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Poster Display session

55P - Real-world monitoring of hybrid dosing of pembrolizumab in stage IV non-small cell lung cancer in the Netherlands


31 Mar 2023


Poster Display session


Esther Dronkers


Journal of Thoracic Oncology (2023) 18 (4S): S35-S88.


E. Dronkers1, E. van Geffen2, C. Bekkers3, A. Sobels4, R. van Drie-Pierik5, A. Eldering - Heldens6, J. Zwaveling7, J. Eijsink8, H.J.M. Smit9, D. Hilarius10

Author affiliations

  • 1 Amsterdam/NL
  • 2 LOGEX, Amsterdam/NL
  • 3 Jeroen Bosch Hospital, 's-Hertogenbosch/NL
  • 4 Hagaziekenhuis, Den Haag/NL
  • 5 Medisch Spectrum Twente, Enschede/NL
  • 6 Noordwest Ziekenhuisgroep, Alkmaar/NL
  • 7 LUMC-Leiden University Medical Center, Leiden/NL
  • 8 Isala, Zwolle/NL
  • 9 Rijnstate Hospital Arnhem, Arnhem/NL
  • 10 Rodekruis Ziekenhuis Beverwijk, Beverwijk/NL


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Abstract 55P


In the Netherlands, pembrolizumab dosing guidelines have been altered from a fixed dose to hybrid dosing. Hybrid dosing reduces costs and helps to maintain a sustainable healthcare system, without compromising the safety and efficacy. Implementation of these new dosing guidelines can be challenging in daily clinical practice. The Dutch Institute for Clinical Auditing (DICA) medicine program was set up to help hospitals overcome these challenges by analyzing real-world drug use and discussing the different policies between hospitals. In this project we aimed to determine to what extent hybrid dosing is being used and aid to further implementation.


Clinical and claims data of stage IV non-small cell lung cancer patients from 2018–2022 were linked to analyze dosing strategies of pembrolizumab in the 26 Dutch hospitals that participated in the DICA medicine program. Standard dosing was defined as a fixed dose of 200 mg per three weeks or 400 mg per six weeks. Hybrid dosing was defined as 100 mg or 150 mg per three weeks, or 200 mg or 300 mg per six weeks depending on patients’ weight. Insights per hospital were discussed in a roundtable session with medical specialists and hospital pharmacists.


Of the 26 hospitals involved, five prescribed pembrolizumab with hybrid dosing. Implementation of hybrid dosing increased between 2020 and 2022. One hospital reduced the dosage using a different dosing strategy. Within the hospitals that fully implemented hybrid dosing, a reduction of costs for pembrolizumab of 25% was observed. In the roundtable session hospital staff shared best practices. Technical limitation was among others mentioned as challenge to overcome by hospitals that did not implement hybrid dosing yet.


The DICA medicine program is a platform to use real-world data to improve quality of care. Clinical and claims data showed that hybrid dosing of pembrolizumab in NSCLC patients was only partially implemented in the Netherlands. Providing insights on implementation across hospitals and sharing best practices may support the implementation of guidelines. Because the DICA medicine program is connected with different clinical registrations, in the future real-world outcome of this new strategy can be assessed.

Legal entity responsible for the study

Dutch Institute for Clinical Auditing.


Zorgverzekeraars Nederland.


E. Dronkers: Financial Interests, Institutional, Funding: Zorgverzekeraars Nederland; Financial Interests, Personal, Full or part-time Employment: LOGEX. E. van Geffen: Financial Interests, Institutional, Funding: Zorgverzekeraars Nederland; Financial Interests, Personal, Full or part-time Employment: LOGEX. All other authors have declared no conflicts of interest.

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