C43.6 | Malignant melanoma of upper limb, including shoulder |
| C43.60 | Malignant melanoma of unspecified upper limb, including shoulder |
| C43.61 | Malignant melanoma of right upper limb, including shoulder |
| C43.62 | Malignant melanoma of left upper limb, including shoulder |
| C43.7 | Malignant melanoma of lower limb, including hip |
| C43.70 | Malignant melanoma of unspecified lower limb, including hip |
| C43.71 | Malignant melanoma of right lower limb, including hip |
| C43.72 | Malignant melanoma of left lower limb, including hip |
| C43.8 | Malignant melanoma of overlapping sites of skin |
| C43.9 | Malignant melanoma of skin, unspecified |
| Malignant mesothelioma of pleura | |
| C45.0 | Mesothelioma of pleura |
| Merkel cell carcinoma | |
| C4A | Merkel cell carcinoma |
| C4A.0 | Merkel cell carcinoma of lip |
| C4A.1 | Merkel cell carcinoma of eyelid, including canthus |
| C4A.10 | Merkel cell carcinoma of unspecified eyelid, including canthus |
| C4A.11 | Merkel cell carcinoma of right eyelid, including canthus |
| C4A.111 | Merkel cell carcinoma of right upper eyelid, including canthus |
| C4A.112 | Merkel cell carcinoma of right lower eyelid, including canthus |
| C4A.12 | Merkel cell carcinoma of left eyelid, including canthus |
| C4A.121 | Merkel cell carcinoma of left upper eyelid, including canthus |
| C4A.122 | Merkel cell carcinoma of left lower eyelid, including canthus |
| C4A.2 | Merkel cell carcinoma of ear and external auricular canal |
| C4A.20 | Merkel cell carcinoma of unspecified ear and external auricular canal |
| C4A.21 | Merkel cell carcinoma of right ear and external auricular canal |
| C4A.22 | Merkel cell carcinoma of left ear and external auricular canal |
| C4A.3 | Merkel cell carcinoma of other and unspecified parts of face |
| C4A.30 | Merkel cell carcinoma of unspecified part of face |
| C4A.31 | Merkel cell carcinoma of nose |
| C4A.39 | Merkel cell carcinoma of other parts of face |
| C4A.4 | Merkel cell carcinoma of scalp and neck |
| C4A.5 | Merkel cell carcinoma of trunk |
| C4A.51 | Merkel cell carcinoma of anal skin |
| C4A.52 | Merkel cell carcinoma of skin of breast |
| C4A.59 | Merkel cell carcinoma of other part of trunk |
| C4A.6 | Merkel cell carcinoma of upper limb, including shoulder |
| C4A.60 | Merkel cell carcinoma of unspecified upper limb, including shoulder |
| C4A.61 | Merkel cell carcinoma of right upper limb, including shoulder |
| C4A.62 | Merkel cell carcinoma of left upper limb, including shoulder |
| C4A.7 | Merkel cell carcinoma of lower limb, including hip |
| C4A.70 | Merkel cell carcinoma of unspecified lower limb, including hip |
| C4A.71 | Merkel cell carcinoma of right lower limb, including hip |
| C4A.72 | Merkel cell carcinoma of left lower limb, including hip |
| C4A.8 | Merkel cell carcinoma of overlapping sites |
| C4A.9 | Merkel cell carcinoma, unspecified |
| C7B.1 | Secondary merkel cell carcinoma |
| Microsatellite instability-high colorectal cancer | |
| C18 | Malignant neoplasm of colon |
| C18.0 | Malignant neoplasm of cecum |
| C18.1 | Malignant neoplasm of appendix |
| C18.2 | Malignant neoplasm of ascending colon |
| C18.3 | Malignant neoplasm of hepatic flexure |
| C18.4 | Malignant neoplasm of transverse colon |
| C18.5 | Malignant neoplasm of splenic flexure |
| C18.6 | Malignant neoplasm of descending colon |
| C18.7 | Malignant neoplasm of sigmoid colon |
| C18.8 | Malignant neoplasm of overlapping sites of colon |
| C18.9 | Malignant neoplasm of colon, unspecified |
| C19 | Malignant neoplasm of rectosigmoid junction |
| C20 | Malignant neoplasm of rectum |
| C21.8 | Malignant neoplasm of overlapping sites of rectum, anus and anal canal |
| Microsatellite instability-high solid malignant tumor | |
| C15 | Malignant neoplasm of esophagus |
| C15.3 | Malignant neoplasm of upper third of esophagus |
| C15.4 | Malignant neoplasm of middle third of esophagus |
| C15.5 | Malignant neoplasm of lower third of esophagus |
| C15.8 | Malignant neoplasm of overlapping sites of esophagus |
| C15.9 | Malignant neoplasm of esophagus, unspecified |
| C16 | Malignant neoplasm of stomach |
| C16.0 | Malignant neoplasm of cardia |
| C16.1 | Malignant neoplasm of fundus of stomach |
| C16.2 | Malignant neoplasm of body of stomach |
| C16.3 | Malignant neoplasm of pyloric antrum |
| C16.4 | Malignant neoplasm of pylorus |
| C16.5 | Malignant neoplasm of lesser curvature of stomach, unspecified |
| C16.6 | Malignant neoplasm of greater curvature of stomach, unspecified |
| C16.8 | Malignant neoplasm of overlapping sites of stomach |
| C16.9 | Malignant neoplasm of stomach, unspecified |
| C17 | Malignant neoplasm of small intestine |
| C17.0 | Malignant neoplasm of duodenum |
| C17.1 | Malignant neoplasm of jejunum |
| C17.2 | Malignant neoplasm of ileum |
| C17.3 | Meckel's diverticulum, malignant |
| C17.8 | Malignant neoplasm of overlapping sites of small intestine |
| C17.9 | Malignant neoplasm of small intestine, unspecified |
| C18 | Malignant neoplasm of colon |
| C18.0 | Malignant neoplasm of cecum |
