Bortezomib (Velcade®) is a targeted therapy drug. It is used to treat multiple myeloma and mantle cell lymphoma.
Bortezomib is a type of targeted therapy called a proteasome inhibitor. Proteasomes work in cells to break down proteins that are no longer needed. Bortezomib blocks the proteasomes. The proteins then build up in the cell and it dies. Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
You will usually be given bortezomib at a day unit or sometimes during a stay in hospital. Bortezomib can be given on its own or in combination with other cancer drugs.
During treatment you usually see a cancer doctor, a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.
At times during the course of your treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that your blood cells are at a safe level to have treatment.
You will see a doctor or nurse before you have treatment. They will ask you how you have been feeling. If your blood results are okay, the pharmacist will prepare your targeted therapy. Your nurse will tell you when your treatment is likely to be ready.
The drug can be given as an injection under the skin (subcutaneous) in the tummy (abdomen) or thigh. Or it can be given as an injection into a vein (intravenous).
Your course of treatment
Your doctor will decide how often you have bortezomib. Bortezomib is usually given in treatment cycles lasting 3 to 6 weeks. Each treatment cycle includes days you are given treatment and days you are not given treatment (rest period). You will usually be given several treatment cycles. Your doctor, specialist nurse or pharmacist will explain your treatment plan to you.
We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.
You may also have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.
Some people may have side effects while they are being given the treatment or shortly after they have it:
Rarely, some people have an allergic reaction to bortezomib. Contact the hospital straight away if you develop:
- red, warm and itchy bumps on the skin (like nettle rash)
- swelling of the lips, tongue or throat
- breathlessness, wheezing, a cough, or sudden difficulty with breathing
- feeling dizzy or faint
- a tight chest or chest pain.
Risk of infection
This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.
If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:
- your temperature goes over 37.5°C (99.5°F)
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection.
Symptoms of an infection include:
- feeling shivery
- a sore throat
- a cough
- needing to pass urine often.
It is important to follow any specific advice your cancer treatment team gives you.
The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.
G-CSF (granulocyte-colony stimulating factor) is a type of drug called a growth factor. It encourages the body to make more white blood cells.
Your doctor may give you G-CSF:
- if the number of white blood cells is very low
- to stop the number of white blood cells getting low.
You have it as a small injection under the skin.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.
Tell your doctor if you have any bruising or bleeding that you cannot explain. This includes:
- bleeding gums
- tiny red or purple spots on the skin that may look like a rash.
Some people may need a drip to give them extra platelets. This is called a platelet transfusion.
Numb or tingling hands or feet (peripheral neuropathy)
This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes, but for some people they may never go away. Talk to your doctor if you are worried about this.
This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.
If you have diarrhoea:
- try to drink at least 2 litres (3½ pints) of fluids each day
- avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
- contact the hospital for advice.
This treatment can cause constipation. Here are some tips that may help:
- Drink at least 2 litres (3½ pints) of fluids each day.
- Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
- Do regular gentle exercise, like going for short walks.
If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.
Feeling tired is a common side effect. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.
Muscle, joint or bone pain
You may get pain in your muscles, joints or bones. You may also get weakness or spasms in your muscles. If this happens, tell your doctor so they can give you give you painkillers. Tell them if the pain does not get better. Having warm baths and taking regular rests may help.
Sore mouth and throat
Your mouth or throat may get sore and you may get mouth ulcers. This can make you more likely to get a mouth infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth or throat is sore:
- tell your nurse or doctor – they can give you a mouthwash or medicines to help
- try to drink plenty of fluids
- avoid alcohol, tobacco, and foods that irritate your mouth.
Changes to your taste
You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.
Loss of appetite
This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.
Bortezomib may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. Bortezomib can cause a rash, which may be itchy.
Sometimes, bortezomib can cause a more serious skin rash that blisters. If this happens, tell your doctor straight away.
