Velcade became the first in a class of drugs called proteasome inhibitors to be approved by the FDA for use in myeloma. Velcade can be given as an intravenous (IV, into the vein) infusion injected through either a peripheral IV line (usually in the arm) or a central IV line (usually in the chest, also known as a “central venous catheter”). Velcade is also approved to be given as a subcutaneous (SQ, sometimes written “SC”) injection, commonly known as a “shot.” which causes significantly less peripheral neuropathy than IV Velcade and may also reduce the occurrence of gastrointestinal side effects.
Velcade is used throughout the myeloma disease course. Velcade can be used alone, in combination with dexamethasone, or as part of a more complex multi-drug regimen. Numerous clinical trials conducted over the years have shown that administration of Velcade on a once-weekly schedule in combination with other anti-myeloma agents is associated with reduction in side effects, without reduction in efficacy, when compared to twice-weekly Velcade.
How Does It Work?
Velcade works by inhibiting enzyme complexes called proteasomes. Both normal cells and cancer cells contain proteasomes, which break down damaged and unwanted proteins into smaller components. Proteasomes also carry out the regulated breakdown of undamaged proteins in the cell, a process that is necessary for the control of many critical cellular functions. These smaller protein components are then used to create new proteins required by the cell. Proteasomes can be thought of as crucial to the cell’s “recycling” of proteins.
When Velcade inhibits proteasome function, the normal balance within a cell is disrupted. This disruption results in a number of effects on the cell, some of which are still being studied. When proteasomes are inhibited, myeloma cells stop dividing. Proteasome inhibition also causes myeloma cells to stop producing chemicals that stimulate other myeloma cells: the autocrine feedback loop is interrupted. Myeloma cells are more sensitive to these effects than normal cells, so myeloma cells die while normal cells can recover.
Possible Side Effects
Peripheral neuropathy (PN) is a serious condition in which treatment affects nerves in the hands, feet, legs, and/or arms. Symptoms of PN include numbness, tingling, or even pain in the hands, feet, legs, and/or arms. Some patients may have experienced PN from the effects of the monoclonal protein itself and/or from previous treatments for myeloma. If you begin taking Velcade with this pre-existing condition, then it is especially important that you pay particular attention to the extent of your discomfort. You should quickly report to your doctor if your condition is worsening. If detected and managed appropriately, the neuropathy is often reversible.
Subcutaneous (SQ) Velcade causes significantly less PN than IV Velcade. SQ Velcade may also have a reduced level of gastrointestinal side effects (nausea, constipation/diarrhea) as compared to IV Velcade.
Fatigue is a common side effect associated with Velcade therapy. Even though fatigue is generally not severe, use caution if you are operating machinery, including automobiles.
Nausea may occur while taking Velcade and may be associated with dizziness, lightheadedness, or fainting if it leads to dehydration. Medical treatment may be required for dehydration.
Diarrhea may occur while taking Velcade. Dizziness, lightheadedness, or fainting may occur due to dehydration caused by either excessive or persistent diarrhea.
For more information about nausea and/or diarrhea, visit gastrointestinal problems.
Decreased platelet levels
Myeloma patients taking Velcade often experience a condition called thrombocytopenia – a lowered level of platelets in the blood. Platelets help blood to clot after an injury; fewer platelets can lead to bruising, bleeding, and slower healing. The platelet level falls with treatment. However, after the required interval between doses, platelet levels should return to the baseline level by the beginning of the next cycle. For more information on thromboctyopenia, visit myelosuppression.
Low blood pressure (hypotension)
A drop in blood pressure may occur after receiving Velcade. If you have a history of fainting or low blood pressure or are taking medication that can cause low blood pressure (such as medication to treat high blood pressure), then it is important to tell your doctor about your condition before receiving Velcade. Dizziness, especially when it occurs after rapidly sitting up or standing from a lying-down position, may be a sign of low blood pressure.
Other side effects of Velcade
Other side effects may occur with Velcade, including headache, insomnia, occasional rash, fever, cough, back pain, and muscle cramps. Velcade has been shown to increase the incidence of herpes zoster virus (also known as “shingles”), a painful, itchy rash usually located on one side of the body. Patients with MM have a higher risk for developing shingles because myeloma compromises the immune response. Please discuss taking an anti-viral medication to reduce your risk for this condition, and remember to discuss ANY changes in your health with a doctor or nurse on your healthcare team.
In this video, Dr. Brian G.M. Durie answers a patient’s question about taking a supplement like vitamin B12 on the same day as Velcade.
Understanding Velcade as a Subcutaneous (SQ) injection videos
VELCADE® Treatment Approaches
Information for patients and clinicians on indications and usage
As someone living with multiple myeloma or relapsed mantle cell lymphoma—or as someone caring for a person with one of these diseases—you may have many questions about the disease and its treatment. Our dedicated case managers at 1-866-VELCADE(835-2233), option 2 can provide you and your loved ones with day-to-day and long-term support.
A program is available for patients, physicians, and caregivers to provide assistance regarding reimbursement issues related to the use of VELCADE® (bortezomib) for Injection.