Summary for doctors
- First line in non-squamous lung cancer without EGFR, ALK, ROS1 or other targetable alterations [1].
- 4 cycles of the three drugs, then maintenance pembrolizumab and pemetrexed [1].
- Do not use pemetrexed with a creatinine clearance below 45; vitamins are mandatory.
Dose and schedule
Carbo/Pem/Pembro
Metastatic non-squamous lung cancer, first lineCycle length: Every 21 days
Metastatic non-squamous lung cancer, first line
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Phase 1: 4 cycles | |||
| Pembrolizumab | 200 mg | IV | Day 1 |
| Pemetrexed | 500 mg/m² | IV | Day 1 |
| Carboplatin (or cisplatin 75 mg/m²) | AUC 5 | IV | Day 1 |
| Phase 2: maintenance | |||
| Pembrolizumab | 200 mg | IV | Day 1 |
| Pemetrexed | 500 mg/m² | IV | Day 1 |
Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.
Premedication and supportive care
- Pemetrexed: folic acid 350 to 1000 micrograms daily from 7 days before the first dose until 21 days after the last dose, vitamin B12 1000 micrograms IM one week before the first dose and every 9 weeks, and dexamethasone 4 mg twice a day on the day before, the day of and the day after the infusion.
- Antiemetics: carboplatin AUC 5: NK1, 5-HT3 and dexamethasone.
- With a creatinine clearance of 45 to 79, stop NSAIDs from 2 days before until 2 days after pemetrexed.
Monitoring and dose adjustment
- Blood counts and creatinine before each cycle; TSH, glucose, liver enzymes and creatinine at baseline and every 6 weeks; immune-related toxicity as in the immunotherapy toxicity lesson.
Main evidence
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KEYNOTE-189: 12-month overall survival was 69.2% with pembrolizumab vs 49.4% with placebo, and the benefit was seen at all PD-L1 levels [1].
Related cancer types
Treatment regimens (physicians)
References
2 referencesShow all referencesClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
- 1
- 2KEYTRUDA (PEMBROLIZUMAB) — Prescribing Information
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
Printed from the website; the full and up-to-date version: https://drdabiri.com/en/regimens/carboplatin-pemetrexed-pembrolizumab/