Always tell your doctor or nurse about any skin changes. They can give you advice and may give you creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Changes to your mood or problems sleeping
Changes to your blood pressure
Bortezomib may cause low or high blood pressure. Tell your doctor or nurse if you have ever had any problems with your blood pressure.
If you are taking medicine to lower your blood pressure, your doctor or nurse may need to adjust the dose. If you feel dizzy, light-headed or faint when you get up from a lying or sitting position, it can help to move more slowly when you do this. Drinking plenty of fluids can also help.
Your nurse will check your blood pressure regularly during treatment. Let them know if you feel dizzy or have any headaches.
Effects on the kidneys and liver
This treatment can affect how your kidneys and liver work. This is usually mild and goes back to normal after treatment. You will have blood tests before chemotherapy to check how well your kidneys and liver are working.
Effects on the lungs
This treatment can cause changes to the lungs. Tell your doctor if you develop:
- a cough
- a fever (high temperature)
You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.
This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.
Effects on the eyes
Sometimes this treatment can affect the eyes. They may become red and irritated or you may have eye pain. Tell your doctor or nurse if you notice these symptoms. If your vision is affected, contact the hospital straight away. Do not drive if your vision is affected.
You may feel sick with this treatment. Your doctor will give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.
If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.
Blood clot risk
Bortezomib can cause a blood clot. Symptoms of a blood clot include:
- pain, redness or swelling in a leg or arm
- chest pain
- weakness down one side, difficulty speaking or confusion.
If you have any of these symptoms, contact a doctor straight away.
A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.
Changes to blood sugar
Some people have an increase in their blood sugar level when taking bortezomib. You will have regular blood tests to check this. If your blood sugar level is too high, you may feel thirsty and need to pass urine more often. Tell your doctor or nurse if you have these symptoms.
If you are diabetic, you may find that your blood sugar levels are higher or lower than usual. Talk to your doctor or nurse so that you know how to manage this. You may need to change your insulin or tablet dose.
Some people get swelling around their eyes or in their hands, ankles or feet. This is because of a build-up of fluid. If you have any swelling, or if you put on weight very quickly, contact the hospital for advice. Your doctor may prescribe drugs called diuretics to make you pass more urine (pee). This helps get rid of some of the fluid.
Effects on the heart
In a small number of people bortezomib can affect the heart.
Contact a doctor straight away if you:
- have pain or tightness in your chest
- feel breathless or dizzy
- feel your heart is beating too fast or too slowly.
Other conditions can cause these symptoms, but it is important to get them checked by a doctor.
Raised levels of uric acid (tumour lysis syndrome)
This treatment may cause the cancer cells to break down quickly. This releases uric acid (a waste product) into the blood. The kidneys usually get rid of uric acid, but may not be able to cope with large amounts. Too much uric acid can cause swelling and pain in the joints, which is called gout.
Your doctor may give you drugs to help prevent this. Drinking at least 2 litres (3 ½ pints) of fluid a day will also help. You will have regular blood tests to check the uric acid levels.
Effects on the brain
Bortezomib can increase the chance of seizures, particularly in people who have had them before. Tell your doctor if you have epilepsy or have had seizures in the past.
Very rarely, bortezomib can cause swelling of the brain. This can cause symptoms including:
- severe headaches
- sudden loss of vision
- a seizure.
If you have these symptoms, you or someone with you should contact the hospital on the number you have been given straight away.
Do not drive if you have dizziness or blurred vision, or if you feel tired or sleepy. Talk to your doctor if you are not sure whether it is safe for you to drive.
Some medicines can affect your treatment or be harmful when you are having it. This includes medicines you can buy in a shop or chemist. Tell your cancer doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies.
You may be more likely to develop a viral infection called shingles during this treatment. Your doctor may give you medicine to help prevent shingles.
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm the developing baby. It is important to use effective contraception.
Women are advised not to breastfeed while having this treatment. This is because the drugs could be passed to the baby through breast milk.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.