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Kyprolis 60mg Powder for solution for intravenous infusion (single-dose vial)
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Indications & Clinical Uses
- Kyprolis 60 mg is carfilzomib, a selective proteasome inhibitor supplied as a lyophilised powder in a single-dose vial that a healthcare professional reconstitutes and gives as an intravenous infusion; it is never given as a bolus or push and is never self-administered.
- It is approved for adults with relapsed or refractory multiple myeloma who have had one to three prior lines of therapy, in combination with lenalidomide and dexamethasone, with dexamethasone alone, with daratumumab and dexamethasone, with daratumumab and hyaluronidase-fihj and dexamethasone, or with isatuximab and dexamethasone, and it may also be used alone.
- Vials come as 10 mg, 30 mg and 60 mg.
- Three dosing schedules exist and THEY ARE NOT INTERCHANGEABLE: 20/27 mg/m2 twice weekly over 10 minutes, 20/56 mg/m2 twice weekly over 30 minutes, and 20/70 mg/m2 once weekly over 30 minutes.
Side Effects
- Common reactions include anaemia, diarrhoea, high blood pressure, tiredness, upper respiratory tract infection, low platelets, fever, cough, breathlessness, nausea and difficulty sleeping.
- Kyprolis has NO boxed warning, but it carries serious risks that need urgent attention.
- Cardiac toxicity, including new or worsening heart failure, reduced heart function, chest pain from reduced blood supply and cardiac arrest, occurred in about 8% of patients, most often early in treatment.
- Acute kidney failure occurred in about 9%, tumour lysis syndrome can follow the first dose, and pulmonary toxicity including acute respiratory distress syndrome affected about 2%.
- Liver failure, thrombotic microangiopathy, posterior reversible encephalopathy syndrome, progressive multifocal leukoencephalopathy and venous blood clots, in about 13% on combination therapy, have occurred.
- Report chest pain, breathlessness, swollen legs, reduced urine, confusion or fits immediately.
Precautions & Warnings
- Kyprolis is a hospital or clinic treatment only.
- Give it by intravenous infusion over 10 or 30 minutes according to the chosen schedule, never as an injection or push, and never mix it with or infuse it alongside any other medicine.
- Good hydration before and after dosing, particularly in cycle 1, protects the kidneys and reduces tumour lysis syndrome; dexamethasone premedication reduces infusion reactions such as fever, chills, flushing, chest tightness and low blood pressure, which can appear up to 24 hours after a dose.
- Heart function, blood pressure, fluid balance, kidney function, liver tests and blood counts are monitored throughout, and thromboprophylaxis is recommended.
- Carfilzomib can harm an unborn baby, so effective contraception is needed during treatment and for a period afterwards.
- Unopened vials are refrigerated at 2°C to 8°C in the original carton.
Avoid Interactions
- Kyprolis must not be mixed with, or infused through the same line at the same time as, any other medicine; the line is flushed with saline or dextrose before and after each dose.
- Medicines that add to the risk of clots, notably lenalidomide, dexamethasone and oral contraceptives or hormone replacement therapy, increase the chance of deep vein thrombosis and pulmonary embolism, so hormonal contraception is usually replaced with another effective method.
- Combining Kyprolis with other treatments that damage the kidneys, such as some antibiotics, contrast dyes and non-steroidal anti-inflammatory drugs, raises the risk of acute kidney failure.
- Live vaccines should be avoided because myeloma treatment suppresses immunity.
- Carfilzomib may reduce the effectiveness of oral contraceptives.
- Tell the treating team about every prescription medicine, over-the-counter product, herbal remedy and supplement before each cycle.
References
Frequently Asked Questions
Kyprolis (carfilzomib) treats relapsed or refractory multiple myeloma in adults who have already had one to three lines of treatment. It is a proteasome inhibitor given with lenalidomide and dexamethasone, with dexamethasone alone, or with daratumumab or isatuximab plus dexamethasone, and it can also be used on its own.
Kyprolis is given only in hospital or clinic, as an intravenous infusion over 10 or 30 minutes, never as a bolus or push. Carfilzomib follows 28-day cycles using one of three schedules: 20/27 mg/m2 twice weekly, 20/56 mg/m2 twice weekly, or 20/70 mg/m2 once weekly.
No. The Kyprolis 20/27, 20/56 and 20/70 mg/m2 schedules are not interchangeable. They use different doses, different infusion times and different combination partners, so swapping one carfilzomib schedule for another can seriously under-treat or overdose you. The schedule is chosen with your combination regimen and must be followed exactly.
Common Kyprolis side effects are anaemia, diarrhoea, high blood pressure, tiredness, chest infections, low platelets, fever, cough, breathlessness and poor sleep. Carfilzomib has no boxed warning but can cause heart failure, kidney failure, lung problems and blood clots. Report chest pain, breathlessness, swollen legs or reduced urine immediately.
You are given fluids before and after the Kyprolis infusion, especially in the first cycle, to protect your kidneys, plus dexamethasone to reduce infusion reactions. Carfilzomib is never mixed with other medicines in the same line. Blood pressure, heart function, blood counts and kidney tests are checked regularly.
Avoid live vaccines during Kyprolis treatment, and avoid becoming pregnant or fathering a child, as carfilzomib can harm an unborn baby. Hormonal contraception is usually swapped for another effective method because of the clot risk. Tell your team before taking anti-inflammatory painkillers or any new medicine.
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