Bortezomib (Velcade)

Bortezomib is a type of targeted cancer drug. It is also known as Velcade. It is a treatment for myeloma and mantle cell lymphoma. You pronounce bortezomib as bor-teh-zoh-mib.

You can have bortezomib on its own or with other cancer drugs. Your treatment plan depends on your cancer type and the stage of your cancer. You might have bortezomib on its own if you have:

• multiple myeloma

• mantle cell lymphoma

Bortezomib for multiple myeloma

It’s for people with multiple myeloma that has come back after having one other treatment. Or who have had a stem cell transplant . Unless you are not able to have a stem cell transplant. 

Bortezomib for mantle cell lymphoma

You might have bortezomib if you have mantle cell lymphoma that has not been treated before, and a stem cell transplant is not suitable.

How does bortezomib work?

Bortezomib is a type of targeted cancer drug called a proteasome inhibitor.

Proteasomes are in cells. They help to break down and remove proteins that the cell doesn't need. Cells need proteasomes to grow and develop. Bortezomib blocks the function of the proteasomes so the proteins build up inside the cell. The cell then dies.

How do you have bortezomib?

You have bortezomib either as an injection under your skin (subcutaneous injection) or as an injection into your bloodstream (intravenously). 

As an injection under your skin

You usually have injections under the skin into the abdomen (tummy) or thigh. You might have stinging or a dull ache for a short time after this type of injection, but they don't usually hurt much. The skin in the area may go red and itchy for a while.

Into your bloodstream

You might have bortezomib through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Or you might have this treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.

How often do you have bortezomib?

You have bortezomib as cycles of treatment.

Bortezomib on its own

If you have bortezomib on its own you usually have it twice a week, for 2 weeks. Then you have a break of 10 days. This is a 3 week (21 day) cycle of treatment. You might have up to 8 cycles.

After 4 cycles of treatment, you have a blood or urine test. This is to check how well your cancer has responded to bortezomib. You continue with your treatment if you’ve had a response.

The amount of bortezomib you have depends on your type of cancer and your general health. Your doctor or pharmacist will tell you more about your treatment.

Bortezomib with other cancer drugs

If you have bortezomib with other cancer drugs you might have between 4 to 9 cycles. Your doctor and pharmacist will tell you more about bortezomib and the other drugs you have with it.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of bortezomib?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

The side effects listed are for bortezomib on its own. You are likely to have other side effects if you have bortezomib with other anti cancer drugs.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Damage to your nerves 

Bortezomib can cause nerve damage. For example, you might feel pain or a burning sensation when you touch something. Or you might have pain in part of the body that hasn’t been injured. 

You might also have numbness or tingling in your fingers or toes. This is often temporary and can improve after you finish treatment. You might also have weakness in your arms and legs, but this is less common.

Tell your healthcare team if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons.

Pain in the muscles or joints 

You might feel some pain in your muscles and joints. Less commonly, you might notice you have less strength in your muscles, or you have muscle cramps. You might also have pain in your arms and legs.

Speak to your doctor or nurse if you have any of these symptoms. They can tell you about what painkillers you can take to help with this.

High temperature (fever)

Tell your healthcare team straightaway if you get a high temperature. Ask them if you can take paracetamol to help lower your temperature.

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a laxative if needed.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Lowered appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Tiredness and weakness (fatigue)

You are likely to feel very tired during your treatment. It tends to get worse as the treatment goes on. You might also feel weak and lack energy. Rest when you need to.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Lung and breathing problems

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

You might also develop a cough or breathing problems. This could be due to infection, such as pneumonia. The cough could be dry, or you might have phlegm. You might also sweat, feel shivery, and have a fast heartbeat.

Rarely you might have fluid in or around your lungs causing difficulty breathing. Or lower oxygen levels in your body causing shortness of breath even when you are not exercising. Your breathing may become shallow, or you might have wheezing. 

Let your doctor or nurse know straight away if you suddenly become breathless or develop any of these symptoms.

Problems with bleeding

Bortezomib can cause bleeding from anywhere in your body. This is usually mild but there is a risk of a serious bleed. This is due to a drop in the number of platelets in your blood. Signs of bleeding include bruising, blood in your urine or poo (stool), black poo, vomiting or coughing up blood, nosebleeds, bleeding gums, headaches, dizziness or feeling weak.

Less commonly you may have vaginal bleeding, or you might have bleeding that looks like small red or purple spots on the skin.

Contact your hospital advice line straight away if you have any signs of bleeding.

