This information is about bortezomib, which is commonly known as Velcade®. It is currently used to treat people with multiple myeloma. Velcade may also be used to treat other types of cancer as part of a research trial.

Velcade is a new type of anti-cancer drug called a proteosome inhibitor. In the UK it is currently used to treat multiple myeloma. It is given to people who have already been treated with at least one other type of chemotherapy and who have already had, or are unsuitable for, a bone marrow transplant, but whose myeloma has continued to develop.

Proteosomes are a group of enzymes found in all cells in the body. They have an important role in controlling cell function and growth. By interfering with how proteosomes work, Velcade may cause cancer cells to die and may stop the cancer from growing. Cancer cells are more sensitive to the effects of Velcade than normal cells are.

Velcade is given by injection into a vein (intravenously) through a fine tube (cannula). It may be given through a central line, which is inserted under the skin into a vein near the collarbone, or through a PICC line, which is inserted into a vein in the bend of the arm.

Velcade is usually given as four doses over a three-week period. The doses are given on the first and fourth day of the first two weeks, followed by a ten-day rest period. This completes one cycle of treatment. You can have up to eight cycles of treatment over six months.

Each person’s reaction to any drug is different. Some people have very few side effects while others may experience more. The side effects described in this information will not affect everyone having Velcade. We have outlined the most common side effects. We have not included those that are rare, however, and which are therefore unlikely to affect you. If you notice any effects which you think may be due to the drugs, but are not listed below, please let your nurse or doctor know.

Feeling sick (nausea) and being sick (vomiting) Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness is not controlled, or if it continues, tell your doctor, who can prescribe other anti-sickness drugs which may be more effective. 

Fatigue (tiredness and a feeling of weakness) You may feel very tired. It is important to allow yourself plenty of time to rest.

Diarrhoea This can usually be controlled with anti-diarrhoea medicines, but let your doctor know if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.

Dehydration It is important that you drink plenty of fluids (2–3 litres per day).

Constipation This can usually be relieved by drinking plenty of fluids, eating a high-fibre diet and taking gentle exercise.

Symptoms of a fever These may include a high temperature and chills. These symptoms can be controlled or reduced with drugs, which your doctor can prescribe for you.

Loss of appetite A dietitian or specialist nurse at your hospital can give advice on how to maintain your weight.

Headaches Let your doctor know if you have headaches while being treated with Velcade.

Dizziness on standing You may feel dizzy for a few moments if you stand too quickly. This is caused by a temporary fall in blood pressure and is more likely if you have a history of fainting or take blood pressure medication. Move slowly from lying to sitting and then sitting to standing.

Lowered resistance to infection Velcade can reduce the production of white blood cells by the bone marrow, making you more prone to infection. Contact your doctor or the hospital straightaway if your temperature goes above 38°C (100.5°F) or if you suddenly feel unwell (even with a normal temperature).

Low platelet count Platelets help to clot the blood and prevent bleeding. The number of platelets in your blood will be checked regularly. If the number is low, you may bruise very easily or develop blood spots or rashes on the skin. You may suffer from nosebleeds or bleed more heavily than usual from minor cuts or grazes.

If you develop any unexplained bleeding or bruising you should contact your doctor or the hospital straight away. You may need to be admitted to hospital for a platelet transfusion. A fluid containing platelets is given by drip into your blood. These platelets will start to work immediately to prevent bruising and bleeding.

Numbness or tingling in hands or feet This is due to the effect of Velcade on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty with tasks like doing up buttons. Tell your doctor if you notice any numbness or tingling in your hands or feet. This may improve if the dose of Velcade is reduced or if it is stopped.

Muscle cramps and painful limbs Let your doctor know if you have muscle cramps or painful limbs, as they can prescribe medication to help.

Talk to your doctor or nurse if you have any questions about these or any other side effects. It is also important to let them know if you have any symptoms or side effects that may be related to the treatment you are having.

Patients wishing to enter trials should speak to their cancer specialist, who can advise them whether Velcade may be a suitable treatment in their case. Cancer specialists can also advise patients on other cancer treatments which are appropriate for their situation.

This section has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.

For further references, please see the general bibliography.