Patient treatment portal · Pembrolizumab + pemetrexed + carboplatin

Your complete treatment reference

Understand the plan. Find what you need.

Medicines, schedule, tests, side effects, daily life, with sources and practical actions.

Open complete patient reference → Explore your 21-day timeline →

Source reconciled; independent clinical, pharmacy and patient/PPI review pending · prepared 2026-10-25

Induction: all three medicines on Day 1 every 21 days for up to four cycles. Maintenance: carboplatin stops; pembrolizumab and pemetrexed may continue every 21 days while appropriate.

How your medicines work

Immunotherapy

Pembrolizumab

Releases an immune brake

Immune cell→Brake blocked→Cancer cell

PD-1 is a control switch on T cells, a type of immune cell. When it connects with PD-L1 or PD-L2, the T cell receives a signal to reduce its activity. Some cancers use this pathway to escape immune attack. Pembrolizumab is an antibody that blocks PD-1, helping T cells recognise and attack the cancer. It does not directly poison cancer cells like chemotherapy. Releasing this brake can also allow immune cells to attack healthy organs, which explains the different side-effect pattern and why symptoms can appear after treatment stops.

The immune system can also inflame healthy organs. New cough, diarrhoea, unusual weakness, severe headache, thirst or a spreading rash need prompt advice. Effects can start during treatment or after it finishes.

Chemotherapy

Pemetrexed

Disrupts DNA building

DNA building blocks→Supply disrupted→Cell division slows

Pemetrexed is an antifolate: it blocks several enzymes that cells use to turn folate-dependent materials into DNA and RNA building blocks. With fewer building blocks, cancer cells have more difficulty copying their genetic instructions and dividing. Healthy rapidly renewing tissues, including bone marrow and the mouth lining, can also be affected. That helps explain low blood counts and mouth soreness. Prescribed folic acid and vitamin B12 reduce toxicity; they are part of the treatment, not supplements to omit because the drug is an antifolate.

Healthy tissues can be affected too: low blood counts, a sore mouth, rash and kidney problems are important. Folic acid, vitamin B12 and prescribed steroids help reduce particular risks.

Chemotherapy

Carboplatin

Damages cancer-cell DNA

DNA strands→Platinum links→Copying disrupted

Carboplatin is a platinum-containing chemotherapy. Inside cells, it forms chemical attachments to DNA, including links that stop DNA strands working normally. This disrupts copying and repair and can lead to cell death. Healthy cells can also be injured, especially blood-forming cells in the bone marrow. The kidneys help remove carboplatin, so kidney function is used to calculate the dose. AUC 5 describes a target drug exposure over time; it is not a fixed dose of 5 mg.

Low blood counts, nausea and vomiting can occur. An allergic reaction is also possible: tell the nurse immediately if you feel flushed, itchy, tight-chested or unwell during the drip.

Baseline → treatment → follow-up

Treatment checks across the course

Relative stages, not equally spaced dates. Agree who books each check, reviews results and gives advice if a check is missed.

Check	Before starting	First treatment	During treatment	Phase / dose review	After treatment
Bloods and symptoms	Blood count, kidney/liver, glucose, thyroid and viral checks; renal estimate	Folate and B12 in place before pemetrexed	Blood count, kidney/liver and glucose each cycle; thyroid every 3–6 weeks	After up to four cycles: carboplatin ends; continue maintenance checks	Folic acid for 21 days after last pemetrexed; remain alert to delayed immune symptoms
Treatment review	Confirm exact cancer setting and biomarkers	Explain expected benefit and how it will be assessed	Report new symptoms between visits	Review response, tolerability and active medicines	Agree the next treatment or surveillance plan
Vitamins and steroids	Folic acid lead-in and B12 in preceding week	One reconciled steroid prescription	Daily folate; B12 every three cycles while pemetrexed continues	Keep vitamins and rash prophylaxis in maintenance; review antiemetics	Folate continues for 21 days after final pemetrexed
Platinum effects	Baseline nerve/hearing and renal assessment	Check kidney function and carboplatin prescription	Nerve/hearing review before each platinum cycle	No carboplatin in maintenance; follow any persisting effects	Follow unresolved kidney, hearing or nerve effects

The whole treatment journey

Pembrolizumab + pemetrexed + carboplatin: treatment and checks

First-line metastatic non-squamous NSCLC without EGFR or ALK alterations

Induction: all three medicines on Day 1 every 21 days for up to four cycles. Maintenance: carboplatin stops; pembrolizumab and pemetrexed may continue every 21 days while appropriate.

