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Bortezomib (Velcade)

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This page tells you about the biological therapy drug bortezomib and its possible side effects. There are sections about

 

What bortezomib is

Bortezomib is pronounced bore-tez-oh-mib. It is a type of biological therapy called a proteasome inhibitor. Proteasomes are in all cells. They help to break down proteins that the cell doesn’t need. Bortezomib blocks the proteasomes so that proteins build up in the cell. The cell then dies.

Bortezomib is also called Velcade. It is a treatment for myeloma.

 

How you have bortezomib

You may have bortezomib either as an injection just under your skin (subcutaneously) into your leg or abdomen (tummy). Or you may have it as an injection into your bloodstream (intravenously). 

Injections into the bloodstream may be through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

Bortezomib can be used on its own for people with myeloma who have had previous treatment. You have bortezomib twice a week for 2 weeks and then have a break for 10 days. This 3 week period is called a cycle of treatment. After 4 cycles you have a blood or urine test to check the levels of a protein called serum M. Serum M is made by myeloma cells. If the bortezomib is working, the serum M levels should go down. If all signs of the myeloma disappear completely you have a further 2 cycles of the bortezomib treatment. If the myeloma does not completely disappear you have 8 cycles of treatment.

Bortezomib is also sometimes used with other cancer drugs such as liposomal doxorubicin, thalidomide or melphalan as a first treatment for myeloma. It is also given with steroids such as prednisone or dexamethasone.

We've listed the side effects associated with bortezomib below. You can use the links to find out more about each side effect. Where there is no link, please go to our cancer drug side effects section or use the search box at the top of the page.

 

Common side effects

More than 10 in every 100 people have one or more of these.

  • Feeling or being sick affects just over 6 in 10 people (60%) but is usually well controlled with anti sickness medicines
  • Diarrhoea affects around 6 out of 10 people (60%) – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe or continues for more than 3 days
  • Tiredness and weakness (fatigue) affects about 5 in 10 people (50%)
  • Loss of appetite affects about 4 in 10 people (40%)
  • Bruising and bleeding due to a drop in platelets occurs in 4 out of 10 people (40%) – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)
  • Increased risk of getting an infection due to a drop in the number of white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) affects about 3 out of 10 people (30%) – you may need a blood transfusion
  • Numbness or tingling in fingers and toes affects 3 out of every 10 people (30%) and can cause difficulty with fiddly things such as doing up buttons
  • A high temperature (fever) for a few hours after having the drug affects more than 3 out of 10 people (30%)
  • Headaches affect about 2 out of 10 people (20%)
  • Constipation – your doctor or nurse may give you laxatives to help prevent this but do tell them if you are constipated for more than 3 days. You may also have a bloated abdomen (tummy)
  • Pain in your muscles, bones or tummy (abdomen)
  • About 1 in 10 people (10%) get shingles (herpes zoster virus) – you may have to take an anti viral drug to prevent this
  • Loss of fertility – you may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
 

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • Breathlessness and a cough
  • Low blood pressure (hypotension) – it can make you feel lightheaded or dizzy and faint. Don't drive or operate machinery if you have this
  • Blurred vision – this is usually mild
  • Kidney problems may cause difficulty or pain passing urine, needing to pass urine often or blood in your urine – tell your doctor or nurse if you have any of these problems
  • Skin changes – you may have a rash or very red, dry, itchy skin
  • Taste changes and weight loss
  • Indigestion or heartburn
  • Swelling of the ankles and legs due to a build up of fluid (oedema) affects 1 in 20 people but is usually mild
  • Swelling around the eyes
  • Difficulty sleeping (insomnia)
  • High blood pressure
  • Flushing of the face or tiny broken blood vessels in the skin
  • Chest pain or breathlessness during exercise
  • Mood changes – you may feel sad, anxious, restless or agitated
  • Dehydration – drink plenty of fluids (around 2 litres a day) to prevent dehydration
  • A runny nose
  • A sore mouth or throat
  • A fast heart beat or a sensation of your heart beating (palpitations)
  • Bleeding into the digestive system – let your doctor or nurse know straight away if you get sudden severe pain in your chest or abdomen or blood in your vomit or poo
  • Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment is finished but you will have regular blood tests to check how well your liver is working
  • Muscle cramps or pain
  • Eye infections (conjunctivitis)
  • Sweating
 

Rare side effects

Fewer than 1 in 100 people have these.

  • Heart problems, including chest pain, affect fewer than 1 in 100 people – contact your doctor or nurse straight away if you have chest pain
  • High uric acid levels in the blood due to the breakdown of tumour cells (tumour lysis syndrome) – you will have regular blood tests to check your uric acid levels and may have a tablet called allopurinol to take
  • Hiccups
  • Blood clots – if this happens you will have treatment to thin your blood, dissolve any clots and stop any more developing. If you are at higher than normal risk of developing blood clots, your doctor will give you medicines to prevent clots
  • Hearing changes – loss of hearing or noises in the ears (tinnitus)
  • A stroke
  • Difficulty concentrating
  • An overactive thyroid gland – let your doctor know if you feel hot, sweaty, agitated, are losing weight, and have problems concentrating and sleeping
  • Hair loss or a change in hair texture
  • Pain at the injection site (with the injection just under the skin)
  • Headaches, seizures (fits), confusion, changes in eye sight, excessive sleepiness, change in behaviour, and possibly high blood pressure – doctors call this group of symptoms reversible posterior leucoencephalopathy syndrome (RPLS)
 

Important points to remember

You may have 1 or 2 side effects or several. A side effect may get worse through your course of treatment, or more side effects may develop as the course goes on. The side effects depend on

  • How many times you've had the drug before
  • Your general health
  • The amount of the drug you have (the dose)
  • Other drugs you are having

Coping with side effects

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines and foods

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

A study in mice published in 2009 found that green tea may stop bortezomib (Velcade) from working properly. The authors of the study strongly recommend that people taking bortezomib do not drink green tea or take any green tea preparations.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for 3 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Do not breastfeed during this treatment because the drug may come through in the breast milk.

 

Immunisations

You should not have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.

 

More information about bortezomib

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.

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Updated: 12 February 2014