Carfilzomib and dexamethasone

Carfilzomib (pronounced car-fill-zo-mib) is a targeted cancer drug.

What is carfilzomib and dexamethasone?

Carfilzomib and dexamethasone is a treatment for myeloma. Carfilzomib is also known as Kyprolis.

You have carfilzomib with a steroid called dexamethasone.

You may have this combination with other cancer drugs, including lenalidomide or daratumumab.

How does carfilzomib and dexamethasone work?

Carfilzomib is a type of targeted cancer drug called a proteasome inhibitor.

Proteasomes are in cells. They help to break down proteins that the cell doesn't need. Carfilzomib blocks the proteasomes so the proteins build up inside the cell. The cell then dies.

Dexamethasone helps carfilzomib to work better and kills myeloma cells.

How do you have carfilzomib and dexamethasone?

You have carfilzomib as a drip into your bloodstream (intravenously) over 30 minutes. You have dexamethasone intravenously or as tablets.

Into your bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

Taking your tablets

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking a cancer drug, or if you miss a dose.

You should take dexamethasone tablets after a meal or with milk as they can irritate your stomach. Taking them in the morning might help to stop difficulty in sleeping (insomnia).

When do you have carfilzomib and dexamethasone?

You have carfilzomib and dexamethasone as cycles of treatment. Each cycle is 28 days (4 weeks). 

You have both drugs two days in a row every week for 3 weeks, followed by a week with two days of dexamethasone on its own.

You usually have this treatment for as long as it is working and your side effects aren’t too bad.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

You might also have regular tests to check how your heart is working.

What are the side effects of carfilzomib and dexamethasone?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of getting an infection 

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nosebleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Low potassium levels in the blood 

You will have regular blood tests to check for this.

Decreased appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Difficulty sleeping (insomnia) 

If you have difficulty sleeping, it can help to change a few things about how you try to sleep. Try to go to bed and get up at the same time each day and spend some time relaxing before you go to bed. Some light exercise each day may also help. 

Headache and dizziness

Let your doctor or nurse know if you have headaches. They can give you painkillers. Don’t drive or operate machinery if you feel dizzy.

Numbness or tingling in hands and feet 

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your healthcare team if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

High blood pressure

Tell your doctor or nurse if you have headaches, nosebleeds, blurred or double vision or shortness of breath. You have your blood pressure checked regularly.

Shortness of breath or a cough

Tell your doctor or nurse if you're breathless or have a cough. This could be due to infection. Or a sign of less common side effects such as fluid on the lungs (pulmonary oedema), a blood clot in your lungs, heart problems or more rarely inflammation of the lungs (pneumonitis) or lung (respiratory) failure.

Tell your doctor or nurse straight away if you have difficulty breathing, wheezing, cough up blood, or have chest or upper back pain.

Diarrhoea or constipation

Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help. 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Tummy (abdominal) pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Joint, muscle or bone pain

You might get muscle cramps or pain in your joints, back or hands and feet. Less commonly you may have pain in your bones, chest or muscles, or muscle weakness. Let your doctor or nurse know about any pain so that they can give you painkillers to help.

Kidney changes

You will have regular blood tests to check for this. Less commonly your kidneys might stop working properly (kidney failure).

Fluid build up in your hands and legs

You may have swelling of your hands and legs due to a build up of fluid (oedema). 

Tiredness and weakness

Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms
• heart problems such as changes to your heartbeat, heart failure or chest pain that can spread to arms, neck and jaw and make you feel sweaty, breathless and sick (heart attack)
• shingles (herpes zoster virus) – you might be given an antiviral drug to try to prevent this
• low levels of fluid in the body (dehydration)
• changes to mineral levels in the blood, which could be due to the breakdown of cancer cells (tumour lysis syndrome) – you will have regular blood tests to check this
• low levels of a protein called albumin in the blood
• anxiety or confusion
• eyesight changes (such as blurred vision or cataracts)
• ringing in the ears (tinnitus)
• low blood pressure
• sudden reddening and warmth of the neck, upper chest and face (flushing)
• hoarse voice
• bleeding in the stomach or bowel – tell your doctor if you have blood or what looks like coffee grounds in your sick, or your poo looks black or bloody
• indigestion
• toothache
• liver changes – you have regular blood tests to check for this
• stuffy nose and sore throat
• skin rash (redness) and itching – tell your doctor if you have this
• sweating more than usual
• pain and swelling at the drip site
• generalised pain
• high sugar levels in the blood

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

• bleeding, including in the lungs or brain
• a stroke (cerebrovascular accident)
• a hole in the bowel wall (perforation)
• hepatitis B (a viral infection affecting the liver) can flare up (reactivate) – your doctor will check to see if you’ve had this virus in the past
• liver failure
• a blockage in the flow of bile from the liver (cholestasis) – you might have yellowing of the skin or whites of the eyes (jaundice)
• a nerve disorder causing headaches, fits, confusion and changes in vision (posterior reversible encephalopathy syndrome (PRES) - contact your doctor straight away if you have any of these symptoms
• an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness - some allergic reactions can be life-threatening, alert your nurse or doctor if notice any of these symptoms

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Sodium

Carfilzomib contains sodium (salt). You might need to take account of this if you are on a controlled sodium diet. Tell your doctor if you are on a low salt diet. 

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Women should use contraception during treatment and for 1 month afterwards. Carfilzomib may stop contraceptive pills from working properly.

Men should use contraception during treatment and for 3 months afterwards.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Breastfeeding

It is not known whether these drugs come through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions 

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.