Latest Cancer TreatmentsDr. Mohammadreza Dabiri
Dr. Mohammadreza Dabiriفارسی
Treatment regimen

KEYNOTE-522 regimen: pembrolizumab and chemotherapy in triple-negative breast cancer

Paclitaxel and carboplatin, then AC or EC, with pembrolizumab before and after surgery

Updated: 28 October 20261 min read2 references

Summary for doctors

  • Stage 2 to 3 triple-negative breast cancer (T1c N1-2 or T2-4) [1].
  • Pathological complete response rose from 51.2% to 64.8% [1].
  • Pembrolizumab continues after surgery, regardless of the pathological response.

Dose and schedule

KEYNOTE-522

Early triple-negative breast cancer, before and after surgeryEach drug’s schedule in the table

Early triple-negative breast cancer, before and after surgery

DrugDoseRouteSchedule
Phase 1: 12 weeks
Pembrolizumab200 mgIVEvery 3 weeks
Paclitaxel80 mg/m²IVWeekly
CarboplatinAUC 5 every 3 weeks (or AUC 1.5 weekly)IVDay 1
Phase 2: 4 cycles
Pembrolizumab200 mgIVDay 1
Doxorubicin or epirubicin60 or 90 mg/m²IVDay 1
Cyclophosphamide600 mg/m²IVDay 1
Phase 3: after surgery
Pembrolizumab200 mgIVEvery 3 weeks, 9 doses
Cycle schedule
Phase 2 every 21 days; pembrolizumab every 3 weeks in all phases
Duration
24 weeks before surgery, then 27 weeks of pembrolizumab

Doses as in KEYNOTE-522 [1]. Pembrolizumab 400 mg every 6 weeks is an approved alternative.

Dose source: [2].

Evidence: KEYNOTE-522 (2024), KEYNOTE-522 (2020)

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

  • Phase 1: paclitaxel premedication; carboplatin AUC 5: NK1, 5-HT3 and dexamethasone.
  • Phase 2: four-drug antiemetics for AC.
  • Teach the symptoms of immune-related toxicity; adrenal and pituitary insufficiency starts with vague tiredness.

Monitoring and dose adjustment

  • TSH and free T4, glucose, liver enzymes and creatinine at baseline and every 6 weeks; morning cortisol with tiredness or low blood pressure.
  • Echocardiogram before the anthracycline.
  • Grade 2 immune-related toxicity: hold pembrolizumab and treat as in the immunotherapy toxicity lesson; chemotherapy continues depending on the toxicity.

Main evidence

Show detailsHide

KEYNOTE-522: adding pembrolizumab increased the pathological complete response rate from 51.2% to 64.8% [1] and, with longer follow-up, improved event-free and overall survival.

Related cancer types

Breast cancer

Treatment regimens (physicians)

AC followed by paclitaxel (dose-dense and weekly)TC regimen (docetaxel and cyclophosphamide): dose and scheduleTCHP regimen: dose and schedule in HER2-positive breast cancerWeekly paclitaxel with trastuzumab (APT regimen)Trastuzumab emtansine (T-DM1, Kadcyla): dose and scheduleTrastuzumab deruxtecan (T-DXd, Enhertu): dose and monitoringAdjuvant capecitabine after neoadjuvant treatment (CREATE-X)Sacituzumab govitecan (Trodelvy)Pembrolizumab with chemotherapy in metastatic triple-negative breast cancer (KEYNOTE-355)

Physician tools and lessons

Cumulative Anthracycline Dose and Doxorubicin Equivalents10 cheap steps that save patients' livesBone-modifying agents in cancer: bone metastases, adjuvant use and osteonecrosis of the jawGermline genetic testing in cancer: who, and which genes?Management of brain metastasesFertility preservation before cancer treatmentMalignant pleural effusion: drainage, pleurodesis or an indwelling catheterCancer during pregnancy: chemotherapy and decisions

References

2 references
Show all references, 1 with a study cardClose 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. 1
    Pembrolizumab for Early Triple-Negative Breast CancerSchmid P, Cortes J, Pusztai L, et al · N Engl J Med · 2020;382:810-821
    Study cardDOIPubMed Back to text: 1 2 3 4
  2. 2
    KEYTRUDA (PEMBROLIZUMAB) — Prescribing InformationMerck Sharp & Dohme LLC · FDA label · 2026
    Source Back to text

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/keynote-522-pembrolizumab-chemotherapy/

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