Velcade (Bortezomib) for Multiple Myeloma

Velcade (bortezomib) is a prescription medication Approved by the U.S. Food and Drug Administration (FDA) for treating adults with multiple myeloma.

How Velcade Works and How It’s Taken

Velcade is a type of medication called a proteasome inhibitor that works by blocking proteasomes, which are cell structures that break down unwanted proteins. In multiple myeloma, this can disrupt cancer cell function and lead to cancer cell death.

Doctors may prescribe Velcade to adults who need treatment for multiple myeloma.

Velcade is given as an injection, typically on a repeating schedule over several weeks. It may be given into a vein or as an injection under the skin in a healthcare setting. Doses are usually spaced at least 72 hours apart.

If Velcade is injected under the skin, the injection site is usually rotated between the thigh and abdomen. Velcade for injection comes as a powder that is mixed before it is given by a healthcare provider.

Typical Dosing for Multiple Myeloma

The recommended starting dose of Velcade for multiple myeloma is 1.3 milligrams per square meter, with the dose based on body surface area, a standard calculation using height and weight that healthcare providers use to determine dosing. For previously untreated multiple myeloma, Velcade is given with oral melphalan and oral prednisone for nine six-week treatment cycles.

In cycles 1 to 4, Velcade is given twice weekly on days 1, 4, 8, 11, 22, 25, 29, and 32. In cycles 5 to 9, it is given once weekly on days 1, 8, 22, and 29.

For relapsed multiple myeloma, Velcade may be given on days 1, 4, 8, and 11, followed by a 10-day rest period. For extended treatment of more than eight cycles, it may be given on this schedule or once weekly on days 1, 8, 15, and 22, followed by a 13-day rest period.

Doctors may pause Velcade or lower the dose if certain side effects happen. In some cases, the dose may be lowered to 1 milligram per square meter or 0.7 milligrams per square meter.

This information is based on the prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Velcade Side Effects

In clinical studies of Velcade for adults with multiple myeloma, the most common side effects happened in about 7 percent to 52 percent of people. These side effects were reported in studies of people who were newly diagnosed and in people whose multiple myeloma had come back after treatment. Your experience can vary based on your treatment plan and other health conditions.

Nausea
Diarrhea
Thrombocytopenia (low platelet count, which can raise bleeding risk)
Neutropenia (low neutrophil count, which can raise infection risk)
Peripheral neuropathy (nerve damage that can cause numbness, tingling, or pain, usually in the hands or feet)
Fatigue
Neuralgia (nerve pain)
Anemia (low red blood cell count, which can cause tiredness or shortness of breath)
Leukopenia (low white blood cell count, which can raise infection risk)
Constipation
Vomiting
Lymphopenia (low lymphocyte count, which can raise infection risk)
Rash
Pyrexia (fever)
Anorexia (decreased appetite)

Serious Side Effects and Warnings

Velcade can cause serious side effects that may require immediate medical attention. These include:

Severe peripheral neuropathy — Serious nerve damage can affect feeling or movement.
Hypotension — Low blood pressure can cause dizziness, lightheadedness, or fainting.
Heart problems — New or worsening heart failure or reduced heart pumping function can occur.
Serious lung problems — These can include acute respiratory distress syndrome, pneumonitis, interstitial pneumonia, lung infiltration, or pulmonary hypertension.
Posterior reversible encephalopathy syndrome (PRES) — This rare brain condition can cause headache, confusion, vision changes, high blood pressure, or seizures.
Severe gastrointestinal problems — These can include severe nausea, vomiting, diarrhea, constipation, or ileus, which is when the intestines slow down or stop moving.
Severe low blood counts — Thrombocytopenia or neutropenia can lead to serious bleeding or serious infections.
Tumor lysis syndrome — A rapid breakdown of cancer cells can harm the kidneys and other organs.
Severe liver problems — These can include acute liver failure, hepatitis, or high liver enzymes and bilirubin.
Thrombotic microangiopathy, including TTP/HUS — This rare blood vessel and blood-clotting condition can damage organs.
Serious infections — These can include progressive multifocal leukoencephalopathy (PML) and severe herpes virus infections affecting the eyes or brain.
Severe skin reactions — Stevens-Johnson syndrome or toxic epidermal necrolysis can cause widespread blistering and skin peeling.
Severe allergic reactions — Hypersensitivity, including anaphylaxis, can occur.
Embryo-fetal toxicity — Velcade can harm your baby if used during pregnancy.

Get medical help right away if you think you are having a serious reaction to Velcade.

What To Know Before Taking Velcade

Tell your doctor if you have any allergies to bortezomib, boron, or mannitol.

Tell your doctor about all medications you take, including prescription drugs, over-the-counter medicines, and supplements.

Also let your doctor know if you have had nervous system problems in the past.

Do not take Velcade if you have had a serious allergic reaction to bortezomib, boron, or mannitol. Velcade should never be injected into the spinal fluid.

Velcade is also FDA-approved to treat mantle cell lymphoma.

If you are pregnant, planning to become pregnant, or breastfeeding while taking Velcade, talk with your doctor about the risks and benefits. Velcade can harm your baby if used