Pembrolizumab (Keytruda) for Triple-Negative Breast Cancer

Pembrolizumab is an immunotherapy used for triple-negative breast cancer (TNBC). In high-risk early-stage TNBC (Stage II–III) it is given with chemotherapy before surgery and then alone after surgery, to shrink the tumour and lower the chance of recurrence. In advanced or metastatic TNBC, it is combined with chemotherapy when the tumour is PD-L1 positive (CPS of 10 or more). It is not used for hormone-receptor-positive or HER2-positive breast cancer. Your oncologist and tumour board decide whether it fits your specific diagnosis.

Pembrolizumab is given as an intravenous drip in a day-care setting, taking about 30 minutes per infusion, usually once every 3 weeks (or every 6 weeks at a higher dose). For early-stage TNBC, treatment continues for roughly a year — given with chemotherapy before surgery, then on its own for up to nine cycles afterwards. For metastatic TNBC, it is continued as long as it keeps working and side effects remain manageable, often up to two years. Blood tests and organ checks are done before each cycle.

Common side effects are usually mild: tiredness, skin rash or itching, nausea, diarrhoea, loss of appetite, cough and joint pain. Because pembrolizumab activates the immune system, it can also cause immune-related side effects, where the immune system inflames healthy organs — most often the thyroid, lungs (pneumonitis), bowel (colitis), liver or skin. These can appear during or even months after treatment. Most are manageable if caught early, usually by pausing the drug and giving steroids. Report any new breathlessness, persistent diarrhoea, yellow skin or unusual tiredness to your team immediately.

In India, a single dose of pembrolizumab usually costs around ₹2,00,000 to ₹4,50,000, and a full cycle including the day-care infusion is commonly ₹2,15,000 to ₹2,60,000. The total depends on your body weight (dosing is weight-based), the number of cycles, the schedule (3-weekly versus 6-weekly), and the chemotherapy given alongside it. Because early-stage treatment runs for about a year, the costs add up across cycles. At CION we provide a transparent written estimate up front and help you check insurance, Aarogyasri, EMI and patient-assistance options before you start.

It depends on your stage. For high-risk early-stage TNBC, pembrolizumab is offered regardless of PD-L1 status, because the KEYNOTE-522 trial showed benefit in both PD-L1-positive and PD-L1-negative patients. For metastatic TNBC, a PD-L1 test is required: pembrolizumab is added to chemotherapy only when the tumour scores a Combined Positive Score (CPS) of 10 or more. The test is done by a pathologist on a sample of your tumour from a biopsy or surgery. Your oncologist will arrange the right test for your situation.

In the KEYNOTE-522 trial for high-risk early-stage TNBC, adding pembrolizumab to chemotherapy before surgery raised the pathological complete response rate to 64.8% from 51.2% with chemotherapy alone, improved event-free survival (hazard ratio 0.63), and later showed an overall survival benefit (hazard ratio 0.66). In metastatic PD-L1-positive TNBC (KEYNOTE-355), pembrolizumab plus chemotherapy extended median overall survival to 23.0 months versus 16.1 months. Results vary from person to person; your oncologist can explain what these numbers mean for your individual case.

Many private health insurers now reimburse checkpoint inhibitors such as pembrolizumab, often through cashless tie-ups, and some corporate and government schemes provide cover. Coverage and limits vary by policy, so it is important to check your specific plan. At CION, our team helps you confirm your insurance benefits, check Aarogyasri eligibility, arrange EMI where suitable, and explore any applicable patient-assistance programmes — so you have a clear picture of out-of-pocket costs before treatment begins.

Yes. CION Cancer Clinics delivers pembrolizumab immunotherapy across its centres in Hyderabad and wider Telangana, given by senior medical oncologists in a monitored day-care setting. Every case is first reviewed by a tumour board of medical, surgical and radiation oncologists to confirm immunotherapy is the right choice and to plan how it fits with surgery, chemotherapy and radiation. You receive a 45-minute consultation, transparent written costs, and ongoing monitoring for immune side effects. Your first consultation is free for all cancer patients.