Bortezomib (Velcade ®)
Bortezomib, which is commonly known as Velcade®, is currently used to treat people with multiple myeloma. Bortezomib may also be used to treat other types of cancer as part of a research trial.
You'll see your doctor regularly while you have this treatment so they can monitor its effects. This information should help you discuss any queries about your treatment and its side effects with your doctor or specialist nurse.
Bortezomib is a type of treatment called a proteasome inhibitor. Proteasomes are a group of enzymes found in all cells in the body. They play an important role in controlling cell function and growth.
Bortezomib interferes with how proteasomes work, which may cause cancer cells to die and may stop the cancer from growing. Cancer cells are more sensitive to the effects of bortezomib than normal cells are.
When bortezomib is used
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Bortezomib can be given on its own to treat people who have already been treated with at least one other type of chemotherapy, and who have already had, or are unsuitable for, a bone marrow transplant but whose myeloma has continued to develop.
It can also be given in combination with chemotherapy, as the first treatment for people with multiple myeloma who aren’t suitable for high-dose chemotherapy with a bone marrow transplant. It’s usually given with the chemotherapy drug melphalan and the steroid prednisone.
The National Institute for Health and Clinical Excellence (NICE) gives advice on which new drugs or treatments should be available on the NHS in England and Wales. The Scottish Medicines Consortium (SMC) makes recommendations on the use of new drugs within the NHS in Scotland. NICE and the SMC have both recommended the use of bortezomib as a treatment for people who have previously been treated, but whose myeloma has continued to develop. NICE is yet to issue guidance on bortezomib’s use in combination with chemotherapy.
If you live in Northern Ireland, you should speak to your cancer specialist about whether bortezomib is recommended to treat your type of cancer.
If bortezomib isn’t recommended for you, it may not be available on the NHS, although you may be given it as part of a clinical trial.
We have more information about what you can do if a treatment isn’t available.
What bortezomib looks like
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Bortezomib is a clear, colourless fluid.
How bortezomib is given
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Bortezomib is given by injection into a vein (intravenously) through a fine tube (cannula). It may be given through a central line, which is inserted under the skin into a vein near your collarbone. Alternatively, it may be given through a PICC line, which is inserted into a vein in the crook of your arm. Bortezomib can also be given as an injection under the skin (subcutaneously).
When given on its own, bortezomib is usually given as four doses over a three-week period. The doses are given on days 1, 4, 8 and 11, followed by a 10 day rest period. This completes one cycle of treatment. You can have up to eight cycles of treatment over six months.
When bortezomib is given in combination with melphalan and prednisone, it’s given over nine cycles of six weeks. During the first four cycles, the bortezomib is given twice a week. During cycles 5 to 9, the bortezomib is given once a week. Your doctor, specialist nurse or pharmacist will explain this to you.
Possible side effects of bortezomib
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Each person’s reaction to any drug is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone being treated with bortezomib.
We have outlined the most common side effects, but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your nurse or doctor.
Numbness or tingling in hands or feet
This is due to the effect of bortezomib on the nerves and is known as peripheral neuropathy. You may also notice that you have difficulty buttoning clothes or doing fiddly tasks, or that you have painful, restless legs. Let your doctor know about any changes. It's important to tell your doctor if you get pain in your hands or feet as the dose of bortezomib will need to be reduced to prevent further problems.
If symptoms are more severe, bortezomib may be stopped for a time until they improve and then restarted using a lower dose.
Dizziness on standing
You may feel dizzy or light-headed if you stand up quickly. This is caused by a temporary drop in blood pressure. Let your doctor know if you have dizziness or feel light-headed, as you may need additional treatment to help. Drinking plenty of fluids and moving slowly when getting up from a lying or sitting position can help.
Feeling tired is a common side effect of bortezomib. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Feeling sick (nausea) and being sick (vomiting)
Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting.
If the sickness isn't controlled, or if it continues, tell your doctor as they can prescribe other anti-sickness drugs that may work better for you. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Loss of appetite
Some people lose their appetite while they’re having bortezomib. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Constipation or diarrhoea
Bortezomib can cause constipation or diarrhoea. Constipation can usually be helped by drinking plenty of fluids, eating more fibre in your diet and doing some gentle exercise. If constipation is severe or continues for more than three days, tell your doctor as you may need additional treatment.
Diarrhoea can usually be easily controlled with medicine but tell your doctor if it’s severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
A high temperature and chills
This may occur within a few hours of treatment with bortezomib, but it doesn't usually last long. Your doctor may prescribe medicines to reduce these effects.
Let your doctor know if you have headaches, so they can advise you on what can help.
Risk of infection
Bortezomib can reduce the number of white blood cells, which help to fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low, you’ll be more prone to infections. A low white blood cell count is called neutropenia.
Contact your doctor or the hospital straight away if:
your temperature goes above 38°C (100.4°F)
you suddenly feel unwell, even if your temperature is normal.
Bortezomib can increase the risk of developing shingles (herpes zoster virus). You may be given anti-viral drug to help prevent this infection.
Bruising and bleeding
Bortezomib can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion if your platelet count is low.
Anaemia (low number of red blood cells)
Bortezomib can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Muscle cramps and painful limbs
Tell your doctor if you have muscle cramps or painful limbs, so that suitable painkillers can be prescribed.
Bortezomib can cause temporary breathlessness. Let your doctor know if you’re breathless or notice any changes in your breathing.
Changes to your eyes
Bortezomib may cause eye pain or blurred vision. Let your doctor know if you notice any change in your vision.
In some people, bortezomib may cause lowered mood (depression), feelings of anxiety or difficulty sleeping. Talk to your doctor if this happens to you.
It's important that you drink plenty of fluids (2-3 litres a day) while having treatment with bortezomib.
It's important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they're not mentioned above.
Additional information about bortezomib
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Bortezomib may affect your ability to drive. Don't drive if you experience dizziness, blurred vision or excessive tiredness. Seek advice from your doctor if you have any concerns.
Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you are having bortezomib. Tell your doctor about any medicines you’re taking, including over-the-counter drugs, complementary therapies and herbal drugs.
It's not advisable to become pregnant or father a child while having bortezomib, as it may harm the developing baby. It’s important to use effective contraception while having this drug, and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether bortezomib is present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after treatment.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
There is a potential risk that bortezomib may be present in breast milk, so women are advised not to breastfeed during treatment and for a few months afterwards.
Non-cancer hospital admission
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having bortezomib treatment. You should tell them the name of your cancer specialist so that they can ask them for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. During office hours you can contact the clinic or ward where you had your treatment. Your specialist nurse or doctor will tell you who to contact during the evening or at weekends.
This information has been compiled using a number of reliable sources, including:
Bortezomib monotherapy for relapsed multiple myeloma. October 2007. National Institute for Health and Clinical Excellence (NICE).
British National Formulary. March 2012. 63rd edition. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). Bortezomib. Summary of Product Characteristics (SPC). (accessed September 2012).
302/06 - Bortezomib (Velcade®). November 2009. Scottish Medicines Consortium (SMC).
With thanks to: Professor Gareth Morgan, Consultant Haematologist; and the people affected by cancer who reviewed this edition. Reviewing is just one of the ways you could help when you join our Cancer Voices network.