From the Guidelines
Bortezomib should be administered subcutaneously and once weekly to reduce the risk of peripheral neuropathy, as recommended by the NCCN Panel 1.
Bortezomib Overview
Bortezomib is a proteasome inhibitor medication primarily used to treat multiple myeloma and mantle cell lymphoma. It works by blocking the proteasome, which is responsible for breaking down proteins in cells, leading to an accumulation of proteins that causes cancer cell death.
Dosage and Administration
The typical dose for multiple myeloma is 1.3 mg/m² administered as an intravenous injection or subcutaneous injection, given twice weekly for two weeks, followed by a 10-day rest period, completing a 21-day treatment cycle. However, the weekly schema is preferred to reduce the risk of peripheral neuropathy 1.
Side Effects and Monitoring
Common side effects include peripheral neuropathy (numbness or tingling in extremities), fatigue, nausea, diarrhea, and decreased blood cell counts. Patients should be monitored for herpes zoster reactivation, and antiviral prophylaxis is often recommended during treatment 1.
Combination Therapy
Bortezomib is often used in combination with other medications such as dexamethasone or immunomodulatory drugs like lenalidomide to enhance its effectiveness in treating multiple myeloma. The combination of bortezomib, dexamethasone, and rituximab has shown excellent activity in the management of Waldenström's macroglobulinemia, with an overall response rate of 96% 1.
Key Considerations
- Subcutaneous administration is the preferred method to reduce the risk of peripheral neuropathy 1.
- Dose adjustments may be necessary for patients with liver or kidney impairment.
- Regular blood tests are required to monitor for potential toxicities.
- Herpes zoster prophylaxis is recommended for patients treated with proteasome inhibitors 1.
From the FDA Drug Label
Bortezomib for injection is a proteasome inhibitor indicated for: treatment of adult patients with multiple myeloma (1.1) treatment of adult patients with mantle cell lymphoma who have received at least 1 prior therapy (1.2)
The indications for bortezomib are:
- Treatment of adult patients with multiple myeloma
- Treatment of adult patients with mantle cell lymphoma who have received at least 1 prior therapy 2 2
From the Research
Bortezomib Overview
- Bortezomib is a proteasome inhibitor used in the treatment of multiple myeloma and mantle cell lymphoma 3, 4.
- It has been shown to be effective in patients with relapsed or refractory multiple myeloma, as well as in those with newly diagnosed disease 5, 6.
Efficacy in Multiple Myeloma
- Bortezomib has been found to improve progression-free survival and overall survival in patients with relapsed or refractory multiple myeloma 3, 6.
- It is also effective as part of a first-line regimen in previously untreated patients with multiple myeloma 6.
- The combination of bortezomib with other agents, such as lenalidomide and dexamethasone, has been shown to be effective in patients with newly diagnosed multiple myeloma 5.
Toxicity and Side Effects
- The most common toxicities associated with bortezomib include peripheral neuropathy, thrombocytopenia, and fatigue 3, 5.
- Bortezomib can be administered in the outpatient setting with manageable toxicities 7.
Use in Mantle Cell Lymphoma
- Bortezomib has been approved for the treatment of relapsed and refractory mantle cell lymphoma, as well as in the upfront setting 4.
- The optimal regimen for the treatment of mantle cell lymphoma remains to be defined, and treatment decisions are based on disease risk stratification models and patient factors 4.