Bortezomib

How it works

It reversibly inhibits the 26S proteasome, disrupting protein degradation and accumulating regulatory proteins that trigger cell-cycle arrest and apoptosis in malignant plasma cells.

Prescribing in practice

• Peripheral neuropathy is a common dose-limiting toxicity, so assess neurological symptoms before each cycle and adjust dosing accordingly.
• It is usually given by subcutaneous injection, which reduces neuropathy compared with intravenous use, in repeated cycles.
• Herpes zoster reactivation and thrombocytopenia are recognised, so antiviral prophylaxis and blood count monitoring are advised.

Monitoring

Monitor full blood count and neurological symptoms before each dose, and watch for signs of herpes zoster reactivation.

Counselling the patient

• Report numbness, tingling or burning in the hands or feet promptly.
• Antiviral medicine is often given to prevent shingles during treatment.
• Stay well hydrated and report dizziness, as blood pressure can drop.

Evidence & guidelines

Bortezomib improved outcomes in multiple myeloma in landmark trials and is recommended by NICE within several treatment regimens.