The mechanism of action for Kyprolis is to block a key part of protein recycling in myeloma cells. This action causes the myeloma cells to fill up with unprocessed protein and burst. Kyprolis is used as an intravenous infusion.
Uses
Kyprolis is targeted cell therapy, This means that it attacks cancer cells while having little to no impact on other bodily cells, which minimizes side effects.
Kyprolis is a proteasome inhibitor that functions by preventing cells from recycling protein. Myeloma cells make large amounts of defective protein that must be broken down—or the cells will burst. By gumming up that process, Kyprolis acts on a cellular level to stop these cancer cells. It has been shown to inhibit tumor growth and cause the cancer cells to die.
The FDA-approved indication for Kyprolis is for multiple myeloma that either:
Has relapsed (has come back after a round of treatment)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 if other treatments have not worked. 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
You would undergo a thorough medical history and medication review as part of an intensive evaluation before being recommended to take Kyprolis.
If your healthcare provider determines that this treatment is indicated for you, they would also determine whether it should be taken in combination with other drugs or by itself. Dosage of 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 healthcare provider. 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.
Important considerations while being treated with this drug :
Adequate hydration is strongly encouraged prior to your first dose to assist your kidneys and immune system in metabolizing the medication to maintain non-toxic levels in the bloodstream. If you have a history of electrolyte imbalances, your electrolytes should be closely monitored while taking Kyprolis. If you are receiving hemodialysis treatment for kidney disease, you should receive Kyprolis following your hemodialysis treatment. This ensures that your kidneys are functioning at their best in order to adequately metabolize Kyprolis. If you are at risk for herpes zoster (shingles), you should also take an antiviral medication while under treatment with Kyprolis. This decreases the risk of reactivating the herpes virus.
Other Proteasome Inhibitors
There are other proteasome inhibitors used to treat multiple myeloma:
Velcade (bortezomib)Ninlaro (ixazomib)
Dosage
Your dosage is determined according to your medical history, medication regimen, and the clinical judgment of your healthcare provider.
All listed dosages are according to the drug manufacturer.
The usual dosage of Kyprolis is often either in 50 milliliters (mL) or 100 mL combined with 5% of dextrose. Kyprolis is infused over the course of 10-30 minutes depending on the dosage. Kyprolis should not be mixed with other medications for any purpose. 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.
Check your prescription and talk to your healthcare provider to make sure you are taking the right dose for you.
Storage
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 can be made to Kyprolis, as the only method for administration is intravenously.
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. The use of Kyprolis in children has not been tested and, therefore, is not currently recommended.
Overdose
Kyprolis therapeutic dose is calculated based on weight and height and, in general, should never exceed 154 milligrams (mg) per dose. An overdose of Kyprolis at 200 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 manage a Kyprolis overdose.
Side Effects
Kyprolis side effects have been reported as predictable and manageable by healthcare practitioners. These side effects have also been noted to resolve after Kyprolis treatments are complete.
Common
Common side effects of Kyprolis include:
FatigueNauseaShortness of breathDiarrheaFeverLow 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:
PneumoniaHeadacheCoughSwellingVomitingConstipationMuscle pain and spasmsInsomniaChillsNumbness/tingling in hands and feetLow blood levels of potassium, sodium, phosphorus, and magnesiumIncreased levels of liver enzymes and blood calcium levelsHigh blood pressureDizzinessLow appetiteIncreased 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, bring it to the attention of your healthcare provider. Otherwise, these symptoms often do not warrant emergency medical intervention.
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.
Warnings and Interactions
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.
You may also have some risks if you have certain underlying health conditions:
Patients with severe cardiac issues who take Kyprolis are at risk for cardiac failure. 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. Patients who were previously at risk for liver failure or liver-associated conditions should be closely monitored.
If you have any of these underlying medical conditions, your providers will monitor you to assess the risks.
You can stop Kyprolis immediately if instructed to do so by your healthcare provider. This is not known to cause any side effects or harm. There are no black box warnings associated with Kyprolis.
