Carfilzomib (Kyprolis®)

Carfilzomib (Kyprolis®) is a targeted therapy drug. It is used to treat myeloma. It may also be used to treat other cancers.

It is best to read this information with our general information about targeted therapies and the type of cancer you have.

Carfilzomib is given into a vein. You usually have it as an outpatient or during a hospital stay. Your cancer doctor, nurse or pharmacist will tell you how often you will have it.

Like all cancer drugs, carfilzomib can cause side effects. Some of the side effects can be serious, so it is important to read the detailed information below.

Your healthcare team can give you advice on how to manage any side effects. Tell your doctor or nurse straight away if you feel unwell or have severe side effects, including any we do not mention here.

Rarely, side effects may be life-threatening. Your cancer doctor, nurse or pharmacist can explain the risk of these side effects to you.

If you need medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

What is carfilzomib (Kyprolis®)?

Carfilzomib (Kyprolis®) is a targeted therapy drug used to treat myeloma. It may sometimes be used to treat other cancers. It is best to read this information with our general information about targeted therapies and the type of cancer you have.

Carfilzomib is a type of targeted therapy called a proteasome inhibitor. Proteasomes work in cells to break down proteins that are no longer needed. Carfilzomib blocks the proteasomes so the proteins build up in the cell. This causes the cell to die.

Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.


How carfilzomib is given

You will have carfilzomib at a day unit as an outpatient. Carfilzomib is usually given with steroids. It may be given in combination with other cancer drugs.

During treatment you usually see a cancer doctor, a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.

At times during the course of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that your blood cells are at a safe level to continue on the treatment.

You will see a doctor or nurse before you have treatment. They will ask you how you have been feeling. If your blood results are okay, the pharmacist will prepare your targeted therapy. Your nurse will tell you when your treatment is likely to be ready.

Your targeted therapy is given as a drip into a vein (intravenous infusion).

Your course of treatment

Carfilzomib is usually given in treatment cycles. Each cycle lasts 4 weeks. The treatment cycle includes days when you are given treatment and days when you do not have treatment (rest periods). You usually have carfilzomib 2 days a week for 3 weeks. On week 4 you do not have treatment.

You usually have a course of several cycles of treatment over a few months. Your nurse, pharmacist or doctor will discuss your treatment plan with you.


About side effects

We explain the most common side effects of this treatment here. We also include some less common side effects.

You may get some of the side effects we mention, but you are unlikely to get all of them. 

If you are also having treatment with other cancer drugs, you may have some side effects that we haven’t listed here. 

Always tell your doctor, nurse or pharmacist about any side effects you have.

Your doctor can give you drugs to help control some side effects. 

It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. 

Your nurse will give you advice about managing your side effects. 

After your treatment is over, most side effects start to improve.

Serious and life-threatening side effects

Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. 

Save these numbers in your phone or keep them somewhere safe.

More information

We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.


Side effects while treatment is being given

Some people may have side effects while they are being given this treatment or shortly after they have it.

Allergic reaction

Some people have an allergic reaction while having this treatment.

Signs of a reaction can include:

  • feeling hot or flushed
  • a skin rash
  • itching
  • shivering
  • feeling dizzy
  • a headache
  • feeling breathless
  • swelling of your face or mouth
  • pain in your back, tummy or chest.

Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, it can be treated quickly.

Sometimes a reaction can happen up to 24 hours after treatment. If you get any signs or feel unwell after you get home, contact the hospital straight away.


Common side effects

Changes to your blood pressure

Carfilzomib may cause high blood pressure. Less commonly it can cause low blood pressure. Tell your doctor or nurse if you have ever had any problems with your blood pressure.

If you are taking medicine to lower your blood pressure, the dose of this medicine may need to be adjusted. You might feel dizzy, light-headed or faint when you get up from a lying or sitting position. If this happens, it can help to move more slowly when you do this. Drinking plenty of fluids can also help.

Your nurse will check your blood pressure regularly during treatment. Tell them if you feel dizzy or have any headaches.

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. 

If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.

If you have an infection, it is important to treat it as soon as possible. 

Contact the hospital straight away on the 24-hour contact number you have if:

  • your temperature goes over 37.5°C (99.5°F)
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection.

Symptoms of an infection include:

  • feeling shivery
  • a sore throat
  • a cough
  • diarrhoea
  • needing to pass urine often.

It is important to follow any specific advice your cancer treatment team gives you.

The number of white blood cells will usually return to normal before your next treatment. 

You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.

Bruising and bleeding

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. 

Tell your doctor if you have any bruising or bleeding that you cannot explain. 

This includes:

  • nosebleeds
  • bleeding gums
  • tiny red or purple spots on the skin that may look like a rash.

Some people may need a drip to give them extra platelets. This is called a platelet transfusion.

Anaemia (low number of red blood cells)

This treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body.

If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this.

If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.

Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. 

The symptoms usually improve slowly after treatment finishes, but for some people they may never go away. Talk to your doctor if you are worried about this.