Read from left to right. Columns show stages, not equal lengths of time. This is a general plan: no dates or personal information are needed. Your team confirms which steps apply and arranges appointments.

On a small screen, swipe the map sideways. The checks below give the same timing in words.

Treatment, tests and reviews across the course
Care / check	Before starting	First treatment	During treatment	Phase / dose review	After treatment
TreatmentNCCP 00568	Confirm exact indication and planned course	Start the source-specific schedule	Continue the active phase as prescribed	Confirm hold, restart, maintenance or completion	Agree follow-up and next decision
Bloods and symptomsNCCP 00568	Blood count, kidney/liver, glucose, thyroid and viral checks; renal estimate	Folate and B12 in place before pemetrexed	Blood count, kidney/liver and glucose each cycle; thyroid every 3–6 weeks	After up to four cycles: carboplatin ends; continue maintenance checks	Folic acid for 21 days after last pemetrexed; remain alert to delayed immune symptoms
Treatment reviewNCCP 00568	Confirm exact cancer setting and biomarkers	Explain expected benefit and how it will be assessed	Report new symptoms between visits	Review response, tolerability and active medicines	Agree the next treatment or surveillance plan
Vitamins and steroidsNCCP 00568	Folic acid lead-in and B12 in preceding week	One reconciled steroid prescription	Daily folate; B12 every three cycles while pemetrexed continues	Keep vitamins and rash prophylaxis in maintenance; review antiemetics	Folate continues for 21 days after final pemetrexed
Platinum effectsNCCP 00568	Baseline nerve/hearing and renal assessment	Check kidney function and carboplatin prescription	Nerve/hearing review before each platinum cycle	No carboplatin in maintenance; follow any persisting effects	Follow unresolved kidney, hearing or nerve effects

What each check is for

1Before startingBefore first dose

Confirm suitability and baseline safety

Ask / act: Confirm results, prescriptions and responsible teams.

Sources: NCCP 00568

2Whole-course and completion reviewAt phase change or completion

Some checks and support continue after a drug stops

Ask / act: Provide the ongoing monitoring and urgent-contact plan.

Sources: NCCP 00568

At the next review, ask

Which treatment phase am I in, and what happens next?
Which test is expected next, who arranges it, and who explains the result?
Who should I contact if an expected appointment has not arrived?

This map does not show whether a test has been ordered, booked or completed. Do not wait for a scheduled test if you develop new symptoms.

Open whole-treatment map Printable journey and checks

Day 1 → Day 21: a general pattern

This is a visual orientation, not a prediction of your personal cycle. It shows when some effects often emerge and which effects are not tied to a particular day.

Induction: all three medicines on Day 1 every 21 days for up to four cycles. Maintenance: carboplatin stops; pembrolizumab and pemetrexed may continue every 21 days while appropriate.

Day of cycle123456789101112131415161718192021

TreatmentDay 1 · infusion visit

Nausea / appetiteEarly days · may continue longer

Blood counts / infectionCounts may fall between visits · timing varies

Energy / mouth / bowelsSymptoms vary across the cycle

Immune effectsAny day · also after treatment ends

Induction: up to four cycles: Pembrolizumab, pemetrexed and carboplatin are given on Day 1 of a 21-day cycle for up to four cycles. The team may delay or change treatment after reviewing symptoms and test results.

Maintenance uses two medicines: After induction, carboplatin stops. Pembrolizumab and pemetrexed may continue every 21 days according to benefit, side effects and the consultant plan. Blood checks, folic acid, vitamin B12 and pemetrexed rash prophylaxis continue.

Symptoms do not follow a fixed calendar: Chemotherapy effects may overlap between cycles. Immune-related effects can begin during treatment or after it has ended. A symptom band does not identify a safe day or predict your personal recovery.

Care continues after the last infusion: Folic acid continues for 21 days after the final pemetrexed dose. Keep your immunotherapy alert information and follow the team’s monitoring and urgent-contact plan.

Why these bands stay broad: The treatment bands show a reference 21-day cycle. Induction and maintenance contain different medicines. Symptom bands are broad educational illustrations, not measured daily risks or a prediction of when you will feel well; immune-related effects can occur after treatment ends. Band length does not show likelihood or severity, and the chart cannot tell you whether it is safe to receive treatment.

