Advanced microsatellite instability-high cancer

ADRIENNE’S TRU STORY

Adrienne, a real patient from a clinical trial. KEYTRUDA may not work for everyone, but this is her TRU STORY.

Adrienne’s journey

In times of turmoil, many of us turn to our families for support. For Adrienne, a digital media professional and single mother to 4 grown daughters, her battle with cancer was truly a family affair.

Some people are either living in the future or living in the past. I’m in the present.
- Adrienne, on her outlook

A shared connection

"When my sister was in her 40s, she went in for what was supposed to be a short surgery and they found she had multiple types of cancer."

Through testing, doctors discovered her sister had Lynch syndrome, a rare genetic condition that increases the risk of certain cancers. This increased risk is often caused by a genetic defect that prevents DNA from repairing errors. This, in turn, may lead to high levels of a biomarker called MSI.

Doctors may test certain cancers for this biomarker (MSI-H), because it can impact the way the cancer is managed. And because Lynch syndrome is inherited, the rest of her family was tested immediately. Adrienne and many of her family members tested positive.

We talk about what you can do with the hand you’ve been dealt, not the cards you wanted.
- Adrienne, on staying optimistic

Embracing uncertainty

“It’s not a great feeling to know you’re walking around with a genetic mutation like this, but that’s the way it is.”

“I am an inherently optimistic person, and my family members are as well. So when they got tested and we got the results, they accepted it. They said, ‘We understand this is nobody’s fault. It’s just the way it is.’”

Through regular screenings, Adrienne’s doctors discovered she had ampullary cancer in 2013 (the ampulla is where the bile and pancreatic ducts meet and empty into the small intestine.) Because doctors knew she had Lynch syndrome, they knew to test for MSI-H.

Her community, by her side

As she went through her journey, her upbeat attitude and close ties with her family and community helped carry her forward.

“I didn’t want to chuck everything and travel the world. I wanted to be connected.”

“So when I was having a tough time, I’d blog about my experiences. I’d crack jokes. Humor helps, because you have to stay positive.”

“I have an amazing support network of friends, between my church and other friends who are close to me, who took care of me. They drove my kid to piano lessons, brought me food, walked the dog. They were amazing.”

“Even the company I work for stood by me. They backed me up the whole way. That’s amazing.”

“That kind of support network is really important, and that’s why it’s important for me to give back now. Because you just never know. Something small can make a huge difference in someone’s life.”

You’ve got to have a sense of humor in life, because stuff can be hard. I make a joke, and it gets me through.
- Adrienne, on facing her diagnosis

FDA-Approved Indications

KEYTRUDA is a prescription medicine used to treat a kind of cancer that is shown by a laboratory test to be a microsatellite instability-high (MSI-H) or a mismatch repair deficient (dMMR) solid tumor. KEYTRUDA may be used in adults and children to treat:

  • cancer that has spread or cannot be removed by surgery (advanced cancer), and
  • has progressed following treatment, and you have no satisfactory treatment options, or
  • you have colon or rectal cancer, and you have received chemotherapy with fluoropyrimidine, oxaliplatin, and irinotecan but it did not work or is no longer working.

It is not known if KEYTRUDA is safe and effective in children with MSI-H cancers of the brain or spinal cord (central nervous system cancers).

Important Safety Information

KEYTRUDA is a medicine that may treat certain cancers by working with your immune system. KEYTRUDA can cause your immune system to attack normal organs and tissues in any area of your body and can affect the way they work. These problems can sometimes become severe or life-threatening and can lead to death. These problems may happen any time during treatment or even after your treatment has ended.

Call or see your doctor right away if you develop any symptoms of the following problems or these symptoms get worse:

Lung problems (pneumonitis). Symptoms of pneumonitis may include shortness of breath, chest pain, or new or worse cough.

Intestinal problems (colitis) that can lead to tears or holes in your intestine. Signs and symptoms of colitis may include diarrhea or more bowel movements than usual; stools that are black, tarry, sticky, or have blood or mucus; or severe stomach-area (abdomen) pain or tenderness.

Liver problems, including hepatitis. Signs and symptoms of liver problems may include yellowing of your skin or the whites of your eyes, nausea or vomiting, pain on the right side of your stomach area (abdomen), dark urine, or bleeding or bruising more easily than normal.

