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Pembrolizumab Retreatment — SCE Medical Oncology MCQ

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HardLung CancerPembrolizumab RetreatmentSCE Medical Oncology

A 72-year-old man with metastatic NSCLC achieves a durable complete response on pembrolizumab monotherapy. At 2 years, pembrolizumab is stopped per protocol. Eighteen months later, surveillance CT shows new bilateral lung nodules consistent with recurrence. What should be offered?

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Correct answer: D — Offer protocol-defined second-course pembrolizumab after complete restaging

The relevant KEYNOTE protocols allowed eligible patients who progressed after completing 35 cycles to receive a defined second course of pembrolizumab, so retreatment can be offered after confirming recurrence, current molecular status and eligibility. Platinum-pemetrexed is a reasonable later strategy in some patients but is not the protocol-defined retreatment answer. Nivolumab-ipilimumab is not automatically substituted after an off-treatment pembrolizumab response. Docetaxel-ramucirumab is a later-line cytotoxic-antiangiogenic option rather than the defined second course. Bilateral pulmonary recurrence is not appropriately managed by local ablation alone.

Reference: Long-term outcomes and second-course pembrolizumab in KEYNOTE-010 (Published May 2020): https://pubmed.ncbi.nlm.nih.gov/32078391/; KEYTRUDA 25 mg/mL UK summary of product characteristics (Current UK SmPC, updated June 2026): https://www.medicines.org.uk/emc/product/2498/smpc