Coronavirus and cancer

We know it’s a worrying time for people with cancer, we have information to help. If you have symptoms of cancer contact your doctor.

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Bortezomib (Velcade)

Bortezomib is also called by its brand name Velcade. It is a treatment for myeloma and mantle cell lymphoma.

You can have bortezomib on its own. Or with other cancer drugs such as:  

  • liposomal doxorubicin
  • thalidomide
  • melphalan
  • steroids (prednisolone or dexamethasone)
  • panobinostat

How it works

Bortezomib is a type of cancer treatment drug called a proteasome inhibitor.

Proteasomes are in cells. They help to break down proteins that the cell doesn't need. Bortezomib blocks the proteasomes so the proteins build up inside the cell. The cell then dies.   

How you have it

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

Into your bloodstream

You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

As an injection under your skin

You usually have injections under the skin (subcutaneous injection) into the stomach, thigh or top of your arm.

You might have stinging or a dull ache for a short time after this type of injection but they don't usually hurt much. The skin in the area may go red and itchy for a while.

When you have it

You can have bortezomib on its own if you have already had treatment for myeloma. 

You usually have bortezomib twice a week, for 2 weeks. Then you have a break of 10 days. This 3 week period is called a cycle of treatment.

The length of your treatment cycle might be different. Your doctor will discuss this with you.

After 4 cycles of treatment you might have a blood or urine test. This is to check the levels of a protein called serum M.

Serum M is made by myeloma cells. So if the bortezomib is working, the serum M levels go down.

You have a further 2 cycles of treament  if all signs of the myeloma disappear. Or you have 8 cycles if the myeloma does not completely disappear.  

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include:

Numbness or tingling in fingers or toes

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Talk to the team looking after you when you first notice this. 

Pain in muscles or joints 

You might feel some pain from your muscles and joints. Speak to your doctor or nurse about what painkillers you can take to help with this.

High temperature (fever)

If you get a high temperature, let your health care team know straight away. Ask them if you can take paracetamol to help lower your temperature.

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.

Diarrhoea

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Lowered appetite

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques, can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Tiredness and weakness (fatigue)

You are likely to feel very tired during your treatment. It tends to get worse as the treatment goes on. You might also feel weak and lack energy. Rest when you need to.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nosebleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechia).

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

  • breathlessness and cough
  • blood pressure changes
  • eyesight changes or eye infections
  • kidney changes
  • taste changes and weight loss
  • indigestion
  • fluid build up (oedema)
  • difficulty sleeping (insomnia)
  • mood changes
  • dehydration
  • sore mouth
  • bleeding in the stomach or bowel
  • liver changes
  • muscle cramps
  • headaches
  • shingles
  • dizziness
  • temporary loss of consciousness (syncope)
  • changes in levels of minerals and salts in your body - you will have regular blood tests to check for this
  • tummy (abdominal) pain
  • skin changes such as a rash or itching

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • heart problems such as a change in heart rhythm
  • high uric acid levels in the blood - due to breakdown of cancer cells
  • hiccups
  • blood clots that can be life threatening; signs are pain, swelling and redness where the clot is
  • hearing changes such as hearing loss or ringing in your ears (tinnitus)
  • stroke
  • difficulty concentrating
  • high or low levels of thyroid hormones (hyperthyroidism)
  • hair loss
  • pain at the injection site
  • runny nose
  • flushing
  • a second cancer some years after treatment has finished
  • an allergic reaction which can be severe

Reversible posterior leucoencephalopathy syndrome (RPLS)

This group of symptoms is rare. You might have a group of symptoms including: 

  • headaches
  • fits (seizures)
  • changes in eyesight
  • excessive sleepiness
  • changes in your behaviour
  • high blood pressure
If you notice this tell your doctor or nurse straight away. Doctors call this group of symptoms reversible posterior leucoencephalopathy syndrome (RPLS).

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

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 at least 3 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Breastfeeding 

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions 

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help