Hormone gland problems (especially the thyroid, pituitary, adrenal glands, and pancreas). Signs and symptoms that your hormone glands are not working properly may include rapid heartbeat, weight loss or weight gain, increased sweating, feeling more hungry or thirsty, urinating more often than usual, hair loss, feeling cold, constipation, your voice gets deeper, muscle aches, feeling very weak, dizziness or fainting, or headaches that will not go away or unusual headache.

Kidney problems, including nephritis and kidney failure. Signs of kidney problems may include change in the amount or color of your urine.

Skin problems. Signs of skin problems may include rash, itching, blisters, peeling or skin sores, or painful sores or ulcers in your mouth or in your nose, throat, or genital area.

Problems in other organs. Signs and symptoms of these problems may include changes in eyesight; severe or persistent muscle or joint pains; severe muscle weakness; low red blood cells (anemia); swollen lymph nodes, rash or tender lumps on skin, cough, shortness of breath, vision changes, or eye pain (sarcoidosis); confusion, fever, muscle weakness, balance problems, nausea, vomiting, stiff neck, memory problems, or seizures (encephalitis); and shortness of breath, irregular heartbeat, feeling tired, or chest pain (myocarditis).

Infusion (IV) reactions that can sometimes be severe and life-threatening. Signs and symptoms of infusion reactions may include chills or shaking, shortness of breath or wheezing, itching or rash, flushing, dizziness, fever, or feeling like passing out.

Rejection of a transplanted organ. People who have had an organ transplant may have an increased risk of organ transplant rejection if they are treated with KEYTRUDA.

Complications, including graft-versus-host disease (GVHD), in people who have received a bone marrow (stem cell) transplant that uses donor stem cells (allogeneic). These complications can be severe and can lead to death. These complications may happen if you underwent transplantation either before or after being treated with KEYTRUDA. Your doctor will monitor you for the following signs and symptoms: skin rash, liver inflammation, abdominal pain, and diarrhea.

Getting medical treatment right away may help keep these problems from becoming more serious. Your doctor will check you for these problems during treatment with KEYTRUDA. Your doctor may treat you with corticosteroid or hormone replacement medicines. Your doctor may also need to delay or completely stop treatment with KEYTRUDA if you have severe side effects.

Before you receive KEYTRUDA, tell your doctor if you have immune system problems such as Crohn’s disease, ulcerative colitis, or lupus; have had an organ transplant or plan to have or have had a bone marrow (stem cell) transplant that used donor stem cells (allogeneic); have lung or breathing problems; have liver problems; or have any other medical problems.

If you are pregnant or plan to become pregnant, tell your doctor. KEYTRUDA can harm your unborn baby. If you are able to become pregnant, your doctor will give you a pregnancy test before you start treatment. Use effective birth control during treatment and for at least 4 months after the final dose of KEYTRUDA. Tell your doctor right away if you think you may be pregnant or you become pregnant during treatment with KEYTRUDA.

If you are breastfeeding or plan to breastfeed, tell your doctor. It is not known if KEYTRUDA passes into your breast milk. Do not breastfeed during treatment with KEYTRUDA and for 4 months after your final dose of KEYTRUDA.

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Common side effects of KEYTRUDA when used alone include feeling tired; pain, including pain in muscles, bones, or joints and stomach area (abdominal) pain; decreased appetite; itching; diarrhea; nausea; rash; fever; cough; shortness of breath; and constipation.

Common side effects of KEYTRUDA when given with certain chemotherapy medicines include feeling tired or weak; nausea; constipation; diarrhea; decreased appetite; rash; vomiting; cough; trouble breathing; fever; hair loss; inflammation of the nerves that may cause pain, weakness, and paralysis in the arms and legs; swelling of the lining of the mouth, nose, eyes, throat, intestines, or vagina; and mouth sores.

Common side effects of KEYTRUDA when given with axitinib include diarrhea; feeling tired or weak; high blood pressure; liver problems; low levels of thyroid hormone; decreased appetite; blisters or rash on the palms of your hands and soles of your feet; nausea; mouth sores or swelling of the lining of the mouth, nose, eyes, throat, intestines, or vagina; hoarseness; rash; cough; and constipation.

In children, feeling tired, vomiting and stomach-area (abdominal) pain, and increased levels of liver enzymes and decreased levels of salt (sodium) in the blood are more common than in adults.

These are not all the possible side effects of KEYTRUDA. Tell your doctor if you have any side effect that bothers you or that does not go away. For more information, ask your doctor or pharmacist.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please read the accompanying Medication Guide for KEYTRUDA and discuss it with your doctor. The physician Prescribing Information also is available.