Ixazomib, lenalidomide and dexamethasone

Ixazomib, lenalidomide and dexamethasone are a combination of cancer drugs. They are a treatment for myeloma.

How does ixazomib, lenalidomide and dexamethasone work?

Ixazomib 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. Ixazomib blocks the proteasomes so the proteins build up inside the cell. The cell then dies.

Lenalidomide works in different ways. It interferes with chemicals that cells use to signal to each other to grow. It affects how the immune system works. And it also stops cancers making their own blood vessels – cancers need a blood supply to be able to grow. 

Dexamethasone is a steroid. It helps the ixazomib and lenalidomide to work better and kills myeloma cells.

How do you have ixazomib, lenalidomide and dexamethasone?

You have ixazomib and lenalidomide as capsules. You usually take dexamethasone as tablets.

You swallow these cancer drugs whole with a glass of water. 

You take ixazomib 1 hour before food or 2 hours afterwards. Lenalidomide can be taken with or without food. You should take dexamethasone with or just after food, usually in the morning.

You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

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

Talk to your specialist or advice line before you stop taking a cancer drug.

When do you have ixazomib, lenalidomide and dexamethasone?

You have ixazomib, lenalidomide and dexamethasone as cycles Open a glossary itemof treatment. Each cycle is 28 days (4 weeks). 

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

You usually have each cycle of treatment in the following way:

Day 1 

You take ixazomib, lenalidomide and dexamethasone.

Day 2 to 7

You take lenalidomide capsules once a day, at about the same time each day.

Day 8 

You take ixazomib, lenalidomide and dexamethasone. 

Day 9 to 14

You take lenalidomide capsules once a day, at about the same time each day.

Day 15

You take ixazomib, lenalidomide and dexamethasone. 

Day 16 to 21 

You take lenalidomide capsules once a day, about the same time each day.

Day 22

You take dexamethasone in the morning after breakfast.

Day 23 to 28 

You have no treatment.

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.

What are the side effects of ixazomib, lenalidomide and dexamethasone?

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely 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. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

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. 

Less commonly, this treatment could cause a virus you’ve had in the past such as the chicken pox virus to become active and cause symptoms again (shingles).

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).

Diarrhoea or constipation 

Tell your doctor or nurse if you have diarrhoea or constipation. They can give you medicine to help. 

Numbness or tingling in hands or feet 

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

Feeling or being sick 

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all 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 treating it once it has started.

Fluid build up in hands or legs 

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

Skin rash and itching 

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your nurse will tell you what products you can use on your skin to help.

Rarely you might have a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening.

Tiredness and weakness (fatigue) 

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.

Do not drive or operate machinery if you have dizziness or extreme fatigue.

Back pain 

You might experience pain in your bones. Speak to your doctor as they can prescribe medicine to help. 

Loss of appetite 

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

Heart changes 

This might be an irregular heartbeat (arrythmia). You might have a heart trace test (ECG) to check for this.

Less commonly there might be changes to how well your heart muscle works (heart failure). Let your treatment team know if you have shortness of breath or wheezing. 

Eye changes

This can include blurred vision, dry eyes, or inflammation of the front of the eye or inside the eyelid (conjunctivitis). You might also have clouding of the lens of the eye (cataracts).

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:

  • low blood pressure
  • liver changes - you have regular blood tests to check this. Tell your doctor if you have yellowing of the skin or whites of the eyes (jaundice)
  • low levels of potassium in the blood – you might have regular blood tests to check this

Rare side effects

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

  • muscle weakness, loss of feelings of the toes and feet or loss of leg movement (transverse myelitis)
  • a rare disorder of the nerves causing headaches, fits, confusion and changes in vision (posterior reversible encephalopathy syndrome) – contact your treatment team straight away if you have these symptoms
  • changes to levels of chemicals in the blood due to the breakdown of cancer cells (tumour lysis syndrome)
  • blood clotting problems (thrombotic thrombocytopenic purpura)

Other side effects

If you have side effects that aren’t listed on this page, you can also look at the individual drug pages:

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.

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 3 months afterwards. 

Women should use contraception for 4 weeks before starting treatment.

If you’re a woman taking hormonal contraceptives such as the pill, you should use an additional barrier form of contraceptive such as a condom. 

Talk to your doctor or nurse about effective contraception before starting treatment.

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 

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

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 Open a glossary item 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.

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 go to the electronic Medicines Compendium (eMC) website.

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

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