What should I know before my first treatment?Back to Starting KEYTRUDA + LENVIMA
About your treatment with KEYTRUDA® (pembrolizumab)
KEYTRUDA is a cancer treatment that is given by a needle through a vein. This is known as an infusion. Your health care provider will give you KEYTRUDA into your vein through an intravenous (IV) line. Infusions are given over 30 minutes. They can take place at your doctor’s office or an infusion clinic.
What should I ask my infusion center?
Before your first appointment to receive KEYTRUDA, call your infusion center and ask:
- Can my family members or friends come?
- Is there public transportation nearby?
- Where is the parking lot and is parking free?
- Will I be able to drive after my infusion?
- What do I need to bring with me?
- How long should I expect to be there?
What should I bring to my infusion with KEYTRUDA® (pembrolizumab)?
- Any paperwork you need to fill out or have already filled out
- A list of all the current medications you're taking
- Insurance cards
- A full water bottle to help you stay hydrated
- Healthy snacks
- A pillow and/or blanket
- Charging devices
What can I do to help feel prepared?
Before your first infusion of KEYTRUDA, you may experience a lot of different emotions. That’s why preparing beforehand can be a big help to making sure you feel ready.
- Be open and talk to someone about how you are feeling
- Ask your doctor about ways to help manage worry and stress
- Drink plenty of water the day before your infusion to help prevent dehydration, flush toxins from your body, and stay as strong as possible
Prepare with others:
- Ask friends or family to come with you, or plan to video chat when you’re there
- Plan ahead for rides as you may not feel up for driving afterwards
What should I expect during the infusion?
Who will give me the infusion?
A nurse will likely give you the infusion by placing an intravenous (IV) line into your arm. They can also answer any questions you may have.
How long will the infusion take?
Each infusion of KEYTRUDA is given over 30 minutes. Remember that your doctor or the infusion center may ask you to be there for a longer period of time than it takes to get your infusion.
What should I pay attention to?
During your infusions, make sure to pay attention to how you are feeling. Sometimes bruising, irritation, or other reactions can occur. If you are in pain or feel something out of the ordinary, make sure to tell the nurse or someone at the infusion center right away.
What should I pay attention to after the infusion?
After your infusion, it’s important to keep paying close attention and write down how you are feeling.
Remember to tell all of your doctors that you are taking KEYTRUDA. Small steps like these can help you and your doctor manage side effects early.
About your treatment with LENVIMA® (lenvatinib)
LENVIMA is an oral medication. LENVIMA capsules come in color-coded cards that contain medicine for 5 days.
How will I receive my oral medication, LENVIMA® (lenvatinib)?
Talk to your health care team to find out how you will receive LENVIMA. You may either receive your prescription through your health care provider’s office/clinic, a hospital pharmacy, or in the mail from a select Specialty Pharmacy.
If you are receiving LENVIMA through a select Specialty Pharmacy, it is important to know which one and to respond promptly to their phone calls and communications.
How will I take my oral medication, LENVIMA® (lenvatinib)?
LENVIMA should be taken one time each day at the same time, with or without food. Your health care provider will tell you how much LENVIMA to take and when to take it. Your health care provider may also adjust your dose during treatment, stop treatment for some time, or completely stop treatment with LENVIMA if you have side effects.
If you miss a dose of LENVIMA, take it as soon as you remember. If your next dose is due within 12 hours, skip the missed dose and take the next dose at your regular time.
If you take too much LENVIMA, call your health care provider or go to the nearest hospital emergency room right away.
If you cannot swallow LENVIMA capsules whole, see more information on taking LENVIMA.
You've finished the first section
Hopefully you’re feeling more prepared for your upcoming treatment. Now that you know how to prepare for infusions, what you’ll need to bring with you, and how to receive and take your oral medication, you’re ready to move onto the next section.
- KEYTRUDA and LENVIMA are prescription medicines used together to treat:
- a kind of kidney cancer called advanced renal cell carcinoma (RCC) as your first treatment when your kidney cancer has spread or cannot be removed by surgery.
- a kind of uterine cancer called advanced endometrial carcinoma:
- when a laboratory test shows that your tumor is mismatch repair proficient (pMMR) or not microsatellite instability-high (MSI-H), and
- you have received anti-cancer treatment, and it is no longer working, and
- your cancer cannot be cured by surgery or radiation.
- It is not known if LENVIMA is safe and effective in children.
Important Safety Information for KEYTRUDA® (pembrolizumab)
KEYTRUDA is a medicine that may treat certain cancers by working with your immune system. KEYTRUDA can cause your immune system to attack normal organs and tissues in any area of your body and can affect the way they work. These problems can sometimes become severe or life-threatening and can lead to death. You can have more than one of these problems at the same time. These problems may happen any time during treatment or even after your treatment has ended.
