(bore TEZ oh mib)

Trade name: Velcade^®

Chemocare.com uses generic names in all descriptions of drugs. Velcade is the trade name for Bortezomib. In some cases, health care professionals may use the trade name Velcade when referring to the generic drug name Bortezomib.

Drug type: Bortezomib is a targeted therapy. Bortezomib is classified as a proteasome inhibitor. (For more detail, see "How this drug works" below).

What Bortezomib Is Used For:

• Treatment of multiple myeloma.
• Treatment of mantle cell lymphoma who have received at least one prior therapy.

Note:  If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Bortezomib Is Given:

• As an intravenous (into the vein) injection.
• As a subcutaneous (under the skin) injection into the thigh or abdomen.
• The amount of bortezomib that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated.  Your doctor will determine your dose and schedule.

Side Effects:

Important things to remember about the side effects of bortezomib:

• Most people do not experience all of the side effects listed.
• Side effects are often predictable in terms of their onset and duration.
• Side effects are almost always reversible and will go away after treatment is complete.
• There are many options to help minimize or prevent side effects.
• There is no relationship between the presence or severity of side effects and the effectiveness of the medication.

The following side effects are common (occurring in greater than 30%) for patients taking bortezomib:

• Fatigue, generalized weakness
• Peripheral neuropathy: characterized by decreased sensation and paresthesia (numbness and tingling of the hands and feet).  There may be worsening of preexisting neuropathy.  Your doctor may need to change your dose or schedule of bortezomib.  Symptoms may improve or return to baseline in some patients once bortezomib is discontinued.
• Nausea, vomiting
• Diarrhea
• Poor appetite
• Constipation
• Low platelet count. (This can put you at increased risk for bleeding.) (Nadir: 11 days)
• Fever
• Low red blood cell count (Anemia).

These side effects are less common side effects (occurring in about 10-29%) of patients receiving bortezomib:

• Headache
• Difficulty sleeping (Insomnia)
• Joint pains, arthralgia, myalgias
• Swelling of the face, hands, feet or legs (edema).
• Low white blood cell count. (This can put you at increased risk for infection.) 
• Shortness of breath 
• Dizziness
• Rash (see skin reactions)
• Dehydration
• Upper respiratory tract infection
• Cough
• Bone pain
• Anxiety
• Muscle cramps
• Heartburn
• Abdominal pain
• Low blood pressure
• Itching
• Blurring of vision
• Blood test abnormalities: (low sodium, low magnesium, low calcium, low potassium).

Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here.  However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

• Fever of 100.4° F (38° C) or higher, chills (possible signs of infection)
• Shortness of breath, wheezing, difficulty breathing, closing up of the throat, swelling of facial features, hives (possible allergic reaction).

The following symptoms require medical attention, but are not an emergency.  Contact your health care provider within 24 hours of noticing any of the following:

• Nausea (interferes with ability to eat and unrelieved with prescribed medication).
• Vomiting (vomiting more than 4-5 times in a 24 hour period).
• Diarrhea (4-6 episodes in a 24-hour period).
• Constipation unrelieved by laxative use.
• Unusual bleeding or bruising
• Black or tarry stools, or blood in your stools.
• Blood in the urine.
• Extreme fatigue (unable to carry on self-care activities).
• New or worsening symptoms of peripheral neuropathy.
• Swelling, redness and/or pain in one leg or arm and not the other.
• Swelling of the feet or ankles.  Sudden weight gain.
• Signs of infection such as redness or swelling, pain on swallowing, coughing up mucous, or painful urination.
• Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst, dry mouth, dark and decrease amount of urine, or dizziness.

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

• Before starting bortezomib treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).   Do not take aspirin, or products containing aspirin unless your doctor specifically permits this.
• Do not receive any kind of immunization or vaccination without your doctor's approval while taking bortezomib.
• Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (bortezomib may be hazardous to the fetus.  Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus.) 
• For both men and women: Do not conceive a child (get pregnant) while taking bortezomib. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
• Do not breast feed while taking this medication.

Self-Care Tips:

• You may experience drowsiness or dizziness; avoid driving or engaging in tasks that require alertness until your response to the drug is known.
• Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
• You may be at risk of infection report fever or any other signs of infection immediately to your health care provider.
• Avoid contact sports or activities that could cause injury.
• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals. 
• In general, drinking alcoholic beverages should be kept to a minimum or avoided completely.  You should discuss this with your doctor.
• Get plenty of rest.
• Maintain good nutrition.
• If you experience symptoms or side effects, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
• Keep your bowels moving. Your health care provider may prescribe a stool softener to help prevent constipation that may be caused by this medicine.
• Follow regimen of anti-diarrhea medication as prescribed by your health care professional.
• Eat foods that may help reduce diarrhea.  (see managing side effects - diarrhea).
• Acetaminophen or ibuprofen may help relieve discomfort from fever, headache and/or generalized aches and pains.  However, be sure to talk with your doctor before taking it.

Monitoring and Testing:

You will be checked regularly by your health care professional while you are taking bortezomib, to monitor side effects and check your response to therapy.  Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) and blood electrolytes will also be ordered by your doctor.   

How Bortezomib Works:

Targeted therapy is the result of about 100 years of research dedicated to understanding the differences between cancer cells and normal cells. To date, cancer treatment has focused primarily on killing rapidly dividing cells because one feature of cancer cells is that divide rapidly. Unfortunately, some of our normal cells divide rapidly too, causing multiple side effects.

Targeted therapy is about identifying other features of cancer cells. Scientists look for specific differences in the cancer cells and the normal cells. This information is used to create a targeted therapy to attack the cancer cells without damaging the normal cells, thus leading to fewer side effects. Each type of targeted therapy works a little bit differently but all interfere with the ability of the cancer cell to grow, divide, repair and/or communicate with other cells.
There are different types of targeted therapies, defined in three broad categories. Some targeted therapies focus on the internal components and function of the cancer cell. The targeted therapies use small molecules that can get into the cell and disrupt the function of the cells, causing them to die. There are several types of targeted therapy that focus on the inner parts of the cells. Other targeted therapies target receptors that are on the outside of the cell. Therapies that target receptors are also known as monoclonal antibodies. Antiangiogenesis inhibitors target the blood vessels that supply oxygen to the cells, ultimately causing the cells to starve.

Research continues to identify which cancers may be best treated with targeted therapies and to identify additional targets for more types of cancer. 

Bortezomib targets and inhibits the proteasome enzyme complex within the cell.  Proteasome is part of the cellular machinery and has many functions within the cell, such as it helps to control the level of many of the proteins that help to regulate cell division and cell survival. By interfering with its function this can lead to apoptosis (cell suicide).  In the laboratory, it has been shown that cancer cells are more susceptible to the effects of proteasome inhibitors, than normal cells are.  In multiple myeloma, bortezemib works by blocking the activation of adhesion molecules that allow plasma cells to "nest" in the bone marrow.

Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

 

 

Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org