Cancer drugs A to Z list
Isa-VRd is a cancer drug combination. You have:
isatuximab (pronounced eye-zuh-tuk-sih-mab)
bortezomib (bor-teh-zoh-mib)
lenalidomide (len-uh-lid-oh-mide)
dexamethasone (deks-ah-meth-uh-zone)
Isatuximab is also called Sarclisa. Bortezomib is also called Velcade.
It is a treatment for myeloma. You might have Isa-VRd if you have just been diagnosed with myeloma and are not able to have an .
Isatuximab is a type of targeted cancer drug called a . Monoclonal antibodies target proteins on the surface of cancer cells. Isatuximab targets a protein called CD38. It works by attaching itself to all the CD38 proteins it finds. Once attached, it helps the find and kill myeloma cells.
Bortezomib is a type of targeted cancer drug called a proteasome inhibitor. Proteasomes are in cells, and they need them to grow and develop. They help to break down and remove proteins that the cell doesn't need. Bortezomib blocks the function of the proteasomes. So the proteins build up inside the cell, causing them to die.
Lenalidomide is an anti angiogenic drug. Anti angiogenic drugs stop cancers from growing their own blood vessels.
Dexamethasone is a . It kills myeloma cells and helps to reduce an allergic reaction to isatuximab.
Find out more about targeted drugs and immunotherapy
You have isatuximab either as an injection under your skin (subcutaneously) or as an injection into your bloodstream (intravenously).
You have bortezomib as an injection under your skin.
Lenalidomide comes as capsules that you take with a glass of water. You need to swallow them whole. Don’t break or chew them. You should take lenalidomide at the same time every day.
You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:
central line
PICC line
portacath
You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.
You usually have injections under the skin into the abdomen (tummy) or thigh. You might have stinging or a dull ache for a short time after this type of injection, but they don't usually hurt much. The skin in the area may go red and itchy for a while.
You should take the right dose, not more or less.
Talk to your healthcare team before you stop taking a cancer drug, or if you have missed a dose.
Taking dexamethasone tablets in the morning after breakfast might help with difficulty sleeping (insomnia). It might also protect your stomach from irritation.
You have Isa-VRd as cycles of treatment. This means that you have the drugs and then a rest to allow your body to recover.
Isatuximab can cause an allergic reaction. So, before each dose you have paracetamol, a steroid and an drug such as chlorphenamine (Piriton). This is to help prevent a reaction.
You might have bortezomib once or twice a week.
There are different ways of having Isa-VRd. Your doctor plans how much treatment you need and how often you have it depending on your individual situation.
You continue taking Isa-VRd for as long as the treatment is working and you are not experiencing too many side effects.
You have blood tests before and during your treatment. They check your levels of and other substances in the blood. They also check how well your liver and kidneys are working.
Before treatment starts you may have a blood test to check for viruses such as hepatitis B, hepatitis C, and HIV. This is called a viral screen.
It’s important for your doctor to know if you have had any of these viruses. This is because this treatment can weaken your and can cause the virus to become active again (reactivation).
Side effects can vary from person to person. They also depend on what other treatments you're having.
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
you have severe side effects
your side effects aren’t getting any better
your side effects are getting worse
Early treatment can help manage side effects better.
We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.
Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.
These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:
Increased risk of getting an infection is due to a drop in . Symptoms include a change in temperature, aching muscles, cough, headaches, feeling cold and shivery, pain or a burning feeling when peeing or generally feeling unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
You might be breathless and look pale due to a drop in . This is called anaemia.
This treatment can cause bleeding from anywhere in your body. This is usually mild but there is a risk of a serious bleed.
This is due to a drop in the number of platelets in your blood. Signs of bleeding include bruising, blood in your pee or poo, black poo, vomiting or coughing up blood, nosebleeds, bleeding gums, headaches, dizziness or feeling weak.
Let your healthcare team know straight away if you have any signs of bleeding.
A reaction may happen during the treatment. Symptoms can include a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Your nurse will give you medicines beforehand to try to prevent a reaction.
Tell your doctor or nurse immediately if at any time you feel unwell.
Blood clots can develop in the deep veins of your body, usually the leg. This is called deep vein thrombosis (DVT). A blood clot can be very serious if it travels to your lungs (pulmonary embolism), although this isn’t common.
Symptoms of a blood clot include:
pain, redness and swelling around the area where the clot is and may feel warm to touch
breathlessness
pain in your chest or upper back – dial 999 if you have chest pain
coughing up blood
You might develop a cough or breathing problems. This could be due to infection, such as pneumonia and bronchitis.
Rarely you might have fluid in or around your lungs causing difficulty breathing. Or lower oxygen levels in your body causing shortness of breath even when you are not exercising. Your breathing may become shallow or you might have wheezing.
