Kyprolis
Kyprolis (carfilzomib) is a targeted therapy that’s used to treat a type of blood cancer called multiple myeloma. It’s usually given together with other medications such as lenalidomide (Revlimid) and dexamethasone. Kyprolis (carfilzomib) is given through the vein (intravenously, IV) at a provider’s office or infusion center once or twice a week. It might cause side effects like tiredness and low blood cell counts, and it has a risk of heart problems.
What is Kyprolis (carfilzomib)?
What is Kyprolis (carfilzomib) used for?
Multiple myeloma that’s been previously treated with at least one therapy
Given by itself; or
Given with other medications such as lenalidomide (Revlimid), Darzalex (daratumumab), and dexamethasone
How Kyprolis (carfilzomib) works
Kyprolis (carfilzomib) is a proteasome inhibitor. It works by attaching to proteins called proteasomes in multiple myeloma cancer cells. This blocks the proteasomes from properly breaking down other proteins that the cell no longer needs to keep the cell alive.
Multiple myeloma cancer cells make more proteins than normal cells. So when Kyprolis (carfilzomib) blocks how proteasomes work, the cancer cells can’t function correctly and usually die. As a result, the myeloma cells can’t grow and spread as well.
Drug Facts
What are the side effects of Kyprolis (carfilzomib)?
Common Side Effects
- Anemia (49%)
- Tiredness (40%)
- Low platelet counts (37%)
- Nausea (35%)
- Trouble breathing (34%)
- Fever (30%)
- Diarrhea (27%)
- Low white blood cell counts (25%)
- Headache (24%)
- Cough (22%)
- Swelling in legs (20%)
Other Side Effects
- High blood pressure
- Chills
- Dizziness
- Vomiting
- Lower appetite
- Back pain
- Muscle spasms
- Trouble sleeping
Serious Side Effects
- Serious heart problems: trouble breathing, chest pain, swelling in legs, feeling lightheaded, abnormal heartbeat
- Serious kidney problems: high creatinine levels on blood tests, urinating less often, having less urine, weakness, confusion, nausea
- Tumor lysis syndrome: abnormal heartbeat, muscle cramps, muscle weakness, abnormal electrolyte levels (high potassium, high uric acid, high creatinine, low calcium)
- Serious lung problems: sudden cough, trouble breathing, very quick breathing, clicking or rattling sound when breathing, pain when breathing
- Severely high blood pressure: sudden headache, confusion, chest pain, trouble breathing, blood pressure reading higher than 180/120
- Blood clots: swelling or red and warm skin in one arm or one leg, sudden trouble breathing, sudden chest pain
- Bleeding: nosebleeds, blood in stool or urine, coughing up blood, sudden headache, severe tiredness
- Serious brain and nerve problems: seizures, confusion, vision or speech changes
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
More common
Agitation
black, tarry stools
bleeding gums
bloating or swelling of the face, arms, hands, lower legs, or feet
blood in the urine or stools
blurred vision
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
chest pain or tightness
confusion
decreased awareness or responsiveness
decreased urine output
difficult or labored breathing
difficulty with moving
dizziness
drowsiness
fast, slow, or irregular heartbeat
headache
hoarseness
hostility
irritability
loss of consciousness
lower back or side pain
muscle spasms (tetany) or twitching
numbness or tingling in the hands, feet, or lips
painful or difficult urination
pale skin
pinpoint red spots on the skin
pounding in the ears
rapid weight gain
seizures
severe sleepiness
tingling of the hands or feet
trembling
trouble breathing
ulcers, sores, or white spots in the mouth
unsteadiness or awkwardness
unusual bleeding or bruising
unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
unusual weight gain or loss
vomiting
Less common
Chills
continuing ringing, buzzing, or other unexplained noise in the ears
hearing loss
muscle pain or cramps
painful blisters on the trunk of the body
weakness in the arms, hands, legs, or feet
Rare
Dark urine
general feeling of discomfort or illness
light-colored stools
stomach pain, continuing
thickening of bronchial secretions
yellow eyes or skin
Incidence not known
Bleeding, blistering, burning, coldness, discoloration of skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
blindness
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fainting
joint pain, stiffness, or swelling
stomach pain
sweating
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Kyprolis (carfilzomib)
Pros
Recommended treatment option for people with multiple myeloma
Less likely to cause nausea or vomiting than some other anticancer medications
Works in a more specific, targeted way than traditional chemotherapy
Cons
Typically given once or twice per week, so less convenient
Given intravenously (into a vein), so it requires a needle for administration
Might cause side effects such as high blood pressure, low red blood cell count, and higher liver enzyme levels
Pharmacist tips for Kyprolis (carfilzomib)
Kyprolis (carfilzomib) is often given along with other medications to treat multiple myeloma, and it can be difficult to keep track of your treatment schedule. Talk to your provider about using a treatment calendar so all your doses and infusion appointments are written down, or consider using an app on your phone to help you remember.
