Bortezomib (Velcade®)

Bortezomib is a targeted therapy drug used to treat multiple myeloma and mantle cell lymphoma. It is best to read this information with our general information about the type of cancer you have.

Bortezomib is usually given as an injection either under the skin or into a vein.

Like all targeted therapy drugs, bortezomib can cause side effects. The side effects of targeted therapy vary from person to person. Some side effects can be serious, so It’s important to read the detailed information below. Your healthcare team can talk to you more about this and give you advice on how to manage any side effects.

Tell your doctor or nurse straight away if you:

  • have a temperature
  • feel unwell
  • have severe side effects, including any we don’t mention here.

Rarely, side effects may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

If you need medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

What is bortezomib?

Bortezomib, also known as Velcade®, is a targeted therapy drug. It interferes with enzymes (proteasomes) that are found in all cells, including cancer cells. Bortezomib causes cancer cells to die and can stop the cancer from growing.

Bortezomib is used to treat multiple myeloma and mantle cell lymphoma. Bortezomib may also be used to treat other types of cancer as part of a research trial.

During treatment, you will see a cancer doctor and a cancer nurse. This is who we mean when we mention doctor or nurse in this information. You will see your doctor and nurse regularly while you are having bortezomib. This information may help you discuss any questions about your treatment and its side effects with them.

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos


When bortezomib is given

Bortezomib can be given on its own or with other drugs. Your cancer doctor can tell you if it is suitable for you.

Some people may have it as part of a clinical trial. If a drug isn’t available on the NHS, there may be different ways you are still able to have it. Your cancer doctor can give you advice.


How bortezomib is given

Bortezomib can be given as an injection under the skin (subcutaneously), in the tummy (abdomen) or thigh. Or it can be given as an injection into a vein (intravenously).

Your doctor will decide how often you have bortezomib. This will depend on whether you have it on its own or with other anti-cancer drugs. Bortezomib is usually given in treatment cycles lasting three to six weeks. Each treatment cycle includes days you are given treatment and rest periods from treatment. You will usually be given several treatment cycles. Your doctor, specialist nurse or pharmacist will explain your treatment plan to you.


Possible side effects

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 here, but you will not get them all. Always tell your doctor or nurse about any side effects you have.

If you have other cancer drugs along with bortezomib, some side effects may be worse. You may also have side effects not listed here. We have more information about targeted cancer drugs and chemotherapy.

If a side effect is more severe, your doctors may need to reduce the dose of bortezomib or stop the treatment for a short time. Some people may have bortezomib stopped completely.

Your doctor can give you drugs to help control some side effects. It is very important to take them exactly as your nurse or pharmacist has explained. This will help the drugs work as well as possible for you. Your nurse will give you advice about managing side effects. Most side effects start to improve after treatment has finished.

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.

More information

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.

Effect on blood cells

Bortezomib can reduce the number of blood cells in your blood. If you are having chemotherapy at the same time as bortezomib, this is more likely. You will have regular blood tests to check the number of blood cells in your blood.

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.

Your nurse may give you injections of a drug called GCSF under the skin. GCSF encourages the bone marrow (where blood cells are made) to make more white blood cells.

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
  • diarrhoea
  • needing to pass urine often.

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.

Bortezomib can increase the risk of developing shingles (herpes zoster virus). You may be given drugs to help prevent this.

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 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 or nurse if you have any bruising or bleeding that you can’t explain. This includes:

  • nosebleeds
  • bleeding gums
  • tiny red or purple spots on the skin that may look like a rash.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment may affect 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.

Feeling sick

Your doctor can give you anti-sickness drugs to help prevent or control sickness. If you still feel sick, tell your doctor. They can prescribe other anti-sickness drugs that may work better for you.

Diarrhoea

If you have diarrhoea, contact the hospital for advice. Try to drink at least 2 litres (3½ pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Constipation

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.

Tummy pain

You may get pain or discomfort in your tummy (abdomen), or have indigestion or wind. Your doctor can give you drugs to help improve these symptoms. Tell them if the pain doesn’t improve or gets worse.

Feeling tired

Feeling tired is a common side effect. 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.

Joint or muscle pain

Some people have pains in their joints or muscles. Your doctor can give you painkillers if needed. Tell your doctor straight away if you have muscle weakness or muscle cramps.

Sore mouth or throat

Your mouth or throat may become sore and you may get mouth ulcers. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals. Tell your nurse or doctor if your mouth or throat are sore. They can give you medicines or mouthwashes to prevent or treat mouth infections and to reduce soreness.

Changes to your taste

You may find that food tastes different. If you don’t have a sore mouth or ulcers, try using herbs and spices or strong-flavoured sauces to give your food more flavour. Taste changes usually get better after treatment finishes. Your nurse or dietician can give you more advice.

Loss of appetite

This treatment can affect your appetite. Don’t worry if you don’t 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.

Skin changes

This treatment may affect your skin. It can cause a rash, which may be itchy. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day.

Always tell your doctor or nurse about any skin changes or if they get worse. They can give you advice and may prescribe 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

Some people become low in mood or feel anxious while having bortezomib. You may also find it difficult to sleep. Talk to your doctor or nurse if this happens to you.

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 reduce blood pressure, the dose may need to be adjusted. 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.

Changes in the way your liver or kidneys work

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 to check how well your kidneys and liver are working.

Effects on the lungs

Sometimes people feel more breathless or develop an infection while taking bortezomib. Let your doctor know if you notice this.

Blood clots

This treatment can increase the chances of a blood clot. A clot can cause:

  • pain, redness and swelling in a leg or arm
  • breathlessness
  • chest pain.

Contact your doctor straight away if you have any of these symptoms. A blood clot is serious, but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.

Blood sugar levels

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 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.

Fluid build-up

Some people get swelling around their eyes or in their hands, ankles or feet because of fluid build-up. If you have any swelling or if you put on weight very quickly, contact the hospital for advice. Your doctor may prescribe drugs to make you pass more urine (diuretics) to help get rid of some of the fluid.

Effects on the heart

In a small number of people, bortezomib can affect the heart. Contact the hospital on the number you have been given straight away if:

  • you have chest pain or chest tightness
  • your heartbeat becomes less regular or feels too fast or too slow.

Effects on the eyes

Sometimes bortezomib 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 on the number you have been given for advice. Don’t drive if your vision is affected.

Tumour lysis syndrome (TLS)

Bortezomib may cause the cancer cells to break down very quickly in some people. This releases a waste product called uric acid into the blood. The kidneys usually get rid of uric acid but may not be able cope with large amounts. This can cause chemical imbalances in the blood that affect the kidneys and the heart. This is called tumour lysis syndrome (TLS).

Your doctor may give you drugs to reduce the risk of TLS. They may also ask you to drink more fluids on the day of your treatment. Your doctor or nurse will explain more about this.

Allergic reaction

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
  • a tight chest or chest pain.

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
  • vomiting
  • confusion
  • 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.


Other information

Driving

Bortezomib may affect whether you can drive. Don't drive if you feel dizzy, have blurred vision or feel sleepy.

Other drugs

Some medicines, including ones you buy in a shop or chemist, can be harmful while you are having this treatment. Tell your cancer doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies.

Contraception

Your doctor will advise you not to get pregnant or father a child while having this treatment and for some time afterwards. The drugs may harm the developing baby. It is important to use effective contraception.

Fertility

Doctors don’t yet know how this treatment may affect your fertility (the ability to become pregnant or father a child). If you are worried about this, talk to you doctor before treatment starts.

Breastfeeding

Women are advised not to breastfeed while having this treatment and for some time afterwards. 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 this treatment.