What to Know About Kyprolis (Carfilzomib)

An anti-cancer drug used to treat multiple myeloma

In This Article

Kyprolis (carfilzomib) is an anti-cancer drug under the class of drugs called proteasome inhibitors. Kyprolis is used to treat a type of cancer called multiple myeloma. It is often used in combination with other drugs to kill current cancer cells and prevent future development of additional cancer cells.

The mechanism of action for Kyprolis is to block a key part of protein recycling in myeloma cells, resulting in the myeloma cells filling up with unprocessed protein and bursting. Kyprolis only comes in the form of an intravenous infusion. There are no major differences between brand-name and generic versions of Empliciti.

Uses

Kyprolis is a proteasome inhibitor which functions by preventing cells from recycling protein. Myeloma cells, in particular, make large amounts of defective protein that they must break down or they will burst. By gumming up that process, Kyprolis acts on a cellular level to stop these cancer cells. It has been shown to inhibit their tumor growth as well as causing cancer cells to die.

Kyprolis is a targeted cell therapy, attacking cancer cells while having little to no impact on other bodily cells. This minimizes side effects and allows an individual to continue functioning amidst this cancer treatment.

The FDA-approved indication for Kyprolis is for multiple myeloma that has relapsed (has come back after a round of treatment) or is refractory (is not responding to other treatment). It is usually not the first form of treatment given after a diagnosis of multiple myeloma, but is given after other treatment has not worked as well as hoped. It may be used in combination with dexamethasone, with lenalidomide plus dexamethasone, or by itself. There are no off-label uses for Kyprolis.

Before Taking

Patients undergo a thorough medical history and medication review as part of an intensive evaluation before being recommended to take Kyprolis. Once your doctor ensures there are no medications or medical conditions which will interfere with these chemotherapy drugs, your doctor will prescribe Kyprolis and determine whether it should be taken in combination with other drugs or by itself. Dosage for patients who take Kyprolis will require close monitoring and adjustments according to tolerance.

Precautions and Contraindications

If you are taking Kyprolis, you should not receive any immunizations or vaccinations unless advised to do so by your doctor. Women who are pregnant or breastfeeding should not take Kyprolis, as this anti-cancer drug will potentially be hazardous to the fetus. You should not take Kyprolis if you are allergic to Kyprolis or other proteasome inhibiting medications. 

Adequate hydration is strongly encouraged prior to your first dose, as this assists the kidneys and immune system in metabolizing the medication to maintain non-toxic levels in the bloodstream. Individuals with a history of electrolyte imbalances should be closely monitored while taking Kyprolis. Individuals who are receiving hemodialysis treatment for kidney disease should receive Kyprolis following their hemodialysis treatment. This ensures the kidneys are functioning at their best in order to adequately metabolize Kyprolis. Individuals who are at risk for herpes zoster should also take an antiviral medication if simultaneously taking Kyprolis. This decreases the risk of reactivating the herpes virus.

Other Proteasome Inhibitors

  • Velcade
  • Ninlaro

Dosage

Dosage of Kyprolis is often either in 50 milliliters (mL) or 100 mL combined with 5% of dextrose. Kyprolis is intended to be infused over the course of 10-30 minutes depending on the dosage. Kyprolis should not be mixed with other medications for any purpose. Dosage is according to your medical history, medication regimen, and the clinical judgment of your doctor.

Calculations for dosage are typically done using the typical surface area of the patient’s body. If patients have a body surface area of more than 2.2 meters squared (m2), dosage should be calculated using a surface area of 2.2 m2. All listed dosages are according to the drug manufacturer. Check your prescription and talk to your doctor to make sure you are taking the right dose for you.

Kyprolis vials are intended to be single-use medication due to the lack of preservatives allowing for its long-term storage. Unopened Kyprolis vials should be stored in original packaging until they are mixed with dextrose and immediately administered intravenously. Kyprolis vials should be stored between 35-46 F (2-8 C).

Modifications

No modifications are able to be made to Kyprolis, as the only method for administration is intravenously. The use of Kyprolis in children has not been tested and, therefore, is not currently recommended. The use of Kyprolis in elderly patients has been tested and determined as effective. According to several research studies, the frequency of adverse side effects from Kyprolis was higher in elderly patients than in adult patients. Being adequately hydrated is important to minimize the likelihood of adverse side effects in anyone who takes Kyprolis.

An overdose of Kyprolis at 200 milligrams (mg) has caused chills, a drop in blood pressure, impaired kidneys, and a drop in white blood cell count. Patients who receive an accidental overdose of Kyprolis should be closely monitored by a healthcare provider while these adverse side effects are treated. There is no known antidote to directly address a Kyprolis overdose.

Side Effects

Kyprolis side effects have been reported as predictable and manageable by health care practitioners. These side effects have also been noted to resolve after Kyprolis treatments are complete.

Common

Common side effects of Kyprolis include fatigue, nausea, shortness of breath, diarrhea, fever, and low white and red blood cell counts. These side effects are typically present in more than 30% of patients taking Kyprolis.

Less common side effects associated with Kyprolis include pneumonia, headache, cough, swelling, vomiting, constipation, muscle pain and spasms, insomnia, chills, numbness/tingling in hands and feet, low blood levels of potassium, sodium, phosphorus, and magnesium, increased levels of kidney function, liver enzymes, and blood calcium levels, high blood pressure, dizziness, low appetite, and increased blood sugar. These side effects have been noted to occur in 10-20% of patients taking Kyprolis.

If any of these side effects are causing significant discomfort, they should be brought to the attention of your health care provider. Otherwise, these symptoms often do not warrant emergency medical intervention if they are able to be tolerated.

Severe

Rare side effects of Kyprolis which warrant contacting emergency medical services include excessive diarrhea and vomiting, signs of dehydration (fatigue, thirst, dry mouth, dark urine, low urine output, and dizziness), yellow eyes or skin, excessive bleeding and bruising, confusion, and intense stomach pain.

If you experience a fever over 100.4 F with chills and severe shortness of breath, contact emergency medical services. These side effects may indicate an infection.

Warnings and Interactions

Patients with severe cardiac issues who take Kyprolis are at risk for cardiac failure due to blockages in the heart. Patients taking Kyprolis with pre-existing respiratory difficulties may experience shortness of breath most frequently following their first Kyprolis dose. Patients who were previously at risk for venous thrombosis, or blood clots, may be at an increased risk for clotting as a result of taking Kyprolis. It may be recommended that patients take additional medication to prevent blood clotting and potential complications.

As with many medications which are infused, patients taking Kyprolis are at risk of infusion reactions which are commonly experienced shortly after the first dose. These reactions are similar to side effects of Kyprolis and warrant a patient be closely monitored for safety. Patients taking Kyprolis may also be at risk for liver failure and patients who were previously at risk for liver failure or liver-associated conditions should be closely monitored.

Individuals are able to stop Kyprolis immediately if instructed to do so by their doctor. This is not known to cause any side effects or harm to the individual. There are no black box warnings associated with Kyprolis.

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