Proteasome inhibitors and monoclonal antibodies
Proteasome inhibitors block the breakdown of protein within myeloma cells, causing them to stop growing and die. Commonly used proteasome inhibitors for myeloma are bortezomib and carfilzomib. Some newer drugs such as ixazomib and oprozomib are being studied.
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Bortezomib is given as an injection under the skin or into a vein. It is often used together with steroids and chemotherapy. Carfilzomib is given intravenously.
Bortezomib and carfilzomib may cause fatigue, diarrhoea, nausea, constipation, low blood counts, infections and shingles. Peripheral neuropathy is common with bortezomib but rare with carfilzomib.
Carfilzomib may also cause hypertension, heart problems or worsen pre-existing heart conditions.
Monoclonal antibodies are made in a laboratory but behave like natural antibodies that fight infection and disease. They target cancer cells and interfere with how they grow and survive. Available drugs include daratumumab and elotuzumab.
How they are given
Monoclonal antibodies are either injected into a vein (intravenously) or injected under the skin (subcutaneously).
As these drugs are often given as an injection, they may cause an allergic reaction. Other side effects may be a fever, nausea, diarrhoea and low blood pressure.
Prof John Gibson, Haematologist, Institute of Haematology, Royal Prince Alfred Hospital and The University of Sydney, NSW; Dr Stephanie Anderson, Registrar, Institute of Haematology, Royal Prince Alfred Hospital, NSW; Tanya Carney, Consumer; Jacqui Keogh, NSW State Manager/Senior Myeloma Nurse NSW, Myeloma Australia; Dr Silvia Ling, Haematologist, Liverpool Hospital, NSW; Rachel McCann, Myeloma Support Nurse NSW, Myeloma Australia; John McMath, Consumer; Karen Robinson, 13 11 20 Consultant, Cancer Council NSW.
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