Let your doctor or nurse know straight away if you suddenly become breathless or develop any of these symptoms.
Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.
Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain . But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables.
Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.
is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a if needed.
Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.
This treatment can cause nerve changes. For example, you might feel pain or a burning sensation when you touch something. Or you might have pain in part of the body that hasn’t been injured.
You might have numbness or tingling in your fingers or toes. This is often temporary and can improve after you finish treatment. You might also have weakness in your arms and legs, but this is less common.
Tell your healthcare team if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons.
Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.
You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.
Your kidneys may stop working. Symptoms might include not peeing enough, breathlessness, feeling tired and weak, feeling confused, feeling sick, and you might have swelling on your legs, ankles and feet. Sometimes this may happen suddenly (acute kidney failure).
Let your healthcare team know if you have any of these symptoms.
If you have difficulty sleeping, it can help to change a few things about how you try to sleep. Try to go to bed and get up at the same time each day and spend some time relaxing before you go to bed. Some light exercise each day may also help.
You might get a high temperature. Or you might feel cold or start shivering (chills).
You might have muscle weakness, spasms or aches and pains. Or you might have pain in the arms, legs, back, joints, tummy (abdomen), hands or feet.
Less commonly you might have swollen joints.
You might get eye problems including clouding of the lens of the eye (cataract), damage to the optic nerve (glaucoma) or eye infections. Your eyes might bulge. These conditions can cause changes with your vision, such as blurred or double vision, pain, headaches, seeing rings (halos) around lights or reddening of the eye.
Rarely you might have an increase in tears, dry eyes or bloodshot eyes.
It’s important to let your healthcare team know if you have any problems with your eyes.
Skin problems include a skin rash, and itching. This usually goes back to normal when your treatment finishes. Your healthcare team can tell you what products you can use on your skin to help.
Less commonly you might develop dry skin.
Rarely you may have a serious skin reaction called Stevens Johnson syndrome (SJS) or toxic epidermal necrolysis – it may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening
Wounds may take longer to heal than usual. You may bruise, develop thinner skin or spotty skin (acne). It is not known how often this happens.
Contact your doctor straight away if you have any serious skin reaction while on treatment.
A build up of fluid may cause swelling in your arms, hands, ankles, legs, face and other parts of the body. Contact your healthcare team if this happens to you.
Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.
This treatment might make you feel dizzy. Don't drive or operate machinery if you feel dizzy.
Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually returns to normal a few weeks after your treatment finishes.
Mood changes can include feeling very sad, depressed, anxious or irritable. You might also have extreme mood swings or an elevated mood with abnormally high energy (mania).
Rarely you might feel confused or see things that aren’t there (hallucinations).
Tell your doctor or nurse if you’re having any of these symptoms. They can arrange for you to talk to someone and give treatment if necessary.
Read about depression and cancer
You may have changes in the levels of minerals and salts in your blood, including low levels of potassium, magnesium and calcium. You might also have high or low sodium levels.
You will have regular blood tests to check the different minerals and salts in the blood.
You may have headaches, muscle aches (myalgia), a high temperature and shivering. You should contact your advice line urgently if you have these symptoms.
You might have low blood pressure. Symptoms of low blood pressure include feeling dizzy, sick, confused, weak and tired.
Less commonly, you might have high blood pressure. This may cause blurred vision, nosebleeds, shortness of breath, chest pain or headaches. Or you may have low blood pressure when you stand up. This can make you feel faint.
You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes.You have regular blood tests to check for any changes in the way your liver is working.
Rarely you might get yellowing of the skin and whites of the eyes (jaundice).
You have regular blood tests to check for any changes in the way your liver is working.
Your mouth might get sore. You might have mouth washes to keep your mouth healthy. You can have painkillers to reduce the soreness. Take them half an hour before meals to make eating easier.
If you have a dry mouth it can help to drink plenty of fluids after treatment. An artificial saliva spray into your mouth might help. Ask you healthcare team about this.
Contact your healthcare team if you have indigestion or heartburn. They can prescribe medicines to help.
Your hands or other parts of the body could feel shaky. Talk to the team looking after you about this.
You may have a loss of body fluid (dehydration). Symptoms include feeling thirsty, having dark yellow, strong-smelling pee, peeing less often than usual, feeling dizzy or lightheaded, feeling tired, having a dry mouth, lips and tongue or sunken eyes.
You might get changes to your blood sugar levels. Some of the symptoms of high blood sugar levels (hyperglycaemia) are feeling very thirsty, having a dry mouth, peeing frequently, feeling tired, having blurred vision, losing weight, feeling or being sick and having a fruity smelling breath.
Symptoms of a low blood sugar level (hypoglycaemia) include sweating, feeling hungry, shaking, or trembling, having a fast heartbeat, feeling dizzy, having changes to your mood and feeling tired.
Rarely you might develop .
You might lose weight. Speak to your doctor or nurse if you are worried about weight loss. They can refer you to a dietitian.
Rarely you might gain weight.
These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:
a second cancer including , skin cancer or a type of blood cancer called
sepsis is a serious reaction to an infection - signs can include feeling very unwell, not peeing enough, a very high or very low temperature, shivering, slurred speech or confusion, breathlessness, mottled or discoloured skin, extreme shivering or muscle pain. Call 999 or go to accident and emergency (A&E) immediately if you have any of these symptoms
caused by the herpes zoster virus (if you have had chicken pox or shingles before)
heart problems such as changes to your heartbeat, palpitations, heart failure or chest pain that can spread to arms, neck and jaw and make you feel sweaty, breathless and sick (a heart attack)
destruction of red blood cells (haemolytic anaemia)
changes to your levels in your blood
fainting
a swollen tummy
problems with your speech, balance or coordination
a sore throat
farting (flatulence)
ringing in your ears (tinnitus) or deafness
changes to your voice
swallowing problems
a blockage in the flow of bile from the liver (cholestasis) – you might have yellowing of the skin or whites of the eyes (jaundice)
inflammation of your blood vessels – symptoms can vary depending on which blood vessels are affected - general symptoms include feeling very tired, loss of appetite, weight loss, a high temperature, and aches and pains
problems peeing including blood in your pee, a urine infection (UTI) which can cause pain on peeing, strong smelling pee, incontinence or being unable to pee
problems getting an erection
risk of falling
an increase in a type of protein in the blood, that indicates inflammation in the body
a blockage in the bowel
toothache
feeling generally unwell
These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:
changes to the levels of chemicals in your blood due to the breakdown of tumour cells (tumour lysis syndrome) - you have regular blood tests to check for this
rare blood disorders, that may cause infections, bleeding and problems with clotting
symptoms affecting the nervous system including the brain, and the nerves in the body. Symptoms include severe headaches, problems with speech, fits and memory loss. You might have uncontrollable movements of your arms, legs, face and chest, difficulty walking and pain in the area if you previously had shingles
hiccups
inflammation of the
difficulty concentrating
changes to your sense of smell
night sweats
a runny nose
hair loss, change to hair texture or unusual hair growth
loss of sex drive
pain in the
feeling thirsty
inflammation of the bowel (colitis)
If you have side effects that aren't listed on this page, you can look at the individual drug pages:
We have more information about side effects and tips on how to cope with them.
Cancer drugs can interact with medicines, herbal products, and some food and drinks. We do not list these interactions on this page. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.
Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know if you have any other medical conditions or allergies.
You may not be able to become pregnant or get someone pregnant after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.
It is important not to become pregnant or get anyone pregnant whilst you are taking this treatment.
Lenalidomide can be harmful to a baby developing in the womb and can cause severe abnormalities. Some people may worry about taking lenalidomide, but it doesn’t cause physical defects in adults.
Because lenalidomide can be harmful to the developing baby, your doctor will talk to you before you start treatment. They will make sure that you understand the risks of this treatment and agree to use contraception.
Women must not become pregnant for at least 8 months after the end of treatment. Men should not get someone pregnant for at least 5 months after treatment.
Let your doctor know straight away if you or your partner becomes pregnant.
Don’t breastfeed during this treatment. This is because the drugs may come through in your breast milk.
If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.
Do not have live vaccines while you’re having treatment and for up to 12 months afterwards. For some people, it may be longer than this. The length of time you need to avoid live vaccines depends on the treatment you’ve had.
Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, chickenpox, BCG, and yellow fever. You can usually have non-live vaccines. But they might not give you as much protection as usual. These include the:
flu vaccine, as an injection
coronavirus (COVID-19) vaccine
Talk to your doctor or pharmacist about the best time to have a vaccine in relation to your cancer treatment.
You can be in contact with other people who have had live vaccines as injections. If someone has had a live vaccine by mouth or nasal spray there may be a small risk the vaccine virus can be passed onto you if your is weakened.
Your healthcare team will let you know if you need to take any precautions if you are in close contact with someone who has had a live vaccine.
For further information about each drug and the possible side effects go to the electronic medicines compendium (emc) website. You can find patient information leaflets for each drug on this website.
You can report any side effect you have to the Medicines and Healthcare Regulatory Agency (MHRA) as part of their Yellow Card Scheme.
Last reviewed: 19 Oct 2026
Next review due: 19 Oct 2029
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