Last Modified: September 16, 2012
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.
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.
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:
Infusion reactions can occur up to 24 hours after the infusion. You may be given a steroid (dexamethasone) before the infusion to reduce the risk of a reaction. Report any symptoms of a reaction to your oncology team right away. These include: fever, chills, facial flushing or swelling, shortness of breath, feeling faint, chest tightness or pain.
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. Read the anemia tip sheet for more information.
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 your platelet count becomes too low, you may receive a transfusion of platelets.
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 F), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips to preventing infection:
For more suggestions, read the Neutropenia Tip Sheet.
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 that absorbs fluid and can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange and grapefruit sections, boiled potatoes, white rice and 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. Read Low Fiber Diet for Diarrhea for more tips.
Take anti-nausea medications as prescribed. If you continue to have nausea or vomiting, notify your doctor or nurse so they can help you manage this side effect. 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. Read the Nausea & Vomiting Tip Sheet for more suggestions.
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.
Peripheral neuropathy is a toxicity that affects the nerves. It causes a numbness or tingling feeling in the hands and feet, often in the pattern of a stocking or glove. This can get progressively worse with additional doses of the drug. In some people, the symptoms slowly resolve after the drug is stopped, but for some it never goes away completely. You should let your healthcare provider know if you experience numbness or tingling in the hands and feet, as they may need to change the doses of your medication. See OncoLink's section on peripheral neuropathy for tips on dealing with this side effect.
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, even if your menstrual cycle stops or you believe your sperm is affected.
Fever can occur after the dose of carfilzomib is given. You should always contact your doctor if you develop a fever, as it could be related to an infection.
While on cancer treatment 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 and see OncoLink's section on fatigue for helpful tips on dealing with this side effect.
Carfilzomib has been associated with the following serious medical conditions. Contact your oncology team right away if you develop these symptoms.
In clinical trials, some patients developed heart failure and/or had a heart attack (myocardial infarction). 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.
Jul 25, 2012 - For patients with newly diagnosed multiple myeloma, induction treatment with a combination of bortezomib, doxorubicin, and dexamethasone followed by bortezomib maintenance therapy improves complete response, progression-free survival, and overall survival rates, according to a study published online July 16 in the Journal of Clinical Oncology.