Kyprolis (carfilzomib) might cause high blood pressure. Your provider will check your blood pressure when you’re in the clinic, but they might also ask you to check it at home and keep a log of your readings. Seek medical help right away if your blood pressure is over 180/120 or if you have symptoms such as sudden, severe headache; confusion; or weakness.
Stay hydrated during your treatment with Kyprolis (carfilzomib) to prevent a complication called tumor lysis syndrome. This is especially important for your first few doses. You might receive extra fluids through your IV on the day of your infusion, but your provider might also suggest that you drink plenty of water, too.
Make sure you continue to get regular blood tests while you're taking Kyprolis (carfilzomib). This medication can sometimes irritate your liver and kidney. Most times, you won't feel any noticeable symptoms. But your provider can see signs of these problems through blood testing. Call your provider if you have stomach pain, yellowish skin, or yellow around the whites of your eyes or if you notice that you’re urinating less often.
Kyprolis (carfilzomib) isn’t safe to take during pregnancy. If you’re a female who’s able to have children, it’s important to use birth control during treatment and for 6 months after the last dose. Your provider might recommend non-hormonal birth control options to lower your risk for blood clots. Having multiple myeloma and taking Kyprolis (carfilzomib) both put you at risk for blood clots, and using hormonal birth control can add to this risk.
Frequently asked questions about Kyprolis (carfilzomib)
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What are the risks and warnings for Kyprolis (carfilzomib)?
Kyprolis (carfilzomib) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Heart problems
Risk factors: Heart failure | Previous heart attack | Chest pain | Heart rhythm problems | Age over 75 years
Though uncommon, some people taking Kyprolis (carfilzomib) have developed heart problems such as heart failure and heart attack, which can be life-threatening. This can happen in people with or without a history of heart problems. Tell your provider if you have a history of heart problems before starting Kyprolis (carfilzomib) so they know to follow up with you more closely during treatment.
Let your provider know right away if you have any new swelling in your legs or trouble breathing at any time during treatment, regardless of your medical history. You might need to take a break from Kyprolis (carfilzomib) while your provider checks your heart. But call 911 right away if you have sudden chest pain or lose consciousness; this could be a medical emergency.
Kidney failure
Risk factors: Chronic kidney disease
Some people taking Kyprolis (carfilzomib) have had kidney failure, which means your kidneys don’t work as well. You might not have symptoms when this happens, but your provider can identify problems with kidney function from lab test results. It’s important to go to your appointments to get your lab work done during treatment so that your provider can keep track of your kidney health. Contact your provider if you have symptoms of kidney problems, such as having less urine or feeling weak, confused, and nauseous.
Tumor lysis syndrome
Tumor lysis syndrome (TLS) is a complication that might happen when cancer cells are destroyed and release what was inside the cells into the bloodstream. This complication can be dangerous because it can lead to high levels of uric acid and potassium in the blood, which can cause problems with your kidneys and heart. You’re most at risk for TLS with the first one or two doses of Kyprolis (carfilzomib).
