Care During Chemotherapy and Beyond
Generic Name: Bortezomib
Velcade is a targeted therapy. It is classified as a proteasome inhibitor. (For
more detail, see "How Velcade Works" below).
What Velcade Is Used For:
- Treatment of multiple myeloma.
- Treatment of mantle cell lymphoma who have received at least one prior therapy.
Note: If a drug has been approved for one use, physicians may elect to use
this same drug for other problems if they believe it may be helpful.
How Velcade Is Given:
- As an intravenous (into the vein) injection.
- As a subcutaneous (under the skin) injection into the thigh or abdomen.
- The amount of Velcade that you will receive depends on many factors, including your
height and weight, your general health or other health problems, and the type of
cancer or condition being treated. Your doctor will determine your dose and
Important things to remember about the side effects of Velcade:
- Most people do not experience all of the side effects listed.
- Side effects are often predictable in terms of their onset and duration.
- Side effects are almost always reversible and will go away after treatment is complete.
- There are many options to help minimize or prevent side effects.
- There is no relationship between the presence or severity of side effects and the
effectiveness of the medication.
The following side effects are common (occurring in greater than 30%) for patients
These side effects are less common side effects (occurring in about 10-29%) of patients
- Difficulty sleeping (Insomnia)
- Joint pains, arthralgia, myalgias
- Swelling of the face, hands, feet or legs (edema).
- Low white blood cell count. (This can put you at increased risk for infection.)
- Shortness of breath
- Rash (see skin reactions)
- Upper respiratory tract infection
- Bone pain
- Muscle cramps
- Abdominal pain
- Low blood pressure
- Blurring of vision
- Blood test abnormalities: (low sodium, low magnesium, low calcium, low potassium).
Not all side effects are listed above. Some that are rare (occurring in less than
10% of patients) are not listed here. However, you should always inform your
health care provider if you experience any unusual symptoms.
When to contact your doctor or health care provider:
Contact your health care provider immediately, day or night, if you should
experience any of the following symptoms:
- Fever of 100.4° F (38° C) or higher, chills (possible signs of infection)
- Shortness of breath, wheezing, difficulty breathing, closing up of the throat, swelling
of facial features, hives (possible allergic reaction).
The following symptoms require medical attention, but are not an emergency.
Contact your health care provider within 24 hours of noticing any of the
- Nausea (interferes with ability to eat and unrelieved with prescribed medication).
- Vomiting (vomiting more than 4-5 times in a 24 hour period).
- Diarrhea (4-6 episodes in a 24-hour period).
- Constipation unrelieved by laxative use.
- Unusual bleeding or bruising
- Black or tarry stools, or blood in your stools.
- Blood in the urine.
- Extreme fatigue (unable to carry on self-care activities).
- New or worsening symptoms of peripheral neuropathy.
- Swelling, redness and/or pain in one leg or arm and not the other.
- Swelling of the feet or ankles. Sudden weight gain.
- Signs of infection such as redness or swelling, pain on swallowing, coughing up
mucous, or painful urination.
- Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst,
dry mouth, dark and decrease amount of urine, or dizziness.
Always inform your health care provider if you experience any unusual symptoms.
- Before starting Velcade treatment, make sure you tell your doctor about any other
medications you are taking (including prescription, over-the-counter, vitamins,
herbal remedies, etc.). Do not take aspirin, or products containing
aspirin unless your doctor specifically permits this.
- Do not receive any kind of immunization or vaccination without your doctor's approval
while taking Velcade.
- Inform your health care professional if you are pregnant or may be pregnant prior
to starting this treatment. Pregnancy category D (Velcade may be hazardous to the
fetus. Women who are pregnant or become pregnant must be advised of the potential
hazard to the fetus.)
- For both men and women: Do not conceive a child (get pregnant) while taking Velcade.
Barrier methods of contraception, such as condoms, are recommended. Discuss with
your doctor when you may safely become pregnant or conceive a child after therapy.
- Do not breast feed while taking Velcade.
- You may experience drowsiness or dizziness; avoid driving or engaging in tasks that
require alertness until your response to the drug is known.
- Drink at least two to three quarts of fluid every 24 hours, unless you are instructed
- You may be at risk of infection report fever or any other signs of infection immediately
to your health care provider.
- Avoid contact sports or activities that could cause injury.
- To reduce nausea, take anti-nausea medications as prescribed by your doctor, and
eat small, frequent meals.
- In general, drinking alcoholic beverages should be kept to a minimum or avoided
completely. You should discuss this with your doctor.
- Get plenty of rest.
- Maintain good nutrition.
- If you experience symptoms or side effects, be sure to discuss them with your health
care team. They can prescribe medications and/or offer other suggestions that
are effective in managing such problems.
- Keep your bowels moving. Your health care provider may prescribe a stool softener
to help prevent constipation that may be caused by this medicine.
- Follow regimen of anti-diarrhea medication as prescribed by your health care professional.
- Eat foods that may help reduce diarrhea. (see managing side effects - diarrhea).
- Acetaminophen or ibuprophen may help relieve discomfort from fever, headache and/or
generalized aches and pains. However, be sure to talk with your doctor before
Monitoring and Testing:
You will be checked regularly by your health care professional while you are taking
Velcade, to monitor side effects and check your response to therapy. Periodic
blood work to monitor your complete blood count (CBC) as well as the function of
other organs (such as your kidneys and liver) and blood electrolytes will also
be ordered by your doctor.
How Velcade Works:
Targeted therapy is the result of about 100 years of research dedicated to understanding
the differences between cancer cells and normal cells. To date, cancer treatment
has focused primarily on killing rapidly dividing cells because one feature of cancer
cells is that divide rapidly. Unfortunately, some of our normal cells divide rapidly
too, causing multiple side effects.
Targeted therapy is about identifying other features of cancer cells. Scientists
look for specific differences in the cancer cells and the normal cells. This information
is used to create a targeted therapy to attack the cancer cells without damaging
the normal cells, thus leading to fewer side effects. Each type of targeted therapy
works a little bit differently but all interfere with the ability of the cancer
cell to grow, divide, repair and/or communicate with other cells.
There are different types of targeted therapies, defined in three broad categories.
Some targeted therapies focus on the internal components and function of the cancer
cell. The targeted therapies use small molecules that can get into the cell and
disrupt the function of the cells, causing them to die. There are several types
of targeted therapy that focus on the inner parts of the cells. Other targeted therapies
target receptors that are on the outside of the cell. Therapies that target receptors
are also known as monoclonal antibodies. Antiangiogenesis inhibitors target the
blood vessels that supply oxygen to the cells, ultimately causing the cells to starve.
Research continues to identify which cancers may be best treated with targeted
therapies and to identify additional targets for more types of cancer.
Velcade targets and inhibits the proteasome enzyme complex within the cell.
Proteasome is part of the cellular machinery and has many functions within the cell,
such as it helps to control the level of many of the proteins that help to regulate
cell division and cell survival. By interfering with it's function this can lead
to apoptosis (cell suicide). In the laboratory, it has been shown that
cancer cells are more susceptible to the effects of proteasome inhibitors, than
normal cells are. In multiple myeloma, bortezemib works by blocking the activation
of adhesion molecules that allow plasma cells to "nest" in the bone marrow.
Note: We strongly encourage you to talk with your health
care professional about your specific medical condition and treatments. The information
contained in this website is meant to be helpful and educational, but is not a substitute
for medical advice.
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