| C18.1 | Malignant neoplasm of appendix |
| C18.2 | Malignant neoplasm of ascending colon |
| C18.3 | Malignant neoplasm of hepatic flexure |
| C18.4 | Malignant neoplasm of transverse colon |
| C18.5 | Malignant neoplasm of splenic flexure |
| C18.6 | Malignant neoplasm of descending colon |
| C18.7 | Malignant neoplasm of sigmoid colon |
| C18.8 | Malignant neoplasm of overlapping sites of colon |
| C18.9 | Malignant neoplasm of colon, unspecified |
| C19 | Malignant neoplasm of rectosigmoid junction |
| C20 | Malignant neoplasm of rectum |
| C22.3 | Angiosarcoma of liver |
| C22.4 | Other sarcomas of liver |
| C24 | Malignant neoplasm of other and unspecified parts of biliary tract |
| C24.0 | Malignant neoplasm of extrahepatic bile duct |
| C24.1 | Malignant neoplasm of ampulla of vater |
| C24.8 | Malignant neoplasm of overlapping sites of biliary tract |
| C24.9 | Malignant neoplasm of biliary tract, unspecified |
| C26.0 | Malignant neoplasm of intestinal tract, part unspecified |
| C34 | Malignant neoplasm of bronchus and lung |
| C34.1 | Malignant neoplasm of upper lobe, bronchus or lung |
| C34.10 | Malignant neoplasm of upper lobe, unspecified bronchus or lung |
| C34.11 | Malignant neoplasm of upper lobe, right bronchus or lung |
| C34.12 | Malignant neoplasm of upper lobe, left bronchus or lung |
| C34.2 | Malignant neoplasm of middle lobe, bronchus or lung |
| C34.3 | Malignant neoplasm of lower lobe, bronchus or lung |
| C34.30 | Malignant neoplasm of lower lobe, unspecified bronchus or lung |
| C34.31 | Malignant neoplasm of lower lobe, right bronchus or lung |
| C34.32 | Malignant neoplasm of lower lobe, left bronchus or lung |
| C34.8 | Malignant neoplasm of overlapping sites of bronchus and lung |
| C34.80 | Malignant neoplasm of overlapping sites of unspecified bronchus and lung |
| C34.81 | Malignant neoplasm of overlapping sites of right bronchus and lung |
| C34.82 | Malignant neoplasm of overlapping sites of left bronchus and lung |
| C34.9 | Malignant neoplasm of unspecified part of bronchus or lung |
| C34.90 | Malignant neoplasm of unspecified part of unspecified bronchus or lung |
| C34.91 | Malignant neoplasm of unspecified part of right bronchus or lung |
| C34.92 | Malignant neoplasm of unspecified part of left bronchus or lung |
| C46 | Kaposi's sarcoma |
| C46.0 | Kaposi's sarcoma of skin |
| C46.1 | Kaposi's sarcoma of soft tissue |
| C46.2 | Kaposi's sarcoma of palate |
| C46.3 | Kaposi's sarcoma of lymph nodes |
| C46.4 | Kaposi's sarcoma of gastrointestinal sites |
| C46.5 | Kaposi's sarcoma of lung |
| C46.50 | Kaposi's sarcoma of unspecified lung |
| C46.51 | Kaposi's sarcoma of right lung |
| C46.52 | Kaposi's sarcoma of left lung |
| C46.7 | Kaposi's sarcoma of other sites |
| C46.9 | Kaposi's sarcoma, unspecified |
| C48 | Malignant neoplasm of retroperitoneum and peritoneum |
| C48.0 | Malignant neoplasm of retroperitoneum |
| C48.8 | Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum |
| C49 | Malignant neoplasm of other connective and soft tissue |
| C49.0 | Malignant neoplasm of connective and soft tissue of head, face and neck |
| C49.1 | Malignant neoplasm of connective and soft tissue of upper limb, including shoulder |
| C49.10 | Malignant neoplasm of connective and soft tissue of unspecified upper limb, including shoulder |
| C49.11 | Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder |
| C49.12 | Malignant neoplasm of connective and soft tissue of left upper limb, including shoulder |
| C49.2 | Malignant neoplasm of connective and soft tissue of lower limb, including hip |
| C49.20 | Malignant neoplasm of connective and soft tissue of unspecified lower limb, including hip |
| C49.21 | Malignant neoplasm of connective and soft tissue of right lower limb, including hip |
| C49.22 | Malignant neoplasm of connective and soft tissue of left lower limb, including hip |
| C49.3 | Malignant neoplasm of connective and soft tissue of thorax |
| C49.4 | Malignant neoplasm of connective and soft tissue of abdomen |
| C49.5 | Malignant neoplasm of connective and soft tissue of pelvis |
| C49.6 | Malignant neoplasm of connective and soft tissue of trunk, unspecified |
| C49.8 | Malignant neoplasm of overlapping sites of connective and soft tissue |
| C49.9 | Malignant neoplasm of connective and soft tissue, unspecified |
| C50 | Malignant neoplasm of breast |
| C50.1 | Malignant neoplasm of central portion of breast |
| C50.11 | Malignant neoplasm of central portion of breast, female |
| C50.111 | Malignant neoplasm of central portion of right female breast |
| C50.112 | Malignant neoplasm of central portion of left female breast |
| C50.119 | Malignant neoplasm of central portion of unspecified female breast |
| C50.12 | Malignant neoplasm of central portion of breast, male |
| C50.121 | Malignant neoplasm of central portion of right male breast |
| C50.122 | Malignant neoplasm of central portion of left male breast |
| C50.129 | Malignant neoplasm of central portion of unspecified male breast |