Call or see your health care provider right away if you develop any signs or symptoms of the following problems or if they get worse. These are not all of the signs and symptoms of immune system problems that can happen with KEYTRUDA:
Lung problems: cough, shortness of breath, or chest pain.
Intestinal problems: diarrhea (loose stools) or more frequent bowel movements than usual; stools that are black, tarry, sticky, or have blood or mucus; or severe stomach-area (abdomen) pain or tenderness.
Liver problems: yellowing of your skin or the whites of your eyes; severe nausea or vomiting; pain on the right side of your stomach area (abdomen); dark urine (tea colored); or bleeding or bruising more easily than normal.
Hormone gland problems: headaches that will not go away or unusual headaches; eye sensitivity to light; eye problems; rapid heartbeat; increased sweating; extreme tiredness; weight gain or weight loss; feeling more hungry or thirsty than usual; urinating more often than usual; hair loss; feeling cold; constipation; your voice gets deeper; dizziness or fainting; changes in mood or behavior, such as decreased sex drive, irritability, or forgetfulness.
Kidney problems: decrease in the amount of your urine; blood in your urine; swelling of your ankles; loss of appetite.
Skin problems: rash; itching; skin blistering or peeling; painful sores or ulcers in your mouth or in your nose, throat, or genital area; fever or flu-like symptoms; swollen lymph nodes.
Problems can also happen in other organs and tissues. Signs and symptoms of these problems may include: chest pain; irregular heartbeat; shortness of breath; swelling of ankles; confusion; sleepiness; memory problems; changes in mood or behavior; stiff neck; balance problems; tingling or numbness of the arms or legs; double vision; blurry vision; sensitivity to light; eye pain; changes in eyesight; persistent or severe muscle pain or weakness; muscle cramps; low red blood cells; bruising.
Infusion reactions that can sometimes be severe or life-threatening. Signs and symptoms of infusion reactions may include chills or shaking, itching or rash, flushing, shortness of breath or wheezing, dizziness, feeling like passing out, fever, and back pain.
Rejection of a transplanted organ. Your health care provider should tell you what signs and symptoms you should report and they will monitor you, depending on the type of organ transplant that you have had.
Complications, including graft-versus-host disease (GVHD), in people who have received a bone marrow (stem cell) transplant that uses donor stem cells (allogeneic). These complications can be serious and can lead to death. These complications may happen if you underwent transplantation either before or after being treated with KEYTRUDA. Your health care provider will monitor you for these complications.
Getting medical treatment right away may help keep these problems from becoming more serious. Your health care provider will check you for these problems during treatment with KEYTRUDA. They may treat you with corticosteroid or hormone replacement medicines. They may also need to delay or completely stop treatment with KEYTRUDA if you have severe side effects.
Before you receive KEYTRUDA, tell your health care provider if you have immune system problems such as Crohn’s disease, ulcerative colitis, or lupus; have had an organ transplant or have had or plan to have a bone marrow (stem cell) transplant that uses donor stem cells (allogeneic); have had radiation treatment in your chest area; have a condition that affects your nervous system, such as myasthenia gravis or Guillain-Barré syndrome.
If you are pregnant or plan to become pregnant, tell your health care provider. KEYTRUDA can harm your unborn baby. If you are able to become pregnant, you will be given a pregnancy test before you start treatment. Use effective birth control during treatment and for 4 months after your last dose of KEYTRUDA. Tell them right away if you think you may be pregnant or you become pregnant during treatment with KEYTRUDA.
Tell your health care provider if you are breastfeeding or plan to breastfeed. It is not known if KEYTRUDA passes into your breast milk. Do not breastfeed during treatment with KEYTRUDA and for 4 months after your last dose of KEYTRUDA.
Tell your health care provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
Common side effects of KEYTRUDA when given with LENVIMA include low levels of thyroid hormone; high blood pressure; feeling tired; diarrhea; joint and muscle pain; nausea; decreased appetite; vomiting; mouth sores; weight loss; stomach-area (abdominal) pain; urinary tract infection; protein in your urine; constipation; headache; bleeding; blisters or rash on the palms of your hands and soles of your feet; hoarseness; rash; liver problems; and kidney problems.
These are not all the possible side effects of KEYTRUDA. Talk to your health care provider for medical advice about side effects.
Important Safety Information for LENVIMA® (lenvatinib)
LENVIMA may cause serious side effects, including:
High blood pressure (hypertension): High blood pressure is a common side effect of LENVIMA and can be serious. Your blood pressure should be well controlled before you start taking LENVIMA. Your healthcare provider should check your blood pressure regularly during treatment with LENVIMA. If you develop blood pressure problems, your healthcare provider may prescribe medicine to treat your high blood pressure.
Heart problems: LENVIMA can cause serious heart problems that may lead to death. Call your healthcare provider right away if you get symptoms of heart problems, such as shortness of breath or swelling of your ankles.