Your provider might give you extra fluids or medications such as allopurinol (Zyloprim) to prevent TLS. Your provider will also monitor your electrolyte levels very closely. If your lab results show signs of TLS, you might need to pause Kyprolis (carfilzomib) while you get treated for this complication.
Lung problems
Though rare, some people taking Kyprolis (carfilzomib) have had serious and sometimes life-threatening lung problems. Talk to your provider right away if you experience sudden or worsening cough, trouble breathing, very quick breathing, a rattling sound while breathing, or fever. You might have to pause or stop Kyprolis (carfilzomib) while your provider figures out what’s causing the lung problem.
Pulmonary hypertension
Rarely, some people taking Kyprolis (carfilzomib) had a problem with the blood vessels in their lungs called pulmonary hypertension. This condition makes it harder for your heart to get blood to your lungs to pick up oxygen. Call your provider if you have trouble breathing or chest pain or if you feel lightheaded; these can be symptoms of pulmonary hypertension. You might need to take a break from the medication while your provider checks out the problem. You might have to stop taking it altogether if it’s confirmed that you have pulmonary hypertension.
High blood pressure
Risk factors: History of high blood pressure
Kyprolis (carfilzomib) can cause high blood pressure (also known as hypertension). Sometimes, high blood pressure can be managed with diet changes or medications. But other times, it can be difficult to control and can be dangerous. Your provider might ask you to check your blood pressure at home and keep a record of your readings. Seek medical help as quickly as possible if your blood pressure is over 180/120 or if you have symptoms such as sudden, severe headache; confusion; or weakness. You might not be able to take Kyprolis (carfilzomib) if you have high blood pressure that’s hard to manage.
Blood clots
People who take Kyprolis (carfilzomib) together with certain medications (such as lenalidomide (Revlimid)) are at higher risk for blood clots. Your provider might recommend that you take a blood thinner such as aspirin to prevent blood clots. Your provider will discuss with you about which blood thinner is most appropriate for you. Get medical help right away if you have symptoms of a blood clot, such as sudden swelling, redness, or warmth in one arm or one leg or sudden trouble breathing.
Infusion-related reactions
Some people have experienced reactions during or within 24 hours of a Kyprolis (carfilzomib) infusion. Symptoms of these infusion-related reactions can include fever, chills, trouble breathing, flushing, and face swelling. Typically, you’ll take a medication called dexamethasone before your Kyprolis (carfilzomib) infusion to prevent a reaction. Your nurse will keep an eye for reactions during each infusion. Seek medical attention as soon as possible if you develop these symptoms after an infusion.
Bleeding
Kyprolis (carfilzomib) can raise your risk for bleeding. In studies, cases of bleeding included nosebleeds, bleeding in the gut or lungs, and rarely, bleeding in the brain. Sometimes, bleeding is related to having low platelet counts, which can be caused by treatment with Kyprolis (carfilzomib). For this reason, your provider will closely check your platelet count with blood tests. Note that bleeding has also happened in people with normal platelet counts.
Tell your provider right away if you have any unusual bleeding. If you bleed or if your platelet count is low, your provider might briefly pause treatment and then restart the medication later at a lower dose when you’ve recovered. But sometimes, you’ll have to stop taking the medication permanently.
Liver problems
Some people taking Kyprolis (carfilzomib) have had blood test results showing high liver enzyme levels, which can suggest liver problems. Most people don’t feel any noticeable symptoms when this happens. Your provider will check your liver health on a regular basis to make sure this medication is still safe for you to take. If your liver labs are too high, your provider might need to pause or stop your treatment with Kyprolis (carfilzomib). Call your provider right away if you experience symptoms of liver problems, such as stomach pain, yellowish skin, or yellow around the whites of your eyes.
