How it is administered

Bortezomib is given as an injection, either intravenously (into a vein) or subcutaneously (under the skin). It is available as a sterile powder in single-dose vials, which is mixed with saline before use. The recommended starting dose is 1.3 mg/m², and it is administered as a quick injection (3 to 5 seconds for IV) or as a subcutaneous shot. The dosing schedule and number of cycles depend on the condition being treated and whether bortezomib is used alone or in combination with other medications.

For mantle cell lymphoma, bortezomib is typically given in combination with rituximab, cyclophosphamide, doxorubicin, and prednisone (VcR-CAP regimen) for several cycles. The injection sites for subcutaneous administration should be rotated to avoid irritation.

How it works

Bortezomib is a type of cancer medicine called a proteasome inhibitor. Proteasomes are structures inside cells that break down and remove proteins that are no longer needed. By blocking the action of proteasomes, bortezomib causes a buildup of unwanted proteins within cancer cells. This disrupts several important processes in the cell, leading to stress and eventually cell death.

Cancer cells, including those in mantle cell lymphoma, are particularly sensitive to this disruption because they grow and divide rapidly and rely on proteasomes to manage their high protein turnover. By interfering with this process, bortezomib helps slow or stop the growth of cancer cells, allowing the body to better control the disease. This targeted approach can help shrink tumors and improve outcomes for patients with certain blood cancers.

Who Should take it

Bortezomib is approved for the treatment of adults with mantle cell lymphoma, both for those who have not received prior treatment and for those whose disease has returned or worsened after previous therapies. It is also used to treat multiple myeloma, another type of blood cancer.

For mantle cell lymphoma, bortezomib is often given as part of a combination regimen with other chemotherapy drugs. It may be recommended for patients who are not candidates for bone marrow transplantation or those who need a strong initial treatment to control their disease. Your doctor will determine if bortezomib is appropriate for you based on your diagnosis, overall health, and previous treatments.

Who should not take it

Bortezomib should not be used in patients who have had a severe allergic reaction to bortezomib, boron, or mannitol. Signs of a serious allergic reaction include swelling, difficulty breathing, or severe rash. It is also strictly contraindicated for intrathecal administration (injection into the spinal canal), as this has resulted in fatal outcomes.

Patients with severe pre-existing nerve damage (peripheral neuropathy) should only receive bortezomib after careful consideration of the risks and benefits. Additionally, bortezomib should be used with caution in patients with significant heart, liver, or lung problems, and in pregnant women, as it can cause harm to an unborn baby. Always inform your healthcare provider about your full medical history before starting treatment.

Commonly used with

For mantle cell lymphoma, bortezomib is most commonly used in combination with:

• Rituximab
• Cyclophosphamide
• Doxorubicin
• Prednisone

This combination is known as the VcR-CAP regimen. In other blood cancers, bortezomib may also be used with melphalan, prednisone, and sometimes dexamethasone. These combinations help enhance the effectiveness of treatment and target cancer cells in different ways.

Commonly tested with

Bortezomib has been tested in clinical trials with a variety of chemotherapy and immunotherapy agents, especially in the context of blood cancers. For mantle cell lymphoma, it has been studied in combination with rituximab, cyclophosphamide, doxorubicin, and prednisone (VcR-CAP), and compared to regimens such as R-CHOP (which includes vincristine instead of bortezomib).

In multiple myeloma, bortezomib has been tested with melphalan and prednisone, as well as with dexamethasone and other agents. These studies have helped define the best ways to use bortezomib to improve patient outcomes.