Problem with blood clots in your blood vessels (arteries): Get emergency medical help right away if you get any of the following symptoms: severe chest pain or pressure; pain in your arms, back, neck, or jaw; shortness of breath; numbness or weakness on one side of your body; trouble talking; sudden severe headache; sudden vision changes.
Liver problems: LENVIMA may cause liver problems that may lead to liver failure and death. Your healthcare provider will check your liver function before and during treatment with LENVIMA. Tell your healthcare provider right away if you have any of the following symptoms: your skin or the white part of your eyes turns yellow (jaundice); dark “tea-colored” urine; light-colored bowel movements (stools); feeling drowsy, confused or loss of consciousness.
Kidney problems: Kidney failure, which can lead to death, has happened with LENVIMA treatment. Your healthcare provider should do regular blood tests to check your kidneys.
Increased protein in your urine (proteinuria): Proteinuria is a common side effect of LENVIMA and can be serious. Your healthcare provider should check your urine for protein before and during your treatment with LENVIMA.
Diarrhea: Diarrhea is a common side effect of LENVIMA and can be serious. If you get diarrhea, ask your healthcare provider about what medicines you can take to treat your diarrhea. It is important to drink more water when you get diarrhea. Tell your healthcare provider or go to the emergency room, if you are unable to drink enough liquids and your diarrhea is not able to be controlled.
An opening in the wall of your stomach or intestines (perforation) or an abnormal connection between two or more body parts (fistula): Get emergency medical help right away if you have severe stomach (abdomen) pain.
Changes in the electrical activity of your heart called QT prolongation: QT prolongation can cause irregular heartbeats that can be life threatening. Your healthcare provider will do blood tests before and during your treatment with LENVIMA to check the levels of potassium, magnesium, and calcium in your blood, and may check the electrical activity of your heart with an ECG.
Low levels of blood calcium (hypocalcemia): Your healthcare provider will check your blood calcium levels during treatment with LENVIMA and may tell you to take a calcium supplement if your calcium levels are low.
A condition called Reversible Posterior Leukoencephalopathy Syndrome (RPLS): Call your healthcare provider right away if you get severe headache, seizures, weakness, confusion, or blindness or change in vision.
Bleeding: LENVIMA may cause serious bleeding problems that may lead to death. Tell your healthcare provider if you have any signs or symptoms of bleeding during treatment with LENVIMA, including severe and persistent nose bleeds; vomiting blood; red or black (looks like tar) stools; blood in your urine; coughing up blood or blood clots; heavy or new onset vaginal bleeding.
Change in thyroid hormone levels: Your healthcare provider should check your thyroid hormone levels before starting and every month during treatment with LENVIMA.
Wound healing problems: Wound healing problems have happened in some people who take LENVIMA. Tell your healthcare provider if you plan to have any surgery before or during treatment with LENVIMA.
- You should stop taking LENVIMA at least 1 week before planned surgery.
- Your healthcare provider should tell you when you may start taking LENVIMA again after surgery.
Severe jaw bone problems (osteonecrosis): Severe jaw bone problems have happened in some people who take LENVIMA. Certain risk factors such as taking a bisphosphonate medicine or the medicine denosumab, having dental disease, or an invasive dental procedure may increase your risk of getting jaw bone problems. Your healthcare provider should examine your mouth before you start and during treatment with LENVIMA. Tell your dentist that you are taking LENVIMA. It is important for you to practice good mouth care during treatment with LENVIMA. Tell your healthcare provider right away if you have any signs or symptoms of jaw bone problems during treatment with LENVIMA, including jaw pain, toothache, or sores on your gums, and if you plan to have any dental procedures before or during treatment with LENVIMA.
- You should stop taking LENVIMA at least 1 week before planned dental surgery or invasive dental procedures.
- Your healthcare provider should tell you when you may start taking LENVIMA again after dental procedures.
The most common side effects of LENVIMA when given with KEYTRUDA include decrease in thyroid hormone levels, increased blood pressure, tiredness, diarrhea, joint and muscle pain, nausea, decreased appetite, vomiting, mouth sores, weight loss, stomach-area (abdomen) pain, urinary tract infection, protein in your urine, constipation, headache, bleeding, rash, redness, itching, or peeling of your skin on your hands and feet, hoarseness, and rash.
LENVIMA may cause fertility problems in males and females and can harm your unborn baby. Tell your healthcare provider if you are:
- pregnant or plan to become pregnant. For females who are able to become pregnant, your healthcare provider should do a pregnancy test before you start treatment with LENVIMA. Use an effective method of birth control during treatment with LENVIMA and for 30 days after the last dose of LENVIMA
- breastfeeding or plan to breastfeed. It is not known if LENVIMA passes into your breast milk. Do not breastfeed during treatment with LENVIMA and for 1 week after the last dose
Your healthcare provider may need to reduce your dose of LENVIMA, or delay or completely stop treatment if you have certain side effects.
These are not all the possible side effects of LENVIMA. Call your doctor for medical advice about side effects.