| C50.2 | Malignant neoplasm of upper-inner quadrant of breast |
| C50.21 | Malignant neoplasm of upper-inner quadrant of breast, female |
| C50.211 | Malignant neoplasm of upper-inner quadrant of right female breast |
| C50.212 | Malignant neoplasm of upper-inner quadrant of left female breast |
| C50.219 | Malignant neoplasm of upper-inner quadrant of unspecified female breast |
| C50.22 | Malignant neoplasm of upper-inner quadrant of breast, male |
| C50.221 | Malignant neoplasm of upper-inner quadrant of right male breast |
| C50.222 | Malignant neoplasm of upper-inner quadrant of left male breast |
| C50.229 | Malignant neoplasm of upper-inner quadrant of unspecified male breast |
| C50.3 | Malignant neoplasm of lower-inner quadrant of breast |
| C50.31 | Malignant neoplasm of lower-inner quadrant of breast, female |
| C50.311 | Malignant neoplasm of lower-inner quadrant of right female breast |
| C50.312 | Malignant neoplasm of lower-inner quadrant of left female breast |
| C50.319 | Malignant neoplasm of lower-inner quadrant of unspecified female breast |
| C50.32 | Malignant neoplasm of lower-inner quadrant of breast, male |
| C50.321 | Malignant neoplasm of lower-inner quadrant of right male breast |
| C50.322 | Malignant neoplasm of lower-inner quadrant of left male breast |
| C50.329 | Malignant neoplasm of lower-inner quadrant of unspecified male breast |
| C50.4 | Malignant neoplasm of upper-outer quadrant of breast |
| C50.41 | Malignant neoplasm of upper-outer quadrant of breast, female |
| C50.411 | Malignant neoplasm of upper-outer quadrant of right female breast |
| C50.412 | Malignant neoplasm of upper-outer quadrant of left female breast |
| C50.419 | Malignant neoplasm of upper-outer quadrant of unspecified female breast |
| C50.42 | Malignant neoplasm of upper-outer quadrant of breast, male |
| C50.421 | Malignant neoplasm of upper-outer quadrant of right male breast |
| C50.422 | Malignant neoplasm of upper-outer quadrant of left male breast |
| C50.429 | Malignant neoplasm of upper-outer quadrant of unspecified male breast |
| C50.5 | Malignant neoplasm of lower-outer quadrant of breast |
| C50.51 | Malignant neoplasm of lower-outer quadrant of breast, female |
| C50.511 | Malignant neoplasm of lower-outer quadrant of right female breast |
| C50.512 | Malignant neoplasm of lower-outer quadrant of left female breast |
| C50.519 | Malignant neoplasm of lower-outer quadrant of unspecified female breast |
| C50.52 | Malignant neoplasm of lower-outer quadrant of breast, male |
| C50.521 | Malignant neoplasm of lower-outer quadrant of right male breast |
| C50.522 | Malignant neoplasm of lower-outer quadrant of left male breast |
| C50.529 | Malignant neoplasm of lower-outer quadrant of unspecified male breast |
| C50.6 | Malignant neoplasm of axillary tail of breast |
| C50.61 | Malignant neoplasm of axillary tail of breast, female |
| C50.611 | Malignant neoplasm of axillary tail of right female breast |
| C50.612 | Malignant neoplasm of axillary tail of left female breast |
| C50.619 | Malignant neoplasm of axillary tail of unspecified female breast |
| C50.62 | Malignant neoplasm of axillary tail of breast, male |
| C50.621 | Malignant neoplasm of axillary tail of right male breast |
| C50.622 | Malignant neoplasm of axillary tail of left male breast |
| C50.629 | Malignant neoplasm of axillary tail of unspecified male breast |
| C50.8 | Malignant neoplasm of overlapping sites of breast |
| C50.81 | Malignant neoplasm of overlapping sites of breast, female |
| C50.811 | Malignant neoplasm of overlapping sites of right female breast |
| C50.812 | Malignant neoplasm of overlapping sites of left female breast |
| C50.819 | Malignant neoplasm of overlapping sites of unspecified female breast |
| C50.82 | Malignant neoplasm of overlapping sites of breast, male |
| C50.821 | Malignant neoplasm of overlapping sites of right male breast |
| C50.822 | Malignant neoplasm of overlapping sites of left male breast |
| C50.829 | Malignant neoplasm of overlapping sites of unspecified male breast |
| C50.9 | Malignant neoplasm of breast of unspecified site |
| C50.91 | Malignant neoplasm of breast of unspecified site, female |
| C50.911 | Malignant neoplasm of unspecified site of right female breast |
| C50.912 | Malignant neoplasm of unspecified site of left female breast |
| C50.919 | Malignant neoplasm of unspecified site of unspecified female breast |
| C50.92 | Malignant neoplasm of breast of unspecified site, male |
| C50.921 | Malignant neoplasm of unspecified site of right male breast |
| C50.922 | Malignant neoplasm of unspecified site of left male breast |
| C50.929 | Malignant neoplasm of unspecified site of unspecified male breast |
| C54.1 | Malignant neoplasm of endometrium |
| C61 | Malignant neoplasm of prostate |
| C64 | Malignant neoplasm of kidney, except renal pelvis |
| C64.1 | Malignant neoplasm of right kidney, except renal pelvis |
| C64.2 | Malignant neoplasm of left kidney, except renal pelvis |
| C64.9 | Malignant neoplasm of unspecified kidney, except renal pelvis |
