Carfilzomib and dexamethasone

Carfilzomib and dexamethasone is the name of a cancer drug combination. Carfilzomib is also known as Kyprolis.

You pronounce carfilzomib as car-fill-zo-mib and dexamethasone as deks-ah-meth-uh-zone.

It is a treatment for myeloma that has come back (relapsed).

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 of treatment lasts 28 days (4 weeks). You continue this treatment for as long as the treatment is working and you are not experiencing too many side effects. 

You have each cycle in the following way:

You then start your next cycle of 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.

Before treatment starts you have a blood test to check for viruses such as hepatitis B, hepatitis C, HIV or cytomegalovirus (CMV) . This is called a viral screen. You may not know if you have one or more of these viruses. But it is important for your doctor to know as this treatment can weaken your immune system .

You also usually have heart tests such as ECG or electrocardiogram 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).

Changes to the levels of substances in the blood

It is common to have low levels of potassium in the blood. Occasionally other substances can also be low including magnesium, sodium, calcium, and phosphate. There are occasions when your calcium and uric acid might go up.

You will have regular blood tests to check on these.

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

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Dizziness

You might feel dizzy with this treatment. Don’t drive or operate machinery if you have this.

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. More rarely this treatment can cause inflammation of the lungs (pneumonitis) or lung (respiratory) failure.

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.

Pain in different parts of the body

You might get muscle cramps or pain in your tummy, joints, back, hands and feet. Less commonly you may have pain in different areas of the body such as your mouth, throat, bones, or chest.

Let your doctor or nurse know about any pain so that they can give you painkillers to help.

Kidney changes

You might have some changes in the way your kidneys work. Less commonly your kidneys might stop working properly (kidney failure).

You have regular blood tests to check how well they are working

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.

High temperature or chills

You might get a high temperature and chills. 

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:

• a serious reaction to an infection (sepsis) - signs can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering - contact your advice line straight away if you have any of these symptoms

• 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)

• low levels of fluid in the body (dehydration)

• 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)

• changes to your voice such as making it sound hoarse

• 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 symptoms include heartburn, bloating and burping

• toothache

• flu-like symptoms include a high temperature, sore throat, runny nose, headaches, muscle aches, shivering (chills), sneezing or coughing

• skin problems such as a rash, reddening, and itching

• sweating more than usual

• pain and swelling at the drip site

• high sugar levels in the blood

• liver changes that you pick up on blood tests. Rarely this treatment can cause the liver to stop working

• unusual feelings of the skin – such as numbness, tingling, pricking, burning, a creeping skin feeling or reduced sense of touch

• muscle weakness

• generally feeling unwell

• 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

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 in different parts of your body such as the lungs or brain
• a stroke (cerebrovascular accident)
• a hole in the bowel wall (perforation)
• 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
• 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
• small blood clots in the blood vessels inside the kidney (haemolytic uremic syndrome) - symptoms can include bloody diarrhoea, weakness, high temperature or being sick
• inflammation of your pancreas – symptoms include severe tummy pain, feeling or being sick, a high temperature or you may have loose poo
• several body parts (organs) stopping working
• infection with hepatitis B can become active again if you've had it in the past

Coping with side effects

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

What else do you need to know?

Other medicines, foods and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Pregnancy and contraception

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment. Women must not become pregnant for at least 1 month after the end of treatment. Men should not get someone pregnant for at least 3 months after treatment. 

Talk to your doctor or nurse about effective contraception before starting treatment. Carfilzomib may stop contraceptive pills from working properly.

Let them know straight away if you or your partner become pregnant while having 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 and for at least 2 days after this treatment.

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

We haven't listed all the very rare side effects of this treatment. For further information see the electronic Medicines Compendium (eMC) website.

You can report any side effect you have that isn’t listed here to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.