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Care During Chemotherapy and Beyond

Ixazomib

(ix-AZ-oh-mib)

Trade Name: Ninlaro®

Ixazomib is the generic name for the trade name drug Ninlaro. In some cases, health care professional may use the trade name Ninlaro when referring to the generic drug name, ixazomib.

Drug Type: Ixazomib is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. This medication is classified as a "proteasome inhibitor." (For more detail, see "How Ixazomib Works" below)

What Ixazomib Is Used For:

  • Multiple myeloma, Ixazomib is used in combination with lenalidomide and dexamethasone in patients who have received at least one prior therapy

Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems or in different combinations if they believe it may be helpful.

How Ixazomib Is Given:

  • Ixazomib is a capsule taken once a week for 3 out of 4 weeks (Days 1, 8, 15 of a 28 day cycle).
  • Ixazomib should be taken on the same day of the week and at the same time of day.
  • Ixazomib should be taken on an empty stomach (1 hour before or two hours after a meal).
  • The capsule should be swallowed whole with a glass of water. Do not open the capsule, crush, chew or dissolve it.
  • If a dose is delayed or missed, take it only if the next schedule dose is at least 72 hours away. Do not take a missed dose within 3 days of the next scheduled dose. Do not double a dose to make up for a missed dose. If vomiting occurs, do not repeat the dose; resume dosing at the next scheduled dose.

The amount of ixazomib that you will receive depends on many factors, including your height and weight, your general health or other health problems (e.g. kidney, liver problems), and the type of cancer or condition you have. Your doctor will determine your exact dosage and schedule.

Side Effects:

Important things to remember about the side effects of ixazomib:

  • Most people will not experience all of the ixazomib side effects listed.
  • Ixazomib side effects are often predictable in terms of their onset, duration, and severity.
  • Ixazomib side effects will improve after therapy is complete.
  • Ixazomib side effects may be quite manageable. There are many options to minimize or prevent the side effects of ixazomib.

The following side effects are common (occurring in greater than 30%) for patients taking ixazomib:

  • Low blood counts. Your white and red blood cells and platelets may temporarily decrease. This can put you at increased risk for infection, anemia and/or bleeding.
    • Nadir (low point): platelets are lowest between days 14-21
  • Diarrhea
  • Constipation

These are less common side effects (occurring in 10-29%) for patients receiving ixazomib:

Not all side effects are listed above. Side effects that are very rare -- occurring in less than about 10 percent of patients -- are not listed here. But you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

  • Fever of 100.4º F (38º C) or higher, chills (possible signs of infection)
  • Unusual bleeding or bruising
  • Black or tarry stools, or blood in your stools
  • Blood in the urine

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:

  • Nausea (interferes with ability to eat and unrelieved with prescribed medication)
  • Vomiting (vomiting more than 4-5 times in a 24 hour period)
  • Diarrhea (4-6 episodes in a 24-hour period)
  • Constipation unrelieved by laxative use.
  • Extreme fatigue (unable to carry on self-care activities)
  • Mouth sores (painful redness, swelling and ulcers)
  • Yellowing of the skin or eyes
  • Swelling of the feet or ankles. Sudden weight gain.
  • Signs of infection such as redness or swelling, pain on swallowing, coughing up mucous, or painful urination.
  • Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst, dry mouth, dark and decrease amount of urine, or dizziness.

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

  • Before starting ixazomib treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over the counter, vitamins, herbal remedies, etc.) There may be serious drug interactions.
  • Do not take aspirin, products containing aspirin unless your doctor specifically permits this.
  • Do not take St. John's Wort while you are on this therapy.
  • Do not receive any kind of immunization or vaccination without your doctor's approval while taking ixazomib.
  • Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category X. Ixazomib may cause fetal harm when given to a pregnant woman. This drug must not be given to a pregnant woman or a woman who intends to become pregnant. If a woman becomes pregnant while taking ixazomib, the medication must be stopped immediately and the woman given appropriate counseling).
  • For both men and women: Use contraceptives, and do not conceive a child (get pregnant) while taking ixazomib. Barrier methods of contraception, such as condoms, are recommended for up to 3 months after last dose of ixazomib.
  • Do not breast feed while taking ixazomib.

Self-Care Tips:

  • Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
  • You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
  • Wash your hands often.
  • To help treat/prevent mouth sores, use a soft toothbrush, and if you should have mouth sores/discomfort rinse three times a day with 1 teaspoon of baking soda with 8 ounces of water.
  • Use an electric razor and a soft toothbrush to minimize bleeding.
  • Avoid contact sports or activities that could cause injury.
  • To reduce nausea, take anti-nausea medication as prescribed by your doctor, and eat small, frequent meals.
  • Follow regimen of anti-diarrhea medication as prescribed by your health care professional.
  • Eat foods that may help reduce diarrhea (see managing side effects - diarrhea).
  • Keep your bowels moving. Your health care provider may prescribe a stool softener to help prevent constipation that may be caused by this medicine.
  • Avoid sun exposure. Wear SPF 30 (or higher) sunblock and protective clothing.
  • In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
  • Get plenty of rest.
  • Maintain good nutrition.
  • Remain active as you are able. Gentle exercise is encouraged such as a daily walk.
  • If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:

You will be checked regularly by your doctor while you are taking ixazomib, to monitor side effects and check your response to therapy. Periodic blood work will be obtained to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.

How Ixazomib Works:

Targeted therapy is the result of about 100 years of research dedicated to understanding the differences between cancer cells and normal cells. To date, cancer treatment has focused primarily on killing rapidly dividing cells because one feature of cancer cells is that they divide rapidly. Unfortunately, some of our normal cells divide rapidly too, causing multiple side effects.

Targeted therapy is about identifying other features of cancer cells. Scientists look for specific differences in the cancer cells and the normal cells. This information is used to create a targeted therapy to attack the cancer cells without damaging the normal cells, thus leading to fewer side effects. Each type of targeted therapy works a little bit differently but all interfere with the ability of the cancer cell to grow, divide, repair and/or communicate with other cells.

There are different types of targeted therapies, defined in three broad categories. Some targeted therapies focus on the internal components and function of the cancer cell. The targeted therapies use small molecules that can get into the cell and disrupt the function of the cells, causing them to die. There are several types of targeted therapy that focus on the inner parts of the cells. Other targeted therapies target receptors that are on the outside of the cell. Therapies that target receptors are also known as monoclonal antibodies. Antiangiogenesis inhibitors target the blood vessels that supply oxygen to the cells, ultimately causing the cells to starve.

Researchers agree that targeted therapies are not a replacement for traditional therapies. They may best be used in combination with traditional therapies. More research is needed to identify which cancers may be best treated with targeted therapies and to identify additional targets for more types of cancer.

Ixazomib targets and reversibly inhibits the proteasome enzyme complex within the cell. Proteasome is part of the cellular machinery and has many functions within the cell. For example. it helps to control the level of many of the proteins that help to regulate cell division and cell survival. By interfering with its function this can lead to apoptosis (cell suicide). In the laboratory, it has been shown that cancer cells are more susceptible to the effects of proteasome inhibitors than normal cells. Ixazomib reversibly inhibits chymotryspin-like activity of the beta 5 subunit of the 20S proteasome. This leads to activation of signaling cascades, cell cycle arrest (so that it does not grow and divide) and apoptosis (cell death).

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in the website is meant to be helpful and educational, but is not a substitute for medical advice.

Reference:

Iaxzomib. Lexicomp Online® [cited 2016 January 22]. Lexi-Drugs®. Hudson, Ohio: Lexi-Comp, Inc.; January 22, 2016.

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