Bortezomib (Velcade)

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.

You may have bortezomib either as an injection just under your skin (subcutaneously) or as an injection into your bloodstream (intravenously) . 

You have injections just under your skin either in your arm, leg, buttock or stomach. You can find more information about subcutaneous injections on the page about how you have cancer drugs.

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 the chemotherapy drug melphalan and a steroid called prednisone as a first treatment for myeloma.

The side effects of bortezomib are listed below. Remember that most people don’t have all of them.

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

• Feeling or being sick affects just over 6 in 10 people but is usually well controlled with anti sickness medicines
• Fatigue (tiredness) affects about 5 in 10 people
• Loss of appetite affects about 4 in 10 people
• Diarrhoea affects around 6 out of 10 people – drink plenty of fluids and tell your doctor if diarrhoea becomes severe or continues for more than 3 days
• Increased risk of getting an infection due to a drop in the number of white blood cells – you may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery. Infections can sometimes be life threatening. You should urgently contact your hospital if you think you have an infection.
• About 1 in 10 people get shingles (herpes zoster virus) – you may have to take an anti viral drug to prevent this
• Bruising and bleeding due to a drop in platelets occurs in 4 out of 10 people – 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)
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) affects about 3 out of 10 people – you may need a blood transfusion
• Numbness or tingling in fingers and toes affects 3 out of every 10 people 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
• Headaches affect about 2 out of 10 people
• Skin changes – about 2 out of 10 people have a rash or very red, dry, itchy skin
• Taste changes affect more than 1 in 10 people
• Indigestion affects 1 in 10 people
• 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
• Breathlessness and a cough affect about 2 out of 10 people
• Low blood pressure (hypotension) affects just over 1 in 10 people – it can make you feel lightheaded or dizzy
• Blurred vision – about 1 in 10 people have this but it is usually mild
• Pain in your muscles, bones or tummy (abdomen)
• Loss of fertility – we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if this is important to you
• This drug may have a harmful effect on a developing baby – do talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant

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

• Flu like symptoms
• 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
• Hiccups
• Mood changes – you may feel sad or anxious
• Dehydration – drink plenty of fluids (around 2 litres a day) to prevent dehydration
• A runny nose
• Wind
• A sore mouth
• A fast heart beat or a sensation of your heart beating (palpitations)
• Fits (seizures)

Fewer than 1 in 100 people have these.

• Heart problems, including chest pain, affect fewer than 1 in 100 people – contact your doctor straight away if you have chest pain
• 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
• 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
• Difficulty sleeping (insomnia)
• 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
• Hearing changes – loss of hearing or noises in the ears (tinnitus)

You may have one or two 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

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

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements, alternative therapies 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, so the authors of the study strongly recommend that people taking bortezomib do not drink green tea or take any green tea preparations.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines 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.