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Treatment Name: Carfilzomib (Kyprolis®)

Carfilzomib (Kyprolis®) is a Chemotherapy Regimen for Multiple Myeloma (MM)

How does carfilzomib work?
Carfilzomib is a proteasome inhibitor that binds to rapidly dividing plasma cells and causes cell death. In other words, it kills the plasma cells that are defective.

Goals of therapy:
Carfilzomib is given by intravenous infusion to decrease myeloma symptoms and possibly prolong life. Carfilzomib is not commonly given with the goal of cure.

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Schedule

  • Cycle 1:  Carfilzomib is an intravenous (I.V.) infusion usually given over 2 to 10 minutes on Days 1, 2, 8, 9, 15, and 16
  • Cycle 2 and beyond:  Carfilzomib is an I.V. infusion usually given over 2 to 10 minutes on Days 1, 2, 8, 9, 15, and 16
  • Hydration with intravenous fluids is common before and after each dose
  • Oral or intravenous dexamethasone is given before carfilzomib in Cycle 1 to prevent infusion related reactions, and may also be given if infusion reactions develop or reappear

Estimated total infusion time for this treatment:

  • Up to 30 minutes if no pre-medications or hydration are given with carfilzomib
  • Up to two hours if pre-medications and/or hydration are given with carfilzomib
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time

Carfilzomib is usually given in an outpatient infusion center allowing the person to go home afterwards.

Carfilzomib is repeated two days in a row each week for three weeks in a row, followed by a 12-day period of rest (Days 17 through 28 of each Cycle). One Cycle consists of a 28-day period. Each cycle requires 6 visits to an infusion center to receive treatment. There is no limit to the number of cycles a person may receive. Treatment with carfilzomib is continued until unacceptable side effects appear or until the multiple myeloma stops responding to treatment

Click here for common carfilzomib (Kyprolis®) starting doses

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Side Effects

In clinical studies the most commonly reported side effects with Carfilzomib were:

  • Fatigue (56%)
  • Anemia [low red blood cell count] (47%)
  • Nausea (45%)
  • Increased bleeding risk [low blood platelet count (36%)
  • Shortness of breath (35%)
  • Diarrhea (33%)
  • Fever (30%)
  • Infection of nose and throat (28%), cough (26%)
  • Headache (28%)
  • Legs and arms swelling (24%)
  • Vomiting (22%)
  • Constipation (21%)
  • Low white blood cell count (21%)
  • Back pain (20%)
  • Difficultly sleeping [insomnia] (18%)

Side effect videos Side Effect Videos
Fatigue Fatigue Nausea and VomitingNausea and VomitingDiarrheaDiarrheaConstipationConstipationPainPainNeutropenic FeverNeutropenic FeverAnemiaAnemiaBleedingBleeding

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Monitoring

How often is monitoring needed?
Labs (blood tests) are usually checked before treatment on Days 1, 8, and 15 of each cycle. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), free light chains, plus any others your doctor may order.

How might blood test results affect treatment?
Blood tests specifically relating to how myeloma is responding are done after several cycles of carfilzomib, determined by your doctor. The results help doctors decide whether to continue, delay, or switch therapy.

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ChemoExperts Tips

  • Hydration (salt water or "saline" infusion) before and after carfilzomib can help prevent kidney toxicity and tumor lysis syndrome
  • Some infusion centers may infuse all carfilzomib doses over 30 minutes to help decrease infusion reactions
  • Some infusion centers give patients two doses in one day instead of one dose on two consecutive days
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for myeloma. Ask your doctor if any studies are currently enrolling in your area or go to clinicaltrials.gov and search “myeloma” to find other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Carfilzomib (Kyprolis®), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Carfilzomib (Kyprolis®). Depending upon your income, they may be able to help cover the cost of:

  • Carfilzomib

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Carfilzomib (Kyprolis®) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Carfilzomib (Kyprolis®)

Individual Drug Label Information

Carfilzomib (Kyprolis®)

