Bortezomib

How it works

It reversibly inhibits the 26S proteasome, disrupting degradation of regulatory proteins and triggering apoptosis in malignant plasma cells.

Prescribing in practice

• Dose-related peripheral neuropathy, often painful and sensory, is a key toxicity that requires dose modification and is reduced by using the subcutaneous route.
• Thrombocytopenia tends to be cyclical and the platelet count should be checked before each dose.
• Herpes zoster reactivation is common, so antiviral prophylaxis is generally given.

Monitoring

Monitor full blood count before each dose and assess regularly for new or worsening neuropathy, hypotension and fluid balance.

Counselling the patient

• Report tingling, numbness, burning pain or weakness in the hands or feet promptly.
• Take antiviral prophylaxis as prescribed and report any shingles-like rash.

Evidence & guidelines

Efficacy in myeloma is established through randomised controlled trials and supported by NICE technology appraisals.