Common brand names

• Velcade

How it is administered

Bortezomib is given as an injection, either intravenously (into a vein) or subcutaneously (under the skin). It comes in a single-dose vial as a sterile powder that is mixed with saline before use. The recommended starting dose is 1.3 mg/m², administered as a quick (3 to 5 second) intravenous injection or as a subcutaneous injection. The dosing schedule and duration depend on the specific blood cancer being treated and whether it is used alone or in combination with other medications. Your healthcare team will determine the best schedule for you and will rotate injection sites if given subcutaneously.

How it works

Bortezomib is a type of cancer medicine known as a proteasome inhibitor. Proteasomes are structures inside cells that break down proteins that are no longer needed. By blocking the action of proteasomes, bortezomib causes a buildup of proteins within cancer cells, which disrupts their normal function and leads to cell death. This effect is especially important in blood cancers like multiple myeloma and mantle cell lymphoma, where the cancerous cells rely on proteasomes to survive and grow. By interfering with this process, bortezomib helps slow or stop the growth of cancer cells, and can shrink tumors or keep them from spreading. The medicine is cytotoxic, meaning it directly kills cancer cells, and it can also make them more sensitive to other treatments.

Who should take it

Bortezomib is approved for adults with certain blood cancers:

• Multiple myeloma: It is used in newly diagnosed patients, as well as those whose disease has returned (relapsed) or did not respond to previous treatment (refractory).
• Mantle cell lymphoma: It is used in adults with this type of non-Hodgkin lymphoma, either as initial therapy or after other treatments have failed.

Bortezomib may be given alone or in combination with other medicines such as melphalan, prednisone, rituximab, cyclophosphamide, doxorubicin, and dexamethasone. Your doctor will decide if bortezomib is right for you based on your specific diagnosis, previous treatments, and overall health.

Who should not take it

You should not take bortezomib if you:

• Are allergic to bortezomib, boron, or mannitol (serious allergic reactions, including anaphylaxis, have occurred).
• Have previously had a severe reaction to bortezomib.
• Bortezomib must NOT be given into the spinal canal (intrathecal administration), as this can be fatal.

Caution is needed if you have severe nerve problems (neuropathy), heart or lung issues, low blood counts, liver problems, or are pregnant or breastfeeding. Always tell your healthcare provider about your medical history and any allergies before starting treatment.

Commonly used with

Bortezomib is often used in combination with other medications to treat blood cancers. Common combinations include:

• Melphalan and prednisone (for multiple myeloma)
• Rituximab, cyclophosphamide, doxorubicin, and prednisone (for mantle cell lymphoma)
• Dexamethasone (for multiple myeloma, especially in relapsed cases)

Your doctor may also recommend supportive medications such as antiviral drugs to prevent herpes zoster (shingles), as bortezomib can increase the risk of viral reactivation.

Commonly tested with

In clinical studies, bortezomib has been tested with:

• Melphalan and prednisone (multiple myeloma)
• Rituximab, cyclophosphamide, doxorubicin, and prednisone (mantle cell lymphoma)
• Dexamethasone (multiple myeloma)
• Other chemotherapy agents in various combinations

These combinations have been shown to improve outcomes in patients with multiple myeloma and mantle cell lymphoma.