Keytruda (pembrolizumab) vs Imfinzi (durvalumab)

Keytruda (pembrolizumab) and Imfinzi (durvalumab) are both immunotherapy drugs known as checkpoint inhibitors, but they target different proteins; Keytruda blocks PD-1, a protein on T cells that normally helps keep these cells from attacking other cells in the body, while Imfinzi blocks PD-L1, which can be expressed on cancer cells and immune cells. Keytruda is approved for a wide range of cancers, including melanoma, lung cancer, head and neck cancer, and others, and has a broad range of clinical trial data supporting its use. In contrast, Imfinzi has shown effectiveness in specific types of cancer, such as non-small cell lung cancer and bladder cancer, and is chosen based on specific clinical criteria and the cancer's characteristics. When deciding between the two, it is essential to consult with a healthcare provider to consider the specific type of cancer, its stage, the patient's overall health, and the safety and efficacy profile of each drug.

Difference between Keytruda and Imfinzi

Metric	Keytruda (pembrolizumab)	Imfinzi (durvalumab)
Generic name	Pembrolizumab	Durvalumab
Indications	Various types of cancers including melanoma, lung cancer, head and neck cancer, Hodgkin lymphoma, and others.	Primarily for locally advanced or metastatic urothelial carcinoma and stage III non-small cell lung cancer after chemoradiation therapy.
Mechanism of action	PD-1 receptor blocker that prevents the PD-1 protein on T cells from binding with PD-L1 and PD-L2 on tumor cells, enabling the immune system to attack the cancer cells.	PD-L1 inhibitor that binds to the PD-L1 protein on tumor cells and tumor-infiltrating immune cells, blocking its interaction with PD-1 and CD80, thus enhancing T-cell mediated tumor cell killing.
Brand names	Keytruda	Imfinzi
Administrative route	Intravenous infusion	Intravenous infusion
Side effects	Fatigue, musculoskeletal pain, decreased appetite, pruritus, diarrhea, nausea, rash, fever, cough, dyspnea, constipation, pain, and abdominal pain.	Fatigue, musculoskeletal pain, constipation, decreased appetite, nausea, peripheral edema, urinary tract infection, fever, and rash.
Contraindications	Severe hypersensitivity to pembrolizumab or any of its excipients.	Severe hypersensitivity to durvalumab or any of its excipients.
Drug class	Anti-PD-1 monoclonal antibody	Anti-PD-L1 monoclonal antibody
Manufacturer	Merck & Co.	AstraZeneca

Efficacy

Keytruda (Pembrolizumab) Efficacy in Lung Cancer

Keytruda, also known by its generic name pembrolizumab, is a highly effective treatment option for certain types of lung cancer. It is a type of immunotherapy that works by blocking the PD-1 pathway, which some cancer cells use to hide from the immune system. By interfering with this pathway, Keytruda helps the immune system to detect and fight cancer cells. It has been approved for the treatment of both non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) in specific contexts, particularly for tumors that express PD-L1 and in combination with other therapies depending on the stage and genetic markers of the cancer.

For advanced NSCLC, Keytruda has shown a significant improvement in overall survival rates compared to traditional chemotherapy in several clinical trials. It is often used as a first-line treatment for patients whose tumors express PD-L1 in 1% or more of their cells and who do not have EGFR or ALK genetic mutations. In some studies, Keytruda has doubled the one-year survival rate compared to chemotherapy, marking a significant advancement in the treatment of lung cancer.

Imfinzi (Durvalumab) Efficacy in Lung Cancer

Imfinzi, or durvalumab, is another immunotherapy drug used in the treatment of lung cancer. Similar to pembrolizumab, durvalumab is a PD-L1 inhibitor that helps the immune system recognize and attack cancer cells. Imfinzi has been approved for the treatment of unresectable, Stage III NSCLC following chemoradiation therapy. It is used as a consolidation therapy to reduce the risk of the cancer progressing.

In clinical trials, Imfinzi has shown a significant increase in progression-free survival (PFS) in patients with Stage III NSCLC who have completed chemoradiation. The PACIFIC trial, a pivotal study for Imfinzi, demonstrated a median PFS of 17.2 months for patients treated with durvalumab compared with 5.6 months for the placebo group. This marked improvement in PFS represents a new standard of care for patients with Stage III NSCLC who are not candidates for surgery. The use of Imfinzi in this context has been a major development in the management of lung cancer, offering hope for improved outcomes in a disease that has historically had limited treatment options after chemoradiation.

Regulatory Agency Approvals

Keytruda

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA
Health Canada
Therapeutic Goods Administration (TGA), Australia
Medsafe (NZ)

Imfinzi

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA
Health Canada
Therapeutic Goods Administration (TGA), Australia
Medsafe (NZ)

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