| C73 | Malignant neoplasm of thyroid gland |
| C92.3 | Myeloid sarcoma |
| C92.30 | Myeloid sarcoma, not having achieved remission |
| C92.31 | Myeloid sarcoma, in remission |
| C92.32 | Myeloid sarcoma, in relapse |
| C96.22 | Mast cell sarcoma |
| C96.4 | Sarcoma of dendritic cells (accessory cells) |
| C96.A | Histiocytic sarcoma |
| Mismatch repair deficient endometrial cancer | |
| C54.1 | Malignant neoplasm of endometrium |
| Mismatch repair proficient endometrial cancer | |
| C54.1 | Malignant neoplasm of endometrium |
| Non-muscle invasive bladder cancer and carcinoma in situ | |
| C67 | Malignant neoplasm of bladder |
| C67.0 | Malignant neoplasm of trigone of bladder |
| C67.1 | Malignant neoplasm of dome of bladder |
| C67.5 | Malignant neoplasm of bladder neck |
| C67.8 | Malignant neoplasm of overlapping sites of bladder |
| C67.9 | Malignant neoplasm of bladder, unspecified |
| D09.0 | Carcinoma in situ of bladder |
| Non-small cell lung cancer | |
| C34 | Malignant neoplasm of bronchus and lung |
| C34.0 | Malignant neoplasm of main bronchus |
| C34.00 | Malignant neoplasm of unspecified main bronchus |
| C34.01 | Malignant neoplasm of right main bronchus |
| C34.02 | Malignant neoplasm of left main bronchus |
| C34.1 | Malignant neoplasm of upper lobe, bronchus or lung |
| C34.10 | Malignant neoplasm of upper lobe, unspecified bronchus or lung |
| C34.11 | Malignant neoplasm of upper lobe, right bronchus or lung |
| C34.12 | Malignant neoplasm of upper lobe, left bronchus or lung |
| C34.2 | Malignant neoplasm of middle lobe, bronchus or lung |
| C34.3 | Malignant neoplasm of lower lobe, bronchus or lung |
| C34.30 | Malignant neoplasm of lower lobe, unspecified bronchus or lung |
| C34.31 | Malignant neoplasm of lower lobe, right bronchus or lung |
| C34.32 | Malignant neoplasm of lower lobe, left bronchus or lung |
| C34.8 | Malignant neoplasm of overlapping sites of bronchus and lung |
| C34.80 | Malignant neoplasm of overlapping sites of unspecified bronchus and lung |
| C34.81 | Malignant neoplasm of overlapping sites of right bronchus and lung |
| C34.82 | Malignant neoplasm of overlapping sites of left bronchus and lung |
| C34.9 | Malignant neoplasm of unspecified part of bronchus or lung |
| C34.90 | Malignant neoplasm of unspecified part of unspecified bronchus or lung |
| C34.91 | Malignant neoplasm of unspecified part of right bronchus or lung |
| C34.92 | Malignant neoplasm of unspecified part of left bronchus or lung |
| C39.9 | Malignant neoplasm of lower respiratory tract, part unspecified |
| Pd-l1 (+) adenocarcinoma of gastroesophageal junction | |
| C16.0 | Malignant neoplasm of cardia |
| Pd-l1 expressing epithelial ovarian carcinoma | |
| C48.1 | Malignant neoplasm of specified parts of peritoneum |
| C48.2 | Malignant neoplasm of peritoneum, unspecified |
| C48.8 | Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum |
| C56 | Malignant neoplasm of ovary |
| C56.1 | Malignant neoplasm of right ovary |
| C56.2 | Malignant neoplasm of left ovary |
| C56.3 | Malignant neoplasm of bilateral ovaries |
| C56.9 | Malignant neoplasm of unspecified ovary |
| C57.00 | Malignant neoplasm of unspecified fallopian tube |
| C57.01 | Malignant neoplasm of right fallopian tube |
| C57.02 | Malignant neoplasm of left fallopian tube |
| Pd-l1 expressing fallopian tube carcinoma | |
| C57.0 | Malignant neoplasm of fallopian tube |
| C57.00 | Malignant neoplasm of unspecified fallopian tube |
| C57.01 | Malignant neoplasm of right fallopian tube |
| C57.02 | Malignant neoplasm of left fallopian tube |
| Pd-l1 expressing triple-negative breast cancer | |
| C50.01 | Malignant neoplasm of nipple and areola, female |
| C50.11 | Malignant neoplasm of central portion of breast, female |
| C50.111 | Malignant neoplasm of central portion of right female breast |
| C50.112 | Malignant neoplasm of central portion of left female breast |
| C50.119 | Malignant neoplasm of central portion of unspecified female breast |
| C50.21 | Malignant neoplasm of upper-inner quadrant of breast, female |
| C50.211 | Malignant neoplasm of upper-inner quadrant of right female breast |
| C50.212 | Malignant neoplasm of upper-inner quadrant of left female breast |
| C50.219 | Malignant neoplasm of upper-inner quadrant of unspecified female breast |
| C50.31 | Malignant neoplasm of lower-inner quadrant of breast, female |
| C50.311 | Malignant neoplasm of lower-inner quadrant of right female breast |
| C50.312 | Malignant neoplasm of lower-inner quadrant of left female breast |
| C50.319 | Malignant neoplasm of lower-inner quadrant of unspecified female breast |
| C50.41 | Malignant neoplasm of upper-outer quadrant of breast, female |
| C50.411 | Malignant neoplasm of upper-outer quadrant of right female breast |
| C50.412 | Malignant neoplasm of upper-outer quadrant of left female breast |
| C50.419 | Malignant neoplasm of upper-outer quadrant of unspecified female breast |
| C50.51 | Malignant neoplasm of lower-outer quadrant of breast, female |
