NICE (the National Institute for Health and Care Excellence) has approved the use of pembrolizumab for routine use on the NHS in England to treat triple negative locally advanced or secondary breast cancer.

Photograph of a patient receiving cancer treatment

What is pembrolizumab?

Pembrolizumab (also known as Ketytruda) is a targeted (biological) therapy. It’s also referred to as an immunotherapy.

Immunotherapy for the treatment of cancer helps the immune system to recognise and attack cancer cells.

When used to treat breast cancer, pembrolizumab is given with chemotherapy. This may be nab-paclitaxel or paclitaxel.

Who might benefit from pembrolizumab?

Pembrolizumab may be offered to people who:

How does pembrolizumab work?

Our immune (defence) system usually protects us from infection and illness by recognising and attacking unfamiliar substances and germs like viruses and bacteria, and abnormal cells like cancer cells, leaving normal healthy cells alone. But sometimes the body’s natural immune system is not able to do this.

Cancer cells can use certain proteins such as PD-1 and PD-L1, sometimes called immune checkpoint proteins, to hide from the immune system enabling them to grow and spread.

Pembrolizumab works by blocking one of these proteins. It is then able to help the immune system to find the cancer cells and destroy them.

Triple negative secondary breast cancers can be tested for PD-L1 levels. This is done in a laboratory on a sample of breast cancer tissue removed during a biopsy.

Is pembrolizumab just available on the NHS in England?

NICE has approved it for use in England, but Wales and Northern Ireland normally follow NICE decisions. Pembrolizumab is now being assessed by the Scottish Medicines Consortium (SMC) which we are inputting into. A decision on its use on the NHS in Scotland is expected later this year.

Pembrolizumab and primary triple negative breast cancer

Pembrolizumab is not currently given for primary (early) triple negative breast cancer, but this is being looked at in clinical trials.

NICE is currently assessing pembrolizumab in combination with chemotherapy before surgery, and when used alone after surgery. A decision on its use on the NHS is expected in autumn 2022. We are also awaiting the timelines for the SMC to assess this treatment for use in Scotland.

If you have experience of pembrolizumab for primary breast cancer, we’d like to hear from you. You can email our Policy team at to inform our work.

If you think that pembrolizumab may be an option for you, speak to your treatment team. You can also call our Helpline team on 0808 800 6000 if you have questions about your treatment or want to talk something through.

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