A proteasome-blocking chemotherapy for multiple myeloma
Carfilzomib
A specialist anti-cancer medicine given by drip to treat multiple myeloma, a cancer of the bone marrow.
What is Carfilzomib?
Carfilzomib is a specialist anti-cancer medicine used to treat multiple myeloma, a cancer of the plasma cells in the bone marrow, usually after other treatments have been tried. It is a proteasome inhibitor, meaning it blocks the cell's waste-disposal system so that cancer cells build up harmful proteins and die. It is given through a drip into a vein, often combined with other medicines. Its most important risks are heart problems, including heart failure, and high blood pressure, as well as infusion reactions, blood clots and effects on the kidneys, so it is given under close specialist supervision.
Education and reference only. This is a plain-language guide to Carfilzomib — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Carfilzomib is an anti-cancer (chemotherapy) medicine used to treat multiple myeloma, a cancer of plasma cells in the bone marrow. It is usually used when the myeloma has come back or has not responded to earlier treatment, and is often given in combination with other anti-myeloma medicines. It is a proteasome inhibitor, a type of medicine that interferes with how cancer cells clear out waste proteins. It is given as an infusion (a drip) into a vein in a hospital or specialist clinic, in treatment cycles, under the care of a cancer team.
How it works
Cells use a structure called the proteasome to break down and recycle unwanted proteins, a bit like a waste-disposal unit. Myeloma cells are very busy and produce large amounts of protein, so they rely heavily on this clean-up system. Carfilzomib blocks the proteasome, so faulty and excess proteins build up inside the cancer cells until they can no longer survive and die off. Because the medicine puts the heart and blood vessels under strain and affects the kidneys, treatment is given in carefully timed doses with close monitoring of the heart, blood pressure and kidney function.
Company & origin
Originated / developed by: Specialist manufacturer.
A specialist anti-cancer medicine used in the UK to treat multiple myeloma, a cancer of the bone marrow, usually after other treatments.
Practical use
How to take Carfilzomib
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It is given as a drip into a vein by your cancer team, in treatment cycles, not taken at home.
- Take any pre-medicines and extra fluids exactly as advised, as these help reduce reactions and protect the kidneys.
- Report breathlessness, swollen ankles, chest discomfort or a fast or irregular heartbeat straight away.
- Tell your team promptly about signs of infection such as fever, or any unusual bruising or bleeding.
- Attend all your blood tests and heart and blood-pressure checks during treatment.
Weighing it up
Advantages & disadvantages of Carfilzomib
Advantages
- An effective treatment option for multiple myeloma, including when it has come back or not responded to other treatment.
- Works in a targeted way by blocking the cancer cell's waste-disposal system.
- Often combined with other medicines to improve how well treatment works.
Disadvantages
- Can cause serious heart problems, including heart failure, and raised blood pressure.
- Can cause reactions during the drip, blood clots, kidney effects and low blood counts.
- Must be given by drip in a specialist setting with close monitoring.
Practical use
Good to know
The most important things to understand about carfilzomib are its effects on the heart and circulation. It can cause or worsen heart failure and other heart problems, and can raise blood pressure significantly, so the team checks your heart and blood pressure carefully and you should report breathlessness, swollen ankles, chest discomfort or a fast or irregular heartbeat straight away. Reactions during or soon after the drip (infusion reactions) can happen, so you are usually given medicines beforehand to reduce the risk, and staying well hydrated is part of protecting the kidneys. It also raises the risk of blood clots, so blood-thinning prevention is often used, and it lowers blood counts, increasing the risk of infection, bleeding and anaemia. Because of these risks it is only given under close specialist supervision, with regular blood tests and heart checks.
Who should not take it / use with caution
- People who have had a serious allergic reaction to carfilzomib should not receive it.
- It is used with great caution, or avoided, in people with significant heart failure or recent heart problems.
- It is used with care in people with poor kidney function or uncontrolled high blood pressure.
- It is avoided in pregnancy and while breastfeeding, and effective contraception is advised during treatment.
Monitoring
- Regular checks of the heart and blood pressure, sometimes including heart scans before and during treatment.
- Regular blood tests to check blood counts and kidney function.
- Watching for infusion reactions, signs of blood clots, infection and bleeding.
Side effects
- Heart problems, including heart failure and an irregular or fast heartbeat.
- High blood pressure, sometimes severe.
- Reactions during or soon after the drip, such as fever, chills, breathlessness or a drop in blood pressure.
- Blood clots, kidney effects, low blood counts, tiredness, breathlessness and an increased risk of infection.
Key interactions
- It is used with care alongside other medicines that affect the heart or blood pressure.
- Blood-thinning medicines are often used with it to lower the risk of clots, and need careful management.
- Tell your team about all your medicines, including over-the-counter and herbal products, before and during treatment.
Available as: A powder made up into a solution for infusion (a drip) into a vein.
Answers
Carfilzomib: frequently asked questions
What is carfilzomib used for?
It is a specialist anti-cancer medicine used to treat multiple myeloma, a cancer of the bone marrow, usually after other treatments have been tried.
How does it work?
It blocks the proteasome, the cell's waste-disposal system, so cancer cells build up harmful proteins and die.
Why is my heart checked during treatment?
Carfilzomib can cause or worsen heart problems, including heart failure, and raise blood pressure, so your heart and blood pressure are monitored closely.
How is it given?
It is given as a drip into a vein by your cancer team, in treatment cycles, usually with pre-medicines and extra fluids to reduce reactions and protect the kidneys.
What should I report straight away?
Report breathlessness, swollen ankles, chest discomfort, a fast or irregular heartbeat, signs of infection, or unusual bruising or bleeding without delay.
The wider class
About Proteasome inhibitor (anti-cancer)
Carfilzomib belongs to the proteasome inhibitor (anti-cancer) class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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