How it is administered

Bortezomib is given as an injection, either under the skin (subcutaneous) or directly into a vein (intravenous). The medication comes as a powder that is mixed with saline before use. The typical starting dose is 1.3 mg/m², and it is administered as a quick injection (3 to 5 seconds for IV) or subcutaneously. The dosing schedule depends on the specific treatment plan and may be given twice weekly for several weeks, followed by a rest period. Your healthcare team will determine the best route and schedule for you.

How it works

Bortezomib is a type of cancer medicine called a proteasome inhibitor. It works by blocking the action of proteasomes, which are structures inside cells that break down proteins. Cancer cells, especially those in blood cancers like multiple myeloma and mantle cell lymphoma, rely heavily on proteasomes to remove proteins that control cell growth and survival. By blocking proteasomes, bortezomib causes a buildup of unwanted proteins inside the cancer cells, disrupting their normal function and leading to cell death.

This targeted action helps slow down or stop the growth of cancer cells, while having less effect on normal, healthy cells. Bortezomib is cytotoxic to a variety of cancer cell types and has been shown to delay tumor growth in laboratory and animal studies. In clinical use, it is most commonly used in combination with other chemotherapy drugs to enhance its effectiveness.

Who Should take it

Bortezomib is approved for adults with multiple myeloma and mantle cell lymphoma. It may be used in patients who are newly diagnosed or those whose cancer has come back after previous treatments. In the context of blood cancers, bortezomib is often part of combination therapy, working together with other medications to improve treatment outcomes.

While there is no specific FDA approval for Adult T-cell Leukemia/Lymphoma (ATLL), bortezomib may sometimes be considered as part of a clinical trial or off-label use in certain cases of blood cancers, depending on your doctor's judgment and the latest research. Your healthcare provider will decide if bortezomib is right for you based on your diagnosis, previous treatments, and overall health.

Who should not take it

You should not take bortezomib if you have had a severe allergic reaction (not just a local reaction) to bortezomib, boron, or mannitol. Reactions can include anaphylaxis, which is a life-threatening allergic reaction. Bortezomib must never be given into the spinal canal (intrathecal administration), as this can be fatal.

Patients with severe pre-existing peripheral neuropathy (nerve damage causing numbness, tingling, or pain) should only be treated with bortezomib after careful consideration of the risks and benefits. If you are pregnant or planning to become pregnant, bortezomib can cause harm to an unborn baby and should not be used. Always inform your healthcare provider about all your allergies and medical conditions before starting treatment.

Commonly used with

Bortezomib is often used in combination with other chemotherapy drugs to treat blood cancers. For multiple myeloma, it is commonly combined with melphalan and prednisone. In mantle cell lymphoma, it is used with rituximab, cyclophosphamide, doxorubicin, and prednisone (the VcR-CAP regimen).

Your doctor may also prescribe supportive medications, such as antiviral drugs to prevent herpes zoster (shingles), anti-nausea medications, or drugs to support blood counts, depending on your individual needs.

Commonly tested with

Bortezomib has been tested in clinical trials with a variety of chemotherapy agents, including dexamethasone, melphalan, prednisone, rituximab, cyclophosphamide, doxorubicin, and vincristine. It has also been studied in combination with newer targeted therapies and immunomodulatory drugs in blood cancers.

In research settings, bortezomib is sometimes tested with other agents in clinical trials for different types of blood cancers, including Adult T-cell Leukemia/Lymphoma, to explore new treatment options.