Classification: Proteasome Inhibitor
Carfilzomib works by inhibiting the 26S proteasome. A proteasome is an enzyme that is responsible for breaking down proteins in all cells (healthy or cancerous). By blocking the action of proteasome, protein builds up in the cells and causes them to die, therefore preventing tumor growth.
How to Take Carfilzomib
Carfilzomib is given by IV (intravenous) infusion, which takes only a few minutes. The dose you receive is based on your body size. Carfilzomib is given on two consecutive days each week, for three weeks, followed by a 12-day rest period. You may be given a steroid (dexamethasone) prior to the infusion to prevent a reaction. Drink plenty of fluids while on this therapy (unless directed otherwise). Your oncology team may also give you IV fluids before and/or after each infusion.
Possible Side Effects
There are a number of things you can do to manage the side effects of Carfilzomib. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
The infusion can cause a reaction that may lead to chills, fever, low blood pressure, facial flushing, shortness of breath, nausea and vomiting, feeling faint, chest pain. You will receive dexamethasone prior to the infusion to help prevent these reactions. Reactions are most common during the first week of therapy, including the evening after the infusion. Your doctor or nurse will tell you what to do if this happens.
Nausea and/or Vomiting
Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.
Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration.
Low Platelet Count (Thrombocytopenia)
Platelets help your blood clot, so when the count is low you are at a higher risk of bleeding. Let your doctor or nurse know if you have any excess bruising or bleeding, including nose bleeds, bleeding gums or blood in your urine or stool. If the platelet count becomes too low, you may receive a transfusion of platelets.
Low White Blood Cell Count (Leukopenia or Neutropenia)
White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips to preventing infection:
Low Red Blood Cell Count (Anemia)
Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your doctor or nurse know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion.
Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.
Carfilzomib can cause changes in the levels of certain electrolytes, including potassium. Your healthcare team will monitor your electrolyte levels throughout treatment.
Carfilzomib can cause or worsen pre-existing heart problems including congestive heart failure, restrictive cardiomyopathy, decreased heart function and heart attack. Notify your healthcare provider if you have sudden weight gain or swelling in the ankles or legs. If you develop chest pain or pressure, pain in the left arm, back, or jaw, sweating, shortness of breath, clammy skin, nausea, dizziness or lightheadedness, call 911 or go to the nearest emergency room.
This medication can cause acute kidney failure, especially in patients with a history of reduced kidney function. Your kidney function will be monitored throughout treatment. If you experience swelling of your face or body or a decrease in the amount of urine you are producing, notify your healthcare team immediately.
Carfilzomib can cause acute respiratory distress syndrome (ARDS), respiratory failure, interstitial lung disease or an inflammation of the lungs (called pneumonitis). Notify your healthcare provider right away if you develop any new or worsening symptoms, including shortness of breath, trouble breathing, cough or fever.
This medication can cause pulmonary hypertension or high blood pressure in the arteries that supply blood to the lungs. Symptoms include: shortness of breath, dizziness, fainting, chest pressure, swelling of feet, ankles or legs, racing heart. If you experience any of these symptoms, contact your healthcare team or go to the emergency room immediately.
High Blood Pressure
This medication can cause high blood pressure (hypertension). Patients should have their blood pressure checked regularly during therapy. Any hypertension should be treated appropriately. If hypertension cannot be controlled, the medication may be stopped.
Carfilzomib can increase the risk of blood clots (DVT or PE). Symptoms can include: swelling, redness or pain in an extremity, or shortness of breath. If you experience symptoms of these problems, you should contact your healthcare provider immediately or go to an emergency room.
This medication can cause liver toxicity, which your doctor may monitor for using blood tests called liver function tests. If you develop elevations in your liver function tests, your healthcare provider may need to lower your dose or stop the medication. Notify your healthcare provider if you notice yellowing of the skin or eyes, your urine appears dark or brown or pain in your abdomen, as these can be signs of liver toxicity.
Posterior Reversible Encephalopathy Syndrome (PRES)
In rare cases this medication has caused a neurological disorder called posterior reversible encephalopathy syndrome (PRES). Symptoms of PRES include headache, seizure, lethargy, confusion, blindness and other visual and neurological disturbances. Report any of these symptoms to your healthcare team immediately.
Thrombotic Thrombocytopenic Purpura/Hemolytic Uremic Syndrome (TTP/HUS)
This medication can also cause another rare syndrome called thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS). Your healthcare team will monitor you for symptoms of TTP/HUS throughout your treatment with carfilzomib. Notify your healthcare team if you have bruising or bleeding.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment and for at least 2 weeks after treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should consult with your healthcare team before breastfeeding while receiving this medication.
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