A sore mouth

You might get a sore mouth and mouth ulcers. It may be painful to swallow drinks or food. You will have mouth washes to keep your mouth healthy.

You can have painkillers to reduce the soreness. Take them half an hour before meals to make eating easier.

Other less common symptoms are a dry mouth, cold sores, gum disease, tooth decay, and sore lips.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• low blood pressure that can cause you to feel lightheaded or dizzy. Sometimes this can happen when you stand up from sitting or lying down

• high blood pressure that might cause headaches, confusion, vision problems, or chest pain

• eye problems such as swelling and infection and changes in your sight. Rarer problems include blurred or double vision, pain, dry eyes, watery eyes, or discharge. Let your healthcare team know if this happens

• kidney changes - including kidney or wee infections. Symptoms include not passing enough wee or passing too much, pain, blood in your wee, feeling tired and weak, and feeling sick. You might have swelling in your legs, ankles and feet

• taste changes

• weight loss

• indigestion

• general swelling including hands and feet (oedema)

• difficulty sleeping (insomnia)

• mood changes, such as feeling very low or confused. Less commonly you may have memory problems, see things that aren’t there, feel anxious or agitated

• dehydration

• sore throat

• liver changes, you have regular blood tests to check for this

• headaches that can be severe

• shingles - this might be all around the body and can also affect your eyes

• dizziness

• temporary loss of consciousness (syncope)

• changes in levels of minerals, salts, blood sugars, enzymes, and a chemical called uric acid in your body. You will have regular blood tests to check for this

• tummy (abdominal) pain

• skin changes such as a rash or itching, dry skin and red inflamed skin or an infection, including fungal infections - some skin problems can be severe

• feeling sick and dizzy with ringing in your ears and a sense of things moving around you (vertigo)

• wind (also known as flatulence and farting)

• hair loss and change in hair texture

• changes to the levels of chemicals in the blood due to breakdown of cancer cells (tumour lysis syndrome)

• too much cortisol in your body (Cushing’s syndrome) – you may gain weight and notice your skin bruises easily

• problems having an erection

• pain around the genitals

• problems with the injection site- including pain and a skin reaction that can be severe

• risk of falling

• heart problems such as a change in heart rhythm and how well your heart pumps blood around the body. Other symptoms include chest pain, a heart attack, fluid or inflammation around the heart and problems with the heart muscle that may cause heart failure

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

• stroke 
• hiccups
• blood clots that can be life threatening; signs are pain, swelling and redness where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms
• rare blood disorders, that may cause infections, bleeding, and problems with clotting 
• hearing changes such as hearing loss or ringing in your ears (tinnitus)
• high or low levels of thyroid hormones
• flushing
• a second cancer some years after treatment has finished
• non cancerous conditions (benign growth)
• an allergic reaction which can happen suddenly and can be severe 
• infections of the ear or teeth and gums 
• swollen lymph nodes 
• build up of protein in the blood and organs in the body, affecting the kidney and heart. Symptoms include feeling weak, breathless, lightheaded, and an abnormal heartbeat
• underactive thyroid - you may feel tired, be sensitive to cold, feel slow in movement and have poor concentration
• changes in your blood glucose levels
• seeing or hearing things that are not real (hallucinations) and believing things are true when they are not (delusional) 
• loss or changed sense of smell
• symptoms affecting the nervous system (this includes the brain, the spinal cord, and the nerves in the body). Including severe headaches, problems with speech, fits (seizures), memory loss and uncontrollable movements of your arms, legs face and chest, difficulty walking, pain in the area if you previously had singles, and memory loss. 
• severe pain in your back, spine, and neck, weakness in your arms and legs, pins and needles or numbness, and difficulty having a wee or poo (spinal cord compression). Contact your healthcare team straight away if you have these symptoms
• inflammation of a vein or blood vessels and poor circulation of blood around your body 
• Inflammation of the pancreas and obstruction of the bile duct
• problems with the digestive system . You might have pain and inflammation, bleeding, blockage in the bowel, difficulty swallowing, and blood in your vomit
• difficulty with walking or loss of vision. These can be symptoms of a brain infection

Other side effects

You may have a condition affecting your brain and nerves. Symptoms are similar to those listed above, including:

• headaches

• seizures

• changes in eyesight

• feeling very tired

• changes in your behaviour

• high blood pressure

This is rare, there isn't enough information to work out how often this might happen.

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, foods and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment with this drug and for at least 3 months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Breastfeeding 

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions 

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.