| C50.511 | Malignant neoplasm of lower-outer quadrant of right female breast |
| C50.512 | Malignant neoplasm of lower-outer quadrant of left female breast |
| C50.519 | Malignant neoplasm of lower-outer quadrant of unspecified female breast |
| C50.61 | Malignant neoplasm of axillary tail of breast, female |
| C50.611 | Malignant neoplasm of axillary tail of right female breast |
| C50.612 | Malignant neoplasm of axillary tail of left female breast |
| C50.619 | Malignant neoplasm of axillary tail of unspecified female breast |
| C50.81 | Malignant neoplasm of overlapping sites of breast, female |
| C50.811 | Malignant neoplasm of overlapping sites of right female breast |
| C50.812 | Malignant neoplasm of overlapping sites of left female breast |
| C50.819 | Malignant neoplasm of overlapping sites of unspecified female breast |
| C50.91 | Malignant neoplasm of breast of unspecified site, female |
| C50.911 | Malignant neoplasm of unspecified site of right female breast |
| C50.912 | Malignant neoplasm of unspecified site of left female breast |
| C50.919 | Malignant neoplasm of unspecified site of unspecified female breast |
| Z17.1 | Estrogen receptor negative status [Er-] |
| Pd-l1 positive cervical cancer | |
| C53.0 | Malignant neoplasm of endocervix |
| C53.1 | Malignant neoplasm of exocervix |
| C53.8 | Malignant neoplasm of overlapping sites of cervix uteri |
| C53.9 | Malignant neoplasm of cervix uteri, unspecified |
| Pd-l1 positive esophageal carcinoma | |
| C15 | Malignant neoplasm of esophagus |
| C15.3 | Malignant neoplasm of upper third of esophagus |
| C15.4 | Malignant neoplasm of middle third of esophagus |
| C15.5 | Malignant neoplasm of lower third of esophagus |
| C15.8 | Malignant neoplasm of overlapping sites of esophagus |
| C15.9 | Malignant neoplasm of esophagus, unspecified |
| Pd-l1 positive non-small cell lung cancer | |
| C34 | Malignant neoplasm of bronchus and lung |
| C34.0 | Malignant neoplasm of main bronchus |
| C34.00 | Malignant neoplasm of unspecified main bronchus |
| C34.01 | Malignant neoplasm of right main bronchus |
| C34.02 | Malignant neoplasm of left main bronchus |
| C34.1 | Malignant neoplasm of upper lobe, bronchus or lung |
| C34.10 | Malignant neoplasm of upper lobe, unspecified bronchus or lung |
| C34.11 | Malignant neoplasm of upper lobe, right bronchus or lung |
| C34.12 | Malignant neoplasm of upper lobe, left bronchus or lung |
| C34.2 | Malignant neoplasm of middle lobe, bronchus or lung |
| C34.3 | Malignant neoplasm of lower lobe, bronchus or lung |
| C34.30 | Malignant neoplasm of lower lobe, unspecified bronchus or lung |
| C34.31 | Malignant neoplasm of lower lobe, right bronchus or lung |
| C34.32 | Malignant neoplasm of lower lobe, left bronchus or lung |
| C34.8 | Malignant neoplasm of overlapping sites of bronchus and lung |
| C34.80 | Malignant neoplasm of overlapping sites of unspecified bronchus and lung |
| C34.81 | Malignant neoplasm of overlapping sites of right bronchus and lung |
| C34.82 | Malignant neoplasm of overlapping sites of left bronchus and lung |
| C34.9 | Malignant neoplasm of unspecified part of bronchus or lung |
| C34.90 | Malignant neoplasm of unspecified part of unspecified bronchus or lung |
| C34.91 | Malignant neoplasm of unspecified part of right bronchus or lung |
| C34.92 | Malignant neoplasm of unspecified part of left bronchus or lung |
| C39.9 | Malignant neoplasm of lower respiratory tract, part unspecified |
| Pd-l1 positive squamous cell carcinoma of esophagus | |
| C15 | Malignant neoplasm of esophagus |
| C15.3 | Malignant neoplasm of upper third of esophagus |
| C15.4 | Malignant neoplasm of middle third of esophagus |
| C15.5 | Malignant neoplasm of lower third of esophagus |
| C15.8 | Malignant neoplasm of overlapping sites of esophagus |
| C15.9 | Malignant neoplasm of esophagus, unspecified |
| Pd-l1 positive squamous cell carcinoma of head and neck | |
| C44.02 | Squamous cell carcinoma of skin of lip |
| C44.12 | Squamous cell carcinoma of skin of eyelid, including canthus |
| C44.121 | Squamous cell carcinoma of skin of unspecified eyelid, including canthus |
| C44.122 | Squamous cell carcinoma of skin of right eyelid, including canthus |
| C44.1221 | Squamous cell carcinoma of skin of right upper eyelid, including canthus |
| C44.1222 | Squamous cell carcinoma of skin of right lower eyelid, including canthus |
| C44.129 | Squamous cell carcinoma of skin of left eyelid, including canthus |
| C44.1291 | Squamous cell carcinoma of skin of left upper eyelid, including canthus |
| C44.1292 | Squamous cell carcinoma of skin of left lower eyelid, including canthus |
| C44.22 | Squamous cell carcinoma of skin of ear and external auricular canal |
| C44.221 | Squamous cell carcinoma of skin of unspecified ear and external auricular canal |
| C44.222 | Squamous cell carcinoma of skin of right ear and external auricular canal |
| C44.229 | Squamous cell carcinoma of skin of left ear and external auricular canal |
| C44.32 | Squamous cell carcinoma of skin of other and unspecified parts of face |