Feeling sick

This is usually mild. Your doctor can prescribe anti-sickness drugs to help. Tell your doctor if it does not get better.

Diarrhoea

If you have diarrhoea, contact the hospital for advice. Try to drink at least 2 litres (3½ pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Constipation

This treatment can cause constipation. Here are some tips that may help:

  • drink at least 2 litres (3½ pints) of fluids each day
  • eat high-fibre foods, such as fruit, vegetables and wholemeal bread
  • do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.

Tummy pain

You may get pain in your tummy (abdomen), or have indigestion. Your doctor can give you drugs to help improve these symptoms. Tell them if the pain gets worse or does not get better.

Feeling tired

This is a common side effect. Pace yourself and get as much rest as you need. It helps to balance this with some [gentle exercise], such as short walks. If you feel sleepy, do not drive or operate machinery.

Muscle, joint or bone pain

You may get pain in your muscles, joints or bones. This can include back pain. You may also get weakness or spasms in your muscles. If this happens, tell your doctor so they can give you give you painkillers. Tell them if the pain does not get better. Having warm baths and taking regular rests may help.

Loss of appetite

This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.

Skin changes

This treatment may affect your skin. You may have a rash, which may be itchy. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.

Mood changes or problems sleeping

Some people feel anxious while having treatment with carfilzomib. You may also find it difficult to sleep. This may be caused by carfilzomib or the steroids you have with it. Talk to your doctor or nurse if this happens to you.

Headaches

This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.

Very rarely, carfilzomib can cause a more serious condition that affects the brain. Always contact a doctor straight away if you have:

  • severe headaches
  • vomiting
  • confusion
  • sudden loss of vision
  • a seizure.

Effects on the kidneys or liver

Carfilzomib can sometimes affect the kidneys or liver. This is usually mild and goes back to normal after treatment. You will have regular blood tests to check how well your kidneys and liver are working.

Effects on the lungs

This treatment can cause changes to the lungs. Tell your doctor if you develop:

  • a cough
  • wheezing
  • a fever (high temperature)
  • breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

Eye problems

This treatment may cause blurry vision or cataracts. Always tell your doctor or nurse if you notice any change in your vision.

Fluid build-up

Some people get swelling around their eyes or in their hands, ankles or feet. This is because of a build-up of fluid. If you have any swelling, or if you put on weight very quickly, contact the hospital for advice. Your doctor may prescribe drugs called diuretics to make you pass more urine (pee). This helps get rid of some of the fluid.

Raised blood sugar levels

This treatment may raise your blood sugar levels. This can be caused by carfilzomib, or by the steroids you have with it. Symptoms of raised blood sugar include:

  • feeling thirsty
  • needing to pass urine (pee) more often
  • feeling tired.

Tell your doctor or nurse if you have these symptoms.

If you have diabetes, your blood sugar levels may be higher than usual. Your doctor will talk to you about how to manage this.


Less common side effects

Effects on the heart

This treatment can affect the way the heart works. You may have tests to see how well your heart is working. These may be done before, during, and sometimes after treatment.

Contact a doctor straight away if you:

  • have pain or tightness in your chest
  • feel breathless or dizzy
  • feel your heart is beating too fast or too slowly.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor straight away.

Changes in hearing

Carfilzomib can affect your hearing. You may get ringing in your ears (tinnitus). Tinnitus usually gets better after treatment finishes. Some hearing changes can be permanent. Tell your doctor if you notice any changes in your hearing.

Raised levels of uric acid (tumour lysis syndrome)

This treatment may cause the cancer cells to break down quickly. This releases a waste product called uric acid into the blood. The kidneys usually get rid of uric acid, but may not be able to cope with large amounts. Too much uric acid can cause swelling and pain in the joints. This is called gout. It can also affect the kidneys and the heart.

Your doctor may give you tablets called allopurinol (Zyloric®) to help prevent this. They may ask you to drink more fluids on the day of your treatment. You may also have fluid through a drip before, and sometimes after your treatment. You will have regular blood tests to check the levels of uric acid in your blood.


Other information

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

  • pain, redness or swelling in a leg or arm
  • breathlessness
  • chest pain. 

If you have any of these symptoms, contact a doctor straight away. 

A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.

Shingles

You may be more likely to develop a viral infection called shingles during this treatment. Your doctor may give you medicine to help prevent shingles.

Other medicines

Some medicines can affect chemotherapy or be harmful when you are having it. This includes medicines you can buy in a shop or chemist. 

Tell your cancer doctor about any drugs you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.

Contraception

Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. This is because the drugs may harm a developing baby.

It is important to use effective contraception during your treatment and for a while after treatment finishes. Hormonal contraceptives such as the pill may not be suitable for use with carfilzomib. It is important to ask your doctor or nurse for advice about the type of contraception to use.

Breastfeeding

Women are advised not to breastfeed while having this treatment and for some time afterwards. This is because the drugs could be passed to the baby through breast milk.

Fertility

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. 

Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.