  • Carfilzomib is an intravenous (I.V.) injection infused over two to ten minutes
  • If you miss a scheduled dose, your physician will decide any changes in the schedule
  • Dosage adjustments may be required problems with heart, kidneys, liver, lungs, nerve pain, or low blood counts 
General Carfilzomib (Kyprolis) Side Effects
  • Heart or kidney problems: report any leg or ankle swelling to your physician
  • Fatigue
  • Nausea and vomiting
  • Low platelet count, which could increase bleeding
  • Shortness of breath
  • Diarrhea or constipation, be cautious of both
  • Infection of nose and throat, cough (upper respiratory system)
  • Headache
  • Legs and arms swelling
  • Fever due to low white blood cell count
  • Back pain
  • Trouble sleeping
  • Click on the carfilzomib (Kyprolis) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue BleedingBleedingConstipationConstipationPainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

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References

1. Siegel DS, Martin T, Wang M, et al. A phase 2 study of single-agent carfilzomib (PX-171-003-A1) in patients with relapsed and refractory multiple myeloma. Blood. 2012;120:2817-2825.

Created: August 6, 2015 Updated: August 13, 2018

What is Multiple Myeloma (MM)?

Multiple Myeloma is a disease of the white blood cells, called plasma cells, found in the blood or bone marrow. Plasma cells are a type of white blood cell known as a B-lymphocyte.

Sometimes plasma cells form collections on bone and weaken or destroy it. These are known as "lytic lesions". Multiple Myeloma is a rare condition with an unknown cause. The stage can vary at diagnosis and throughout treatment. Staging is based on the international staging system (ISS). The type and effectiveness of the treatment may depend upon the stage.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

dexamethasone

 is an anti-inflammation drug that helps calm your body's reactions to many chemotherapy treatments

Tumor Lysis Syndrome

Tumor lysis syndrome occurs when many cancer cells die quickly and release their contents into the bloodstream. Many times the body has the ability to flush these substances out through the kidneys or metabolize them via the liver. However, sometimes the body needs medicines to help eliminate these substances and to prevent organ damage.

Common carfilzomib starting doses

  • Carfilzomib 20 mg/m2 (max 44 mg) intravenous (I.V.) infusion over 10 minutes on Days 1 and 2 of Cycle 1
    • then, Carfilzomib 27 mg/m2 (max 59.4 mg) I.V. over 10 minutes on Days 8, 9, 15, and 16 of Cycle 1
    • then, Carfilzomib 27 mg/m2 (max 59.4 mg) I.V. over 10 minutes on Days 1, 2, 8, 9, 15, and 16 of Cycles 2 - 12
    • then, Carfilzomib 27 mg/m2 (max 59.4 mg) I.V. over 10 minutes on Days 1, 2, 15, and 16 of cycles 13 and on

      OR
  • Carfilzomib 20 mg/m2 (max 44 mg) intravenous (I.V.) infusion over 30 minutes on Days 1 and 2 of Cycle 1
    • then, Carfilzomib 56 mg/m2 (max 123.2 mg) I.V. over 30 minutes on Days 8, 9, 15, and 16 of Cycle 1
    • then, Carfilzomib 56 mg/m2 (max 123.2 mg) I.V. over 30 minutes on Days 1, 2, 8, 9, 15, and 16 of Cycles 2 - 12
    • then, Carfilzomib 56 mg/m2 (max 123.2 mg) I.V. over 30 minutes on Days 1, 2, 15, and 16 of cycles 13 and on

      OR

          (some infusion centers infuse all carfilzomib doses over 30 minutes)

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium

What are free light chains?

An antibody, sometimes referred to as an immunoglobulin, is made up of two pieces - 1 heavy chain, and 1 light chain. They are normally attached to one another. Free light chains are fragments, or small parts of antibodies (also known as immunoglobulins) that are found unattached to the heavy chain and can be detected in the blood or urine. Myeloma cells sometimes produce too many of these antibody chains.

  • The blood test used to detect free light chains may be referred to as a "Serum Protein Electrophoresis," or SPEP
  • The urine test used to detect free light chains may be referred to as a "Urine Protein Electrophoresis," or UPEP

Chemotherapy may cause the level of free light chains to decrease in the blood or urine and is often a sign that the chemotherapy is working.

To learn more about free light chains, visit the International Myeloma Foundation

What does Cure mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.