Proteasome inhibitors block the breakdown of protein within myeloma cells, causing them to stop growing and die.
The most commonly used proteasome inhibitors for myeloma are bortezomib and carfilzomib, but new types are emerging.
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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, low blood counts, shingles and peripheral neuropathy.
Carfilzomib may cause heart problems or worsen pre-existing conditions. Most side effects can be managed.
A range of new drug therapies for myeloma are being developed. These include new proteasome inhibitors such as ixazomib and oprozomib, as well as monoclonal antibodies such as daratumumab and elotuzumab.
Monoclonal antibodies are made in a laboratory, but behave like the natural antibodies that our bodies produce to fight infection and disease. They target cancer cells and affect their growth or survival.
The cost of these new drugs is not subsidised for myeloma on the Pharmaceutical Benefits Scheme (PBS), so they are expensive. If your doctor thinks they are the most promising treatment for you, ask whether there are any clinical trials or compassionate access schemes that may be able to help with the costs.
Dr Jane Estell, Senior Staff Specialist, Haematology Department, Concord Cancer Centre, and Senior Clinical Lecturer, The University of Sydney; Brenda Clasquin, 13 11 20 Consultant, Cancer Council NSW; Jacqui Keogh, Senior Myeloma Support Nurse, Myeloma Australia; Dr Silvia Ling, Haematologist, Liverpool Hospital and Sydney Adventist Hospital; and John Miller, Consumer.
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