What  is bortezomib 

Bortezomib is pronounced bore-tez-oh-mib. It is a  type of biological therapy called a proteasome inhibitor. Proteasomes are in all cells. They help to break down proteins that  the cell doesn’t need.  Bortezomib blocks the proteasomes so  that proteins build up  in the cell. The cell then dies. 

Bortezomib is also called Velcade. It is a treatment for myeloma for people  who have already had chemotherapy and  a bone marrow transplant. Your doctor may also prescribe it if you have had chemotherapy but can’t have a transplant. 

How you have bortezomib 

You have bortezomib  as an injection  into a vein through  a fine tube called  a cannula  or through  a central line if you have one. 

You have  bortezomib twice a week for 2 weeks and then have a break for  10 days. This is called a cycle of treatment. After 4 cycles you have a blood or urine test to check  the levels of a protein called serum M. Serum M  is made by myeloma cells. If  the bortezomib is working, the serum M levels should go down. If the levels don’t go down enough,  you stop treatment. If the levels go down  you may have up to 4 more cycles of  treatment - making 8 in total. 

The side effects  of bortezomib are listed below. Remember that most people don’t have all of them. 

Common  side effects

Many people have one  or more  of the following side effects 

• Feeling or being affects just over 6 in 10 people (60%) but is usually well controlled with anti sickness drugs 
• Fatigue (tiredness) affects about 1 in 2 people taking  this drug (50%)
• Loss of appetite affects about 4 in 10 people (40%) 
• Diarrhoea affects around 6 out of 10 people (58%) – drink plenty of fluid and tell  your doctor if diarrhoea becomes severe,  or continues for more than 3 days 
• Increased risk of getting an infection due to a drop  in the number of white blood cells - you may have headaches, aching muscles, a cough, sore throat, pain passing urine  or feel cold and shivery. Infections can sometimes be life threatening. You should urgently contact your hospital if you think you have an infection 
• About 1 in 10 people (10%) get shingles (herpes zoster virus) you may have to take an anti viral drug to prevent this 
• Bruising and bleeding due to a drop in platelets occurs in 4 out  of 10 people (40%) - you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on  your arms  or legs (known as petechia) 
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) affects about 3 out  of 10 people (30%) - you  may need a blood transfusion 
• Numbness or tingling in fingers and toes affects 3 out of every 10 people (30%) and can cause difficulty with fiddly things such as doing up buttons.   
• A high temperature (fever) for a few hours after having the drug affects about 1 in 3 people (33%) 
• Headaches affect about 1 in 4 people (25%) 
• Skin changes - about 1 out of 4 people (25%) have a rash or very red, dry, itchy skin 
• Taste changes affect just over 1 in 10 people (13%) 
• Indigestion affects 1 in 10 people (10%) 
• Constipation - your doctor may give you laxatives to help prevent this but do tell them if you are constipated for more than 3 days 
• Breathless and a cough affect about 1 in 4 people (25%) 
• Low blood pressure (hypotension) affects just over 1 in 10 people (12%) - this can make you feel lightheaded or dizzy 
• Blurred  vision - about 1 in 10 people (11%) have this but it is usually mild 
• Pain in your muscles, bones or tummy (abdomen) 
• Loss of fertility - we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if this is important to you 
• This drug may have a harmful effect on a developing baby – do talk to your doctor about contraception before having treatment if there is any chance that you  or your partner could become pregnant 

• Flu like symptoms 
• Swelling of ankles and legs due to a build up of fluid (oedema) affects 1 in 20 people (5%) but is usually mild 
• Hiccups
• Mood changes - you may feel anxious or low 
• Dehydration - drink plenty of fluids (around 2 litres a day) to prevent dehydration 

• Heart problems, including chest pain, affect fewer than 1 in 100 people (1%) - contact  your doctor as soon as possible if you have chest pain 
• Liver changes - that are very mild  and unlikely to cause symptoms –  the liver  will almost certainly go back to normal when treatment is finished, but you will have regular blood  tests to check how well  your liver is working 
• Kidney problems may cause difficulty or pain passing urine, needing  to pass urine often or blood in your urine - tell your doctor if you have any of these problems. 

• How many times you've had the drug before 
• Your general health 
• The amount of the drug you have (the dose) 
• Other drugs you are having 

• Your side effect may need treating 
• Your drug dose may need reducing to try to prevent the side effect.