Common brand names

• Velcade

How it is administered

Bortezomib is given either as an intravenous (IV) injection or as a subcutaneous (under the skin) injection. It is provided as a powder that is mixed with a liquid before administration. The recommended starting dose is 1.3 mg/m², given as a quick IV injection (3 to 5 seconds) or as a subcutaneous injection. The frequency and schedule depend on the specific treatment plan, and it is often given in cycles. Bortezomib is not to be administered by any other route, especially not into the spinal fluid (intrathecal), as this can be fatal.

How it works

Bortezomib is a type of medication known as a proteasome inhibitor. Proteasomes are protein complexes inside cells that break down and remove unneeded or damaged proteins. By blocking the action of proteasomes, bortezomib causes a build-up of these proteins within cancer cells, disrupting their normal function and leading to cell death. This mechanism is particularly effective in certain blood cancers, such as multiple myeloma and mantle cell lymphoma, because these cancer cells are especially dependent on proteasome activity for survival and growth.

By interfering with the cancer cells' ability to manage proteins, bortezomib can slow or stop the progression of the disease. Its effects are not limited to cancer cells, so monitoring and managing side effects is important during treatment.

Who should take it

Bortezomib is approved for adults with multiple myeloma and mantle cell lymphoma. While it is not specifically approved for marginal zone lymphoma, it may sometimes be considered in special cases or clinical trials for other blood cancers. Your doctor will determine if bortezomib is appropriate based on your specific diagnosis, previous treatments, and overall health.

In mantle cell lymphoma, bortezomib is often used in combination with other chemotherapy medications. It can be used as part of initial treatment or for patients whose disease has returned after prior therapy. It is important to discuss with your healthcare team whether bortezomib is suitable for your individual situation.

Who should not take it

You should not take bortezomib if you have had a serious allergic reaction to bortezomib, boron, or mannitol. Reactions can include severe rash, swelling, or difficulty breathing (anaphylaxis). Bortezomib must never be given into the spinal fluid (intrathecal administration), as this can be fatal.

Caution is needed if you have severe nerve problems (neuropathy), heart disease, low blood counts, liver problems, or are pregnant or breastfeeding. Your doctor will weigh the risks and benefits and may adjust your dose or recommend additional monitoring if you have these conditions.

Commonly used with

Bortezomib is often used in combination with other chemotherapy drugs. For mantle cell lymphoma, it is commonly combined with rituximab, cyclophosphamide, doxorubicin, and prednisone (a regimen called VcR-CAP). For multiple myeloma, it may be combined with melphalan and prednisone or with other agents depending on the treatment plan.

Your doctor will choose the best combination based on your type of cancer and previous treatments.

Commonly tested with

Bortezomib has been tested in combination with several other medications in clinical trials, including:

• Dexamethasone
• Melphalan and prednisone
• Rituximab, cyclophosphamide, doxorubicin, and prednisone (VcR-CAP)
• Various other chemotherapy regimens

These combinations are designed to improve the effectiveness of treatment for blood cancers such as multiple myeloma and mantle cell lymphoma. Your treatment team will discuss the best options for you based on the latest evidence and your individual needs.