| C44.320 | Squamous cell carcinoma of skin of unspecified parts of face |
| C44.321 | Squamous cell carcinoma of skin of nose |
| C44.329 | Squamous cell carcinoma of skin of other parts of face |
| C44.42 | Squamous cell carcinoma of skin of scalp and neck |
| Pd-l1 positive, EGFr-negative, ALk-negative metast NSCLC | |
| C34 | Malignant neoplasm of bronchus and lung |
| C34.0 | Malignant neoplasm of main bronchus |
| C34.00 | Malignant neoplasm of unspecified main bronchus |
| C34.01 | Malignant neoplasm of right main bronchus |
| C34.02 | Malignant neoplasm of left main bronchus |
| C34.1 | Malignant neoplasm of upper lobe, bronchus or lung |
| C34.10 | Malignant neoplasm of upper lobe, unspecified bronchus or lung |
| C34.11 | Malignant neoplasm of upper lobe, right bronchus or lung |
| C34.12 | Malignant neoplasm of upper lobe, left bronchus or lung |
| C34.2 | Malignant neoplasm of middle lobe, bronchus or lung |
| C34.3 | Malignant neoplasm of lower lobe, bronchus or lung |
| C34.30 | Malignant neoplasm of lower lobe, unspecified bronchus or lung |
| C34.31 | Malignant neoplasm of lower lobe, right bronchus or lung |
| C34.32 | Malignant neoplasm of lower lobe, left bronchus or lung |
| C34.8 | Malignant neoplasm of overlapping sites of bronchus and lung |
| C34.80 | Malignant neoplasm of overlapping sites of unspecified bronchus and lung |
| C34.81 | Malignant neoplasm of overlapping sites of right bronchus and lung |
| C34.82 | Malignant neoplasm of overlapping sites of left bronchus and lung |
| C34.9 | Malignant neoplasm of unspecified part of bronchus or lung |
| C34.90 | Malignant neoplasm of unspecified part of unspecified bronchus or lung |
| C34.91 | Malignant neoplasm of unspecified part of right bronchus or lung |
| C34.92 | Malignant neoplasm of unspecified part of left bronchus or lung |
| Pd-l1+, HEr2-neg gastric or GE junction adenocarcinoma | |
| C16.0 | Malignant neoplasm of cardia |
| C16.1 | Malignant neoplasm of fundus of stomach |
| C16.2 | Malignant neoplasm of body of stomach |
| C16.3 | Malignant neoplasm of pyloric antrum |
| C16.4 | Malignant neoplasm of pylorus |
| C16.5 | Malignant neoplasm of lesser curvature of stomach, unspecified |
| C16.6 | Malignant neoplasm of greater curvature of stomach, unspecified |
| C16.8 | Malignant neoplasm of overlapping sites of stomach |
| C16.9 | Malignant neoplasm of stomach, unspecified |
| Pd-l1+, HEr2-pos gastric or GE junction adenocarcinoma | |
| C16.0 | Malignant neoplasm of cardia |
| C16.1 | Malignant neoplasm of fundus of stomach |
| C16.2 | Malignant neoplasm of body of stomach |
| C16.3 | Malignant neoplasm of pyloric antrum |
| C16.4 | Malignant neoplasm of pylorus |
| C16.5 | Malignant neoplasm of lesser curvature of stomach, unspecified |
| C16.6 | Malignant neoplasm of greater curvature of stomach, unspecified |
| C16.8 | Malignant neoplasm of overlapping sites of stomach |
| C16.9 | Malignant neoplasm of stomach, unspecified |
| Primary mediastinal large b-cell lymphoma | |
| C85.2 | Mediastinal (thymic) large b-cell lymphoma |
| C85.20 | Mediastinal (thymic) large b-cell lymphoma, unspecified site |
| C85.21 | Mediastinal (thymic) large b-cell lymphoma, lymph nodes of head, face, and neck |
| C85.22 | Mediastinal (thymic) large b-cell lymphoma, intrathoracic lymph nodes |
| C85.23 | Mediastinal (thymic) large b-cell lymphoma, intra-abdominal lymph nodes |
| C85.24 | Mediastinal (thymic) large b-cell lymphoma, lymph nodes of axilla and upper limb |
| C85.25 | Mediastinal (thymic) large b-cell lymphoma, lymph nodes of inguinal region and lower limb |
| C85.26 | Mediastinal (thymic) large b-cell lymphoma, intrapelvic lymph nodes |
| C85.27 | Mediastinal (thymic) large b-cell lymphoma, spleen |
| C85.28 | Mediastinal (thymic) large b-cell lymphoma, lymph nodes of multiple sites |
| C85.29 | Mediastinal (thymic) large b-cell lymphoma, extranodal and solid organ sites |
| Renal cell carcinoma | |
| C64 | Malignant neoplasm of kidney, except renal pelvis |
| C64.1 | Malignant neoplasm of right kidney, except renal pelvis |
| C64.2 | Malignant neoplasm of left kidney, except renal pelvis |
| C64.9 | Malignant neoplasm of unspecified kidney, except renal pelvis |
| Squamous cell carcinoma of head and neck | |
| C44.02 | Squamous cell carcinoma of skin of lip |
| C44.12 | Squamous cell carcinoma of skin of eyelid, including canthus |
| C44.121 | Squamous cell carcinoma of skin of unspecified eyelid, including canthus |
| C44.122 | Squamous cell carcinoma of skin of right eyelid, including canthus |
| C44.1221 | Squamous cell carcinoma of skin of right upper eyelid, including canthus |
| C44.1222 | Squamous cell carcinoma of skin of right lower eyelid, including canthus |
| C44.129 | Squamous cell carcinoma of skin of left eyelid, including canthus |
| C44.1291 | Squamous cell carcinoma of skin of left upper eyelid, including canthus |
| C44.1292 | Squamous cell carcinoma of skin of left lower eyelid, including canthus |
| C44.22 | Squamous cell carcinoma of skin of ear and external auricular canal |
