Carfilzomib

How it works

It irreversibly inhibits the chymotrypsin-like activity of the 20S proteasome, causing accumulation of misfolded proteins and apoptosis of myeloma cells.

Prescribing in practice

• Cardiac failure, ischaemia and other serious cardiovascular events can occur; assess cardiac status before treatment, ensure adequate hydration and monitor closely, withholding for significant toxicity.
• Infusion reactions can occur, so premedication with a corticosteroid is used to reduce their incidence.
• Thrombocytopenia, hypertension and a risk of venous thromboembolism require monitoring and appropriate prophylaxis.

Monitoring

Monitor full blood count, blood pressure, fluid status and cardiac and renal function throughout treatment.

Counselling the patient

• Report breathlessness, chest pain, swollen ankles or a rapid weight gain promptly as these can signal heart or fluid problems.
• Tell the team about any signs of bruising, bleeding or infection.
• Maintain good hydration as advised around each infusion.

Evidence & guidelines

NICE has appraised carfilzomib-based combinations for relapsed multiple myeloma, supported by randomised controlled trial data.