There are no guaranteed “safe days”. Fever, shivers, sudden illness or new serious symptoms need prompt contact using your oncology team’s instructions. New breathlessness, cough, severe diarrhoea, marked weakness or other possible immune-related symptoms can occur during or after treatment. Do not wait for the next appointment or use the timeline to decide a symptom is safe.

Practical treatment guide

Practical treatment planning

Agree the arrangements with your oncology team.

STEP 1

Treatment phases and appointments

Induction: all three medicines on Day 1 every 21 days for up to four cycles. Maintenance: carboplatin stops; pembrolizumab and pemetrexed may continue every 21 days while appropriate.

STEP 2

Checks after treatment

Folic acid continues throughout pemetrexed and for 21 days after its last dose. Vitamin B12 remains due every three cycles while pemetrexed continues. Immune-related symptoms can arise during or after treatment; maintain alert-card and urgent-contact education. Response imaging follows the consultant plan.

STEP 3

Access and practical support

IV treatment; no 46-hour home fluorouracil pump. Venous access choice is individual. Check B12 appointments, daily folate supply, steroid directions and the immunotherapy alert card across both phases.

Open practical treatment guide · Printable practical guide

Sources: NCCP 00568 v5 · official regimen. Source reconciled; independent clinical, pharmacy and patient/PPI review pending.

Regimen-specific symptoms

Recognise symptoms and act early.

A picture of side effects

Numbered symptom boxes connect to the anatomical illustration. The medicine responsible may be uncertain; report the symptom.

1Hormones / brain

Pembrolizumab

Unusual tiredness, dizziness, headache, thirst or passing more urine.

3Heart

Pembrolizumab

Chest pain, racing heartbeat or fainting needs urgent assessment.

5Kidneys

Pemetrexed / pembrolizumab

Kidney function is monitored. Report less urine or new swelling.

7Skin / nerves

Pembrolizumab / chemotherapy

Spreading rash, blisters, weakness or new numbness should be reported.

Full-body anatomical illustration with numbered symptom locations

12345678

2Lungs

Pembrolizumab

New cough or breathlessness: report promptly. Infection, cancer or a clot can cause similar symptoms.

4Liver

Pembrolizumab

Yellow eyes or skin, dark urine or changes in blood tests.

6Bowel

Pembrolizumab / chemotherapy

New diarrhoea, persistent vomiting or severe tummy pain: contact your team.

8Blood / infection

Pemetrexed / carboplatin

Fever, shivers or suddenly feeling unwell: contact oncology immediately.

Selected effects, not every possible effect or a prediction. Blood-count, skin and line markers are schematic. Number and text carry meaning; colour is decorative.

Pembrolizumab

Immune inflammation of lungs, bowel, liver, kidneys, glands, skin and other organs
Serious infusion reactions
Effects can develop after treatment ends

Pemetrexed

Low blood counts and infection
Fatigue, nausea, mouth soreness and rash
Kidney toxicity; folate and B12 supplementation are required

Carboplatin

Low blood counts, infection or bleeding
Nausea and vomiting
Allergic reactions
Kidney, hearing and nerve effects

Support around treatment

Induction: carboplatin-containing cycles 1–4

High emetic risk is driven by carboplatin AUC5. Dedicated NCIS carboplatin row has no routine olanzapine. Do not combine rash and antiemetic dexamethasone courses without reconciliation. Carry immunotherapy alert card; do not wait until next cycle for possible immune toxicity.

Maintenance: pembrolizumab + pemetrexed

Folate, B12 and rash prophylaxis continue because pemetrexed continues. Carboplatin ends after induction; review supportive prescriptions at the phase change. Continue renal, glucose, thyroid and immune-toxicity monitoring.

Do not wait for the next appointment

Emergency: 112 / 999. Severe breathing difficulty, collapse, seizure or severe chest pain needs emergency help.

Contact oncology immediately for temperature ≥37.5°C or ≤36°C, shivering or suddenly feeling unwell, even with a normal temperature. Follow your own hospital’s instructions. If you cannot reach the team, seek urgent medical assessment.

Your oncology team · daytimeInsert numbers here

Acute Oncology Service

Your oncology team · out of hoursInsert numbers here

Ask for medical oncology

Evenings / overnightYour out-of-hours pathway / nearest ED

Other hospitals: use the numbers your team provides.

Contact the oncology team promptly for fever or feeling acutely unwell, new breathlessness or cough, severe diarrhoea, dehydration, chest pain, confusion, severe rash or other new symptoms. Use the emergency contact instructions given by your team.