| C44.221 | Squamous cell carcinoma of skin of unspecified ear and external auricular canal |
| C44.222 | Squamous cell carcinoma of skin of right ear and external auricular canal |
| C44.229 | Squamous cell carcinoma of skin of left ear and external auricular canal |
| C44.32 | Squamous cell carcinoma of skin of other and unspecified parts of face |
| C44.320 | Squamous cell carcinoma of skin of unspecified parts of face |
| C44.321 | Squamous cell carcinoma of skin of nose |
| C44.329 | Squamous cell carcinoma of skin of other parts of face |
| C44.42 | Squamous cell carcinoma of skin of scalp and neck |
| Squamous cell carcinoma of lung | |
| C34 | Malignant neoplasm of bronchus and lung |
| C34.0 | Malignant neoplasm of main bronchus |
| C34.00 | Malignant neoplasm of unspecified main bronchus |
| C34.01 | Malignant neoplasm of right main bronchus |
| C34.02 | Malignant neoplasm of left main bronchus |
| C34.1 | Malignant neoplasm of upper lobe, bronchus or lung |
| C34.10 | Malignant neoplasm of upper lobe, unspecified bronchus or lung |
| C34.11 | Malignant neoplasm of upper lobe, right bronchus or lung |
| C34.12 | Malignant neoplasm of upper lobe, left bronchus or lung |
| C34.2 | Malignant neoplasm of middle lobe, bronchus or lung |
| C34.3 | Malignant neoplasm of lower lobe, bronchus or lung |
| C34.30 | Malignant neoplasm of lower lobe, unspecified bronchus or lung |
| C34.31 | Malignant neoplasm of lower lobe, right bronchus or lung |
| C34.32 | Malignant neoplasm of lower lobe, left bronchus or lung |
| C34.8 | Malignant neoplasm of overlapping sites of bronchus and lung |
| C34.80 | Malignant neoplasm of overlapping sites of unspecified bronchus and lung |
| C34.81 | Malignant neoplasm of overlapping sites of right bronchus and lung |
| C34.82 | Malignant neoplasm of overlapping sites of left bronchus and lung |
| C34.9 | Malignant neoplasm of unspecified part of bronchus or lung |
| C34.90 | Malignant neoplasm of unspecified part of unspecified bronchus or lung |
| C34.91 | Malignant neoplasm of unspecified part of right bronchus or lung |
| C34.92 | Malignant neoplasm of unspecified part of left bronchus or lung |
| Squamous cell carcinoma of skin | |
| C44.02 | Squamous cell carcinoma of skin of lip |
| C44.12 | Squamous cell carcinoma of skin of eyelid, including canthus |
| C44.121 | Squamous cell carcinoma of skin of unspecified eyelid, including canthus |
| C44.122 | Squamous cell carcinoma of skin of right eyelid, including canthus |
| C44.1221 | Squamous cell carcinoma of skin of right upper eyelid, including canthus |
| C44.1222 | Squamous cell carcinoma of skin of right lower eyelid, including canthus |
| C44.129 | Squamous cell carcinoma of skin of left eyelid, including canthus |
| C44.1291 | Squamous cell carcinoma of skin of left upper eyelid, including canthus |
| C44.1292 | Squamous cell carcinoma of skin of left lower eyelid, including canthus |
| C44.22 | Squamous cell carcinoma of skin of ear and external auricular canal |
| C44.221 | Squamous cell carcinoma of skin of unspecified ear and external auricular canal |
| C44.222 | Squamous cell carcinoma of skin of right ear and external auricular canal |
| C44.229 | Squamous cell carcinoma of skin of left ear and external auricular canal |
| C44.32 | Squamous cell carcinoma of skin of other and unspecified parts of face |
| C44.320 | Squamous cell carcinoma of skin of unspecified parts of face |
| C44.321 | Squamous cell carcinoma of skin of nose |
| C44.329 | Squamous cell carcinoma of skin of other parts of face |
| C44.42 | Squamous cell carcinoma of skin of scalp and neck |
| C44.52 | Squamous cell carcinoma of skin of trunk |
| C44.520 | Squamous cell carcinoma of anal skin |
| C44.521 | Squamous cell carcinoma of skin of breast |
| C44.529 | Squamous cell carcinoma of skin of other part of trunk |
| C44.62 | Squamous cell carcinoma of skin of upper limb, including shoulder |
| C44.621 | Squamous cell carcinoma of skin of unspecified upper limb, including shoulder |
| C44.622 | Squamous cell carcinoma of skin of right upper limb, including shoulder |
| C44.629 | Squamous cell carcinoma of skin of left upper limb, including shoulder |
| C44.72 | Squamous cell carcinoma of skin of lower limb, including hip |
| C44.721 | Squamous cell carcinoma of skin of unspecified lower limb, including hip |
| C44.722 | Squamous cell carcinoma of skin of right lower limb, including hip |
| C44.729 | Squamous cell carcinoma of skin of left lower limb, including hip |
| C44.82 | Squamous cell carcinoma of overlapping sites of skin |
| C44.92 | Squamous cell carcinoma of skin, unspecified |
| Transitional cell carcinoma of the urinary tract | |
| C65 | Malignant neoplasm of renal pelvis |
| C65.1 | Malignant neoplasm of right renal pelvis |
| C65.2 | Malignant neoplasm of left renal pelvis |
| C65.9 | Malignant neoplasm of unspecified renal pelvis |
| C66 | Malignant neoplasm of ureter |
| C66.1 | Malignant neoplasm of right ureter |
| C66.2 | Malignant neoplasm of left ureter |
| C66.9 | Malignant neoplasm of unspecified ureter |