Serious blood problems
Rarely, people who’ve taken Kyprolis (carfilzomib) have developed blood conditions called thrombotic microangiopathies, which mean your red blood cells or platelets don’t work as well. Sometimes, your provider will notice that you have this condition from your lab test results before you have any symptoms. But seek medical attention right away if you have fever with bruising or red-purple rash on your skin, very pale skin, or bloody diarrhea at any time during treatment. You might not be able to take Kyprolis (carfilzomib) anymore.
Serious brain and nerve problems
Though uncommon, people taking Kyprolis (carfilzomib) have developed serious problems with their brain or nervous system. These problems can include posterior reversible encephalopathy syndrome (PRES) and progressive multifocal leukoencephalopathy (PML). Seek medical help right away if you have new severe headaches, confusion, seizures, severe weakness, or changes in your vision and speech. You might need to pause Kyprolis (carfilzomib) treatment while your provider looks into the problem.
Serious side effects in certain people taking Kyprolis (carfilzomib) with melphalan (Alkeran) and prednisone
In one study, certain people taking Kyprolis (carfilzomib) together with melphalan (Alkeran) and prednisone had higher rates of several serious side effects than those taking Velcade (bortezomib) with the same two medications. These side effects included heart problems, high blood pressure, kidney problems, and trouble breathing. Because of these results, this specific combination of medications isn’t recommended as first-choice treatment for some people with multiple myeloma. Talk to your provider if you’re unsure about your treatment regimen.
Harm to unborn baby
Based on findings from animal studies, Kyprolis (carfilzomib) might harm an unborn baby or raise the risk for miscarriage (pregnancy loss) if the medication is taken during pregnancy. For this reason, if you’re a female who can get pregnant, you should use birth control while you’re taking Kyprolis (carfilzomib) and for 6 months after the last dose. Consider using non-hormonal birth control to avoid raising your risk for blood clots. Males taking Kyprolis (carfilzomib) should use condoms if they have sex while taking the medication and during the 3 months after the last dose. Let your provider know right away if you become pregnant while taking Kyprolis (carfilzomib).
Kyprolis (carfilzomib) dosage forms
Typical dosing for Kyprolis (carfilzomib)
The dose is based on your body surface area (BSA, m2 units), which is calculated using your height and weight measurements. If your BSA is above 2.2 m2, your dose will be calculated using a BSA of 2.2 m2.
Kyprolis (carfilzomib) is given as an infusion through the veins (IV), usually once or twice a week. In general, the medication is given between weeks 1 and 3 in every 4-week treatment cycle.
For once-weekly dosing: The usual starting dose is 20 mg/m2 given IV once a week. After the first week, your provider might raise your dose to 70 mg/m2 once a week.
For twice-weekly dosing: The usual starting dose is 20 mg/m2 given IV twice a week. After the first week, your provider might raise your dose to either 27 mg/m2 or 56 mg/m2 twice a week.
Your dose and your treatment schedule will vary depending on whether you’re taking Kyprolis (carfilzomib) by itself or together with other medications for your cancer. Your dose might also differ if you have liver problems or have serious side effects from Kyprolis (carfilzomib).
Interactions between Kyprolis (carfilzomib) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Measles Virus Vaccine, Live
- Mumps Virus Vaccine, Live
- Rotavirus Vaccine, Live
- Rubella Virus Vaccine, Live
- Varicella Virus Vaccine, Live
- Zoster Vaccine, Live
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Adenovirus Vaccine
- Bacillus of Calmette and Guerin Vaccine, Live
- Cholera Vaccine, Live
- Dengue Tetravalent Vaccine, Live
- Influenza Virus Vaccine, Live
- Poliovirus Vaccine, Live
- Smallpox Vaccine
- Typhoid Vaccine, Live
- Yellow Fever Vaccine
What are alternatives to Kyprolis (carfilzomib)?
Multiple myeloma that’s been previously treated with at least one therapy
Given by itself; or
Given with other medications such as lenalidomide (Revlimid), Darzalex (daratumumab), and dexamethasone
Multiple myeloma in people whose cancer came back after receiving anticancer treatments
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References
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Flint, B., et al. (2023). Body surface area. StatPearls.
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