MULTIPLE MYELOMA KNOWLEDGE CENTER

How is Kyprolis administered?

Kyprolis® (carfilzomib, Onyx) is administered as an injection directly into a vein (intravenously, or IV). During each 28-day treatment cycle, Kyprolis is given over 2 consecutive days each week for 3 weeks, followed by 12 days off. Dosing varies slightly depending on whether Kyprolis is given alone or in combination with other agents.

Single-agent Kyprolis

When used alone, Kyprolis is given as a 10-minute or 30-minute IV infusion, depending on the dosing used.

  • For one dosing regimen, Kyprolis is administered as a 10-minute infusion and is started at 20 mg/m2 during the first cycle on Days 1 and 2. If this dose is tolerated, the dose is increased to 27 mg/m2 for the remaining cycles.
  • For the other dosing regimen, Kyprolis is administered as a 30-minute infusion and is started at 20 mg/m2 during the first cycle on Days 1 and 2. If this dose is tolerated, the dose is increased to 56 mg/m2 for the remaining cycles.

Patients follow either of these schedules for 12 cycles. For Cycle 13 and beyond, patients receive Kyprolis 4 times (2 consecutive days during the first and third weeks).

Kyprolis in combination with Revlimid and dexamethasone

For patients receiving KRd combination therapy, Kyprolis is administered as a 10-minute infusion and is started at 20 mg/m2 during the first cycle on Days 1 and 2. If this dose is tolerated, the dose is increased to 27 mg/m2 for the remaining cycles. Patients receive oral Revlimid 25 mg on Days 1 through 21 and oral or IV dexamethasone 40 mg on Days 1, 8, 15, and 22 of each cycle.

Patients follow this schedule for 12 cycles. For cycles 13 through 18, patients receive Kyprolis 4 times (2 consecutive days during the first and third weeks). After 18 cycles, Kyprolis is stopped, but patients can continue receiving Revlimid-dex.

Kyprolis in combination with dexamethasone

When administered in combination with low-dose dexamethasone, Kyprolis is administered as a 30-minute infusion at a starting dose of 20 mg/m2 during the first cycle on Days 1 and 2. If this dose is tolerated, the dose is increased to 56 mg/m2 for the remaining cycles.

Patients receive oral or IV dexamethasone 20 mg on Days 1, 2, 8, 9, 15, 16, 22, and 23 of each 28-day cycle. Dexamethasone is given 30 minutes to 4 hours before Kyprolis is administered.

Additional information

Patients experiencing severe side effects may have Kyprolis temporarily stopped until the side effects resolve and may have their dose reduced when Kyprolis is restarted.

Patients also receive IV fluids (hydration) before and possibly after administration of each dose of Kyprolis during the first treatment cycle, and as needed in the remaining cycles. Hydration helps reduce the risk of damage to the kidneys and of tumor lysis syndrome.

Dexamethasone pre-medication is also given prior to each dose of Kyprolis during the first treatment cycle as well as during any cycle when the dose of Kyprolis is increased. This pre-medication is given to reduce the risk and severity of infusion reactions, a possible side effect seen with some drugs that are given intravenously. Patients may also receive dexamethasone if they experience symptoms of an infusion reaction.

Patients receiving Kyprolis in combination with low-dose dexamethasone or with Revlimid-low-dose dex may also receive a blood thinner (anticoagulant) to prevent blood clots.

Patients receiving Kyprolis may also receive medication to prevent shingles, a viral infection that causes a painful rash and is due to a reactivation of the herpes zoster virus (the virus that causes chickenpox).

Treatment with Kyprolis is usually continued until disease progression or unless side effects are not tolerated.