| C67 | Malignant neoplasm of bladder |
| C67.0 | Malignant neoplasm of trigone of bladder |
| C67.1 | Malignant neoplasm of dome of bladder |
| C67.2 | Malignant neoplasm of lateral wall of bladder |
| C67.3 | Malignant neoplasm of anterior wall of bladder |
| C67.4 | Malignant neoplasm of posterior wall of bladder |
| C67.5 | Malignant neoplasm of bladder neck |
| C67.6 | Malignant neoplasm of ureteric orifice |
| C67.8 | Malignant neoplasm of overlapping sites of bladder |
| C67.9 | Malignant neoplasm of bladder, unspecified |
| Tumor mutational burden-high solid malignant tumor | |
| C07 | Malignant neoplasm of parotid gland |
| C08 | Malignant neoplasm of other and unspecified major salivary glands |
| C08.0 | Malignant neoplasm of submandibular gland |
| C08.1 | Malignant neoplasm of sublingual gland |
| C08.9 | Malignant neoplasm of major salivary gland, unspecified |
| C21 | Malignant neoplasm of anus and anal canal |
| C21.0 | Malignant neoplasm of anus, unspecified |
| C21.1 | Malignant neoplasm of anal canal |
| C21.2 | Malignant neoplasm of cloacogenic zone |
| C21.8 | Malignant neoplasm of overlapping sites of rectum, anus and anal canal |
| C34 | Malignant neoplasm of bronchus and lung |
| C34.1 | Malignant neoplasm of upper lobe, bronchus or lung |
| C34.10 | Malignant neoplasm of upper lobe, unspecified bronchus or lung |
| C34.11 | Malignant neoplasm of upper lobe, right bronchus or lung |
| C34.12 | Malignant neoplasm of upper lobe, left bronchus or lung |
| C34.2 | Malignant neoplasm of middle lobe, bronchus or lung |
| C34.3 | Malignant neoplasm of lower lobe, bronchus or lung |
| C34.30 | Malignant neoplasm of lower lobe, unspecified bronchus or lung |
| C34.31 | Malignant neoplasm of lower lobe, right bronchus or lung |
| C34.32 | Malignant neoplasm of lower lobe, left bronchus or lung |
| C34.8 | Malignant neoplasm of overlapping sites of bronchus and lung |
| C34.80 | Malignant neoplasm of overlapping sites of unspecified bronchus and lung |
| C34.81 | Malignant neoplasm of overlapping sites of right bronchus and lung |
| C34.82 | Malignant neoplasm of overlapping sites of left bronchus and lung |
| C34.9 | Malignant neoplasm of unspecified part of bronchus or lung |
| C34.90 | Malignant neoplasm of unspecified part of unspecified bronchus or lung |
| C34.91 | Malignant neoplasm of unspecified part of right bronchus or lung |
| C34.92 | Malignant neoplasm of unspecified part of left bronchus or lung |
| C45 | Mesothelioma |
| C45.0 | Mesothelioma of pleura |
| C45.1 | Mesothelioma of peritoneum |
| C45.2 | Mesothelioma of pericardium |
| C45.7 | Mesothelioma of other sites |
| C45.9 | Mesothelioma, unspecified |
| C51 | Malignant neoplasm of vulva |
| C51.0 | Malignant neoplasm of labium majus |
| C51.1 | Malignant neoplasm of labium minus |
| C51.2 | Malignant neoplasm of clitoris |
| C51.8 | Malignant neoplasm of overlapping sites of vulva |
| C51.9 | Malignant neoplasm of vulva, unspecified |
| C53 | Malignant neoplasm of cervix uteri |
| C53.0 | Malignant neoplasm of endocervix |
| C53.1 | Malignant neoplasm of exocervix |
| C53.8 | Malignant neoplasm of overlapping sites of cervix uteri |
| C53.9 | Malignant neoplasm of cervix uteri, unspecified |
| C54.1 | Malignant neoplasm of endometrium |
| C73 | Malignant neoplasm of thyroid gland |
| C7A | Malignant neuroendocrine tumors |
| C7A.0 | Malignant carcinoid tumors |
| C7A.00 | Malignant carcinoid tumor of unspecified site |
| C7A.01 | Malignant carcinoid tumors of the small intestine |
| C7A.010 | Malignant carcinoid tumor of the duodenum |
| C7A.011 | Malignant carcinoid tumor of the jejunum |
| C7A.012 | Malignant carcinoid tumor of the ileum |
| C7A.019 | Malignant carcinoid tumor of the small intestine, unspecified portion |
| C7A.02 | Malignant carcinoid tumors of the appendix, large intestine, and rectum |
| C7A.020 | Malignant carcinoid tumor of the appendix |
| C7A.021 | Malignant carcinoid tumor of the cecum |
| C7A.022 | Malignant carcinoid tumor of the ascending colon |
| C7A.023 | Malignant carcinoid tumor of the transverse colon |
| C7A.024 | Malignant carcinoid tumor of the descending colon |
| C7A.025 | Malignant carcinoid tumor of the sigmoid colon |
| C7A.026 | Malignant carcinoid tumor of the rectum |
| C7A.029 | Malignant carcinoid tumor of the large intestine, unspecified portion |
| C7A.09 | Malignant carcinoid tumors of other sites |
| C7A.090 | Malignant carcinoid tumor of the bronchus and lung |
| C7A.091 | Malignant carcinoid tumor of the thymus |
| C7A.092 | Malignant carcinoid tumor of the stomach |
| C7A.093 | Malignant carcinoid tumor of the kidney |
| C7A.094 | Malignant carcinoid tumor of the foregut, unspecified |
| C7A.095 | Malignant carcinoid tumor of the midgut, unspecified |
| C7A.096 | Malignant carcinoid tumor of the hindgut, unspecified |
| C7A.098 | Malignant carcinoid tumors of other sites |
| C7A.1 | Malignant poorly differentiated neuroendocrine tumors |
| C7A.8 | Other malignant neuroendocrine tumors |
Formulary Reference Tool