Bortezomib Administration Routes
Yes, bortezomib can be administered both intravenously (IV) and subcutaneously (SC), but subcutaneous administration is the preferred route. 1
Preferred Route: Subcutaneous Administration
The NCCN Panel explicitly recommends subcutaneous administration as the preferred method for bortezomib. 1 This recommendation is based on the pivotal MMY-3021 trial, which demonstrated:
- Non-inferior efficacy compared to IV administration with regard to overall response rate after 4 cycles (42% in both groups) 1, 2
- No significant differences in progression-free survival (median 10.4 vs 9.4 months) or 1-year overall survival (72.6% vs 76.7%) 2
- Significantly reduced peripheral neuropathy rates: Grade 3 or worse neuropathy occurred in only 6% with SC versus 16% with IV administration 1, 2
FDA-Approved Routes
Both routes are FDA-approved, with specific reconstitution requirements 3:
- Subcutaneous injection: Reconstitute with 1.4 mL of 0.9% sodium chloride to achieve a final concentration of 2.5 mg/mL 3
- Intravenous injection: Reconstitute with 3.5 mL of 0.9% sodium chloride to achieve a final concentration of 1 mg/mL 3, 4
Clinical Advantages of Subcutaneous Route
The subcutaneous route offers several important clinical benefits:
- Lower peripheral neuropathy risk: Peripheral neuropathy of any grade occurred in 38% with SC versus 53% with IV administration 2
- Better tolerability: Grade 2 or worse neuropathy was 24% with SC versus 41% with IV 2
- Equivalent pharmacokinetics: Systemic exposure (AUC) was equivalent between routes (mean AUC 155 vs 151 ng·h/mL) 5
- Similar proteasome inhibition: 20S proteasome inhibition was comparable between routes (mean Emax 63.7% vs 69.3%) 5
Administration Details
For IV administration: Give as a 3-5 second bolus intravenous injection at 1.3 mg/m² 4
For SC administration: Inject subcutaneously at 1.3 mg/m² using the same dosing schedule 1, 6
Injection site flexibility: SC administration can be given in either the thigh or abdomen with no differences in pharmacokinetic or pharmacodynamic parameters 5
Important Clinical Considerations
Weekly dosing is preferred over twice-weekly dosing regardless of administration route, as it reduces neuropathy rates while maintaining efficacy 1
Herpes zoster prophylaxis is strongly recommended for all patients receiving bortezomib, regardless of administration route 1
The subcutaneous route does not eliminate neuropathy risk entirely—it remains dose-dependent—but significantly reduces its incidence compared to IV administration 1, 2