PVD

PVD is a combination treatment used to treat myeloma that has come back after treatment. 

PVD is named after the initials of the drugs used:

  • panobinostat
  • bortezomib (Velcade®)
  • dexamethasone.

Panobinostat and bortezomib are targeted therapies. Targeted therapies interfere with the way cells grow and divide. Dexamethasone is a steroid drug. It is best to read this information with our general information about chemotherapy, targeted therapies and the type of cancer you have.

Panobinostat is given by mouth, as capsules. Dexamethasone is either given as tablets or into a vein. Bortezomib is usually given as an injection under the skin (subcutaneously). You may have PVD as an outpatient or during a hospital stay. Your cancer doctor or nurse will tell you how often you will have it.

PVD can cause side effects. Some of the side effects can be serious, so it is important to read the detailed information below. 

Your healthcare team can 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 do not 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 PVD?

PVD is a combination treatment used to treat myeloma that has come back after treatment. 

PVD is named after the initials of the drugs used:

It is best to read this information with our general information about chemotherapy, targeted therapies and the type of cancer you have.


How PVD is given

You will be given PVD in the chemotherapy day unit or during a stay in hospital. A chemotherapy nurse will give it to you. 

During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.

Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check your blood cells are at a safe level to have chemotherapy. 

You will see a doctor or nurse before you have chemotherapy. They will ask you how you have been feeling. If your blood test results are okay, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready. 

Panobinostat is given by mouth, as capsules. Dexamethasone is usually given as tablets, but some people have it given into a vein as an infusion. Bortezomib is usually given as an injection under the skin (subcutaneously).

Taking panobinostat

You take panobinostat as capsules once a day, at the same time each day. You should only take panobinostat on the days it has been prescribed. It can be taken with or without food. There are some things to remember when taking panobinostat:

  • Take the capsules with a glass of water. 
  • Do not chew, crush or open the capsules before you take them. This may increase side effects. 
  • Avoid eating grapefruit, star fruit or pomegranate and drinking grapefruit and pomegranate juice during your treatment. It may increase side effects.

Always take panobinostat exactly as your nurse or pharmacist explains. This is important to make sure it works as well as possible for you. Your doctor will talk to you about how long to take panobinostat for.

If you forget to take panobinostat, you can still take it up to 12 hours after the time you would normally take it. After this, do not take the missed dose – take your usual dose at the usual time the next day. You should never take a double dose.

There are some important things to remember when taking your capsules:

  • Keep them in the original packaging. 
  • Keep them at room temperature, away from heat and direct sunlight.
  • Keep them in a safe place, out of the reach of children.

If your doctor decides to stop the treatment, return any remaining drugs to the pharmacist. Do not flush them down the toilet or throw them away.

Taking bortezomib

Avoid green tea while having bortezomib. It may make bortezomib less effective. 

Your course of chemotherapy

Chemotherapy is usually given as a course of several cycles of treatment over a few months. Your nurse or doctor will discuss your treatment plan with you.

A cycle of PVD lasts 21 days (3 weeks). During the 3-week cycle, you will have:

  • panobinostat 3 times a week for the first 2 weeks of the cycle
  • bortezomib 2 times a week for the first 2 weeks of the cycle
  • dexamethasone 4 times a week for the first 2 weeks of the cycle.

The third week of the cycle is a rest period. During this time, you will not be given any of the treatment drugs. 

Once you have finished 8 weeks of the cycle, you will have:

  • bortezomib once a week
  • dexamethasone twice a week.


About 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, but you are unlikely to get all of them.

You may also have some side effects that we haven’t 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.

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) to download a Patient Information Leaflet (PIL) for these drugs. The leaflet lists all known side effects.


Common side effects

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
  • diarrhoea
  • 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.

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:

  • nosebleeds
  • 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.

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.

Feeling tired

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.

Feeling sick

You may feel sick in the first few days after 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.

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.

Tummy pain

You may get pain or discomfort in your tummy (abdomen) or have indigestion. Your doctor can prescribe drugs to help improve these symptoms. Tell them if the pain does not improve or gets worse.

Tell your doctor straight away if you:

  • have sudden or severe pain in your tummy
  • have signs of bleeding from the back passage
  • have black stools (poo)
  • vomit up blood (or vomit that looks like coffee grounds).

Diarrhoea

This treatment may cause severe diarrhoea. Your nurse or doctor may give you anti-diarrhoea drugs to take at home.

If you have diarrhoea:

  • follow any advice you have been given about taking anti-diarrhoea drugs
  • 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 straight away if:

  • you have diarrhoea at night
  • you have diarrhoea more than 6 times in a day
  • the anti-diarrhoea drugs do not work within 24 hours.

Some people may need to go to hospital to have fluids through a drip. You may need to take antibiotics.

Headaches

This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.

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.

Dizziness

PVD may cause dizziness. Tell your doctor if you feel dizzy. Do not drive or operate machinery if you notice these effects.

Skin changes

PVD 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. PVD can cause a rash, which may be itchy.

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.

Eye problems

Sometimes bortezomib can make your eyes feel sore, red and itchy (conjunctivitis). Your doctor will prescribe eye drops to help prevent this. It is important to use these as you are told to.

This treatment may also make your eyes more sensitive to light and cause blurry vision. If you have pain or notice any change in your vision, always tell your doctor or nurse. It is important not to drive or operate machinery if you notice these effects.

Effects on the lungs

This treatment can cause changes to the lungs. Tell your doctor if you develop: 

  • a cough
  • wheezing
  • a fever (high temperature)
  • breathlessness.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.

Build-up of fluid

Some people get swelling around their eyes, or in their hands, ankles or feet, because of fluid build-up. This often settles down by itself. Your doctor may prescribe drugs to make you pass more urine (diuretics) to help get rid of some of the fluid.

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.

Problems sleeping

You may find it difficult to sleep while having bortezomib. Tell your doctor or nurse if this happens.

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.

Changes to your taste

You may get a bitter or metallic taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste bad or have no taste. Try different foods to find out what tastes best to you. Your nurse can give you more advice.


Less common side effects

Effects on the heart

This treatment can affect the way the heart works. You may have tests to see how well your heart is working. These may be done before, during and sometimes after treatment. 

If the treatment is causing heart problems, your doctor can change the type of treatment you are having.

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.


Other information

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

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

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.

Other medicines

Some medicines can affect chemotherapy 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 over-the-counter drugs, complementary therapies and herbal drugs.

Contraception

Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.

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.

Fertility

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Sex

If you have sex in the first few days after chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluids.

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.