Is Altered Taste a Side Effect of Bortezomib?
Altered taste is not a commonly reported or well-documented side effect of bortezomib based on the available clinical trial data and guidelines. While bortezomib causes numerous adverse effects, taste disturbances are notably absent from the comprehensive toxicity profiles reported in major clinical trials and treatment guidelines.
Evidence from Clinical Trials and Guidelines
The extensive safety data from multiple clinical studies does not list altered taste among bortezomib's adverse effects:
In Waldenström's macroglobulinemia trials, the most common adverse events with bortezomib-containing regimens included peripheral neuropathy (35-47% of patients), nausea, IgM flare, lymphopenia, dizziness, and syncope—but taste alterations were not reported 1.
In multiple myeloma studies, the predominant toxicities were hematologic (neutropenia up to 58%, thrombocytopenia), peripheral neuropathy (Grade 3/4 in 8-13%), and gastrointestinal effects (diarrhea in 52% of patients in some regimens)—again without mention of taste disturbances 1, 2.
The National Comprehensive Cancer Network guidelines comprehensively detail bortezomib's adverse event profile, emphasizing peripheral neuropathy as the key dose-limiting toxicity, along with hematologic toxicities and gastrointestinal symptoms, but do not include taste alterations 2.
Documented Gastrointestinal Effects
While bortezomib does cause significant gastrointestinal toxicity, this manifests differently than taste alterations:
Nausea, vomiting, diarrhea, and constipation occur in up to 84% of patients treated with bortezomib, representing the primary gastrointestinal adverse effects 3.
These gastrointestinal symptoms are distinct from chemosensory disturbances and reflect direct gut toxicity rather than taste receptor dysfunction 3.
Important Clinical Caveats
Consider alternative explanations if a patient on bortezomib reports taste changes:
The underlying malignancy itself (multiple myeloma, lymphoma) can cause taste disturbances independent of treatment 4.
Concomitant medications frequently used with bortezomib may be responsible—particularly dexamethasone, which is commonly combined with bortezomib in treatment regimens 1.
Other chemotherapeutic agents in combination regimens (such as lenalidomide, cyclophosphamide, or doxorubicin) may contribute to taste alterations 4.
Infections or metabolic derangements related to the disease or immunosuppression could manifest as taste changes 4.
Bottom Line for Clinical Practice
If a patient receiving bortezomib reports altered taste, systematically evaluate other potential causes before attributing it to bortezomib itself, as this is not an established adverse effect of the medication based on current evidence 1, 2.