Ixazomib, lenalidomide and dexamethasone

Ixazomib, lenalidomide and dexamethasone are a combination of cancer drugs. How to pronounce the drug names are in brackets.

• Ixazomib (ik-sa-zoh-mib)

• Lenalidomide (leh-nah-lih-doh-mide)

• Dexamethasone (dek-sah-meh-thuh-zone)

They are a treatment for myeloma that:

• has come back after treatment finished (relapsed)

• is not responding to treatment (refractory)

How do 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. It also stops cancers from 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 take 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. You can take lenalidomide with or without food. You should take dexamethasone with or just after food in the morning.

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 healthcare team before you stop taking a cancer drug, or if you have missed a dose.

How often do you take ixazomib, lenalidomide and dexamethasone?

You take ixazomib, lenalidomide and dexamethasone as cycles of treatment. This means that you take the drug and then a rest to allow your body to recover.

Each cycle of treatment lasts 28 days (4 weeks). 

You continue taking ixazomib, lenalidomide and dexamethasone for as long as the treatment is working and you are not experiencing too many side effects.

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

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?

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. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

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).

Less commonly, you may have bleeding in the gut, causing black or tarry stools. Bleeding from your bottom or piles may cause bright red blood in your stools or on the toilet paper. Let your healthcare team know straight away if you have this.

Breathlessness and looking pale

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

Rarely, you may develop a type of anaemia called haemolytic anaemia. This is a blood disorder where your red blood cells get destroyed faster than they can be made.

Changes to mineral and salt levels in the blood

You may have changes in levels of minerals and salts in the blood. These include low levels of potassium, calcium and sodium.

Less commonly, you might have low magnesium levels, high uric acid levels or high calcium levels.

You have regular blood tests to check this.

Changes in blood sugar levels

You might get changes to your blood sugar levels. Some of the symptoms of high blood sugar levels (hyperglycaemia) are feeling very thirsty, having a dry mouth, passing urine very often, feeling tired, having blurred vision, losing weight, feeling or being sick, and having a fruity smelling breath.

Symptoms of a low blood sugar level (hypoglycaemia) include sweating, feeling hungry, shaking, or trembling, having a fast heartbeat, feeling dizzy, having changes to your mood, and feeling tired.

Loss of body fluid

You may have a loss of body fluid (dehydration). Symptoms include feeling thirsty, having dark yellow, strong-smelling pee, peeing less often than usual, feeling dizzy or lightheaded, feeling tired, having a dry mouth, lips and tongue or sunken eyes.

Weight loss

You might lose weight while having this treatment. Let your doctor or nurse know and they can recommend ways of maintaining your weight. Or they can refer you to a dietitian.

Low mood

You may have a low mood (depression). Symptoms of depression may include feeling sad and tearful, hopeless or helpless, not getting any enjoyment out of life or having suicidal thoughts. Reach out for help and tell your healthcare team if you feel like this.

Sleep changes

You may find it hard to fall or stay asleep. Let your healthcare team know if you have problems sleeping.

Diarrhoea or constipation 

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

Nervous system changes

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. 

Other nervous system changes may include dizziness, shaking or trembling, taste changes or headaches.

Less commonly, you may have changes in your coordination, balance and speech, feel faint, have nerve pain or an abnormal, unpleasant sensation when being touched.

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.

Blood clots

Blood clots can happen in a vein or the lungs. Blood clots 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.

Blood pressure changes

You might have low blood pressure. Symptoms of low blood pressure include feeling dizzy, sick, confused, weak and tired.

Less commonly, you might have high blood pressure, This may cause blurred vision, nosebleeds, shortness of breath, chest pain or headaches.

Coughing

This treatment may cause a cough.

Tummy pain

You may have tummy pain. Tell your healthcare team if you have tummy pain.

Indigestion

This treatment may cause indigestion. Symptoms include heartburn, bloating and burping.

A sore and dry mouth

You may have a sore and dry mouth. Let your healthcare team know if you have this. They can give advice on what to do or prescribe medicines to help relieve symptoms.

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Rarely, you may have liver failure.

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 changes

Skin problems include a skin rash and dry skin. 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.

Less commonly, you might have hives, excessive sweating or red skin. Some areas of the skin may turn darker or become dry and cracked.

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.

Or you might have an unusual reaction to sunlight.

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.

Flu-like syndrome

You might feel like you are having flu. Symptoms may include having a temperature, cough, muscle aches and pains, headaches and shivers. Contact your advice line if you feel like this.

Muscle, joint and bone changes

You might have muscle weakness, spasms or aches and pains. Or you might have pain in the arms, legs, back or joints.

Less commonly, you might have joint swelling. 

Speak to your doctor, as they can prescribe medicine to help

Kidney changes

Your kidneys may stop working. Symptoms might include not passing enough wee, breathlessness, feeling tired and weak, confused, feeling sick, and you might have swelling on your legs, ankles and feet. Sometimes this may happen suddenly (acute kidney failure).

Less commonly, you may have blood in your urine, or you might be unable to empty your bladder (urinary retention), or you might pass urine without thinking of doing so (urinary incontinence).

Rarely you might have a condition that prevents the kidneys from absorbing salts and minerals. 

Loss of 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.

Eye changes

Eye changes include blurred vision or clouding of the lens of the eye (cataracts).

Less commonly, you may have difficulty seeing the shapes and details of objects.

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 levels of thyroid hormones (hypothyroidism) causing tiredness, weight gain and being sensitive to cold

• hearing loss or ringing or buzzing in the ears (tinnitus)

• heart changes that include an irregular heartbeat (arrythmia). You will have a heart test (ECG) to check for this

• a hoarse voice

• difficulty swallowing

• problems getting and keeping an erection

• chest pain

• falls

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:

• skin cancers, such as basal cell carcinoma or squamous cell carcinoma

• 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

• muscle weakness, loss of feelings of the toes and feet or loss of leg movement, or bladder or bowel problems (transverse myelitis). Contact your healthcare team straight away if you have these symptoms

• a rare disorder of the nerves causing headaches, fits, confusion and changes in vision (posterior reversible encephalopathy syndrome). Contact your healthcare team straight away if you have these symptoms

• changes to the levels of chemicals in the blood due to the breakdown of cancer cells (tumour lysis syndrome) – you have regular blood tests to check for this

• blood clots forming in small blood vessels (thrombotic thrombocytopenic purpura)

• damage to small blood vessels in the body’s organs (thrombotic microangiopathy)

• a low sex drive

• inflammation of the large bowel or small bowel

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 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 might harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant 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. Let them know straight away if you or your partner become pregnant.

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.

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

For further information about each drug and the possible side effects go to the electronic Medicines Compendium (eMC) website. You can find patient information leaflets for each drug 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.