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Velcade® (bortezomib) is an anti-cancer agent available for injection into a vein (intravenously or IV) or under the skin (subcutaneously). The FDA has approved it for the treatment of multiple myeloma. It is the first in the class of drugs called proteasome inhibitors.

Velcade is indicated for the treatment of newly diagnosed and relapsed or refractory myeloma. It is also indicated for the re-treatment of patients who previously responded to Velcade and who relapsed at least six months after completing prior Velcade treatment. It can be used alone, in combination with dexamethasone, or as part of a more complex combination therapy, such as Velcade, Revlimid, and dexamethasone (VRd), which is the standard of care for front-line treatment of multiple myeloma; Velcade, Cytoxan, and dexamethasone (VCD or cybor-d); or Velcade, Thalomid, and dexamethasone (VTd).

Velcade is part of the approved combination relapse therapies Darzalex® (daratumumab), Velcade, and dexamethasone as well as Velcade, Farydak® (panobinostat), and dexamethasone.

Velcade is safe for patients with impaired kidney function and does not cause blood clots. It has also demonstrated its ability to help overcome certain high-risk genetic mutations in myeloma cells and to help prevent bone loss in myeloma patients.

How Does It Work?

Velcade is a proteasome inhibitor. Both normal cells and cancer cells contain proteasomes, enzyme complexes that break down damaged and unwanted proteins into smaller components. These smaller 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. Myeloma cells are particularly sensitive to proteasome inhibition: when their protein recycling system is shut down, myeloma cells die.

Possible Side Effects

Peripheral neuropathy

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

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

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

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.

Additional Information

#AskDrDurie: Is it okay to take vitamin B12 on the same day as Velcade?

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

A Report of Findings from the 2013 Nurse Leadership Board Roundtable Meeting

The VELCADE® website

Information for patients and clinicians on indications and usage

Patient Assistance

VELCADE® downloadable resources

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.

VELCADE Reimbursement Assistance Program

Program is available to patients, physicians, and caregivers to provide assistance regarding reimbursement issues related to the use of VELCADE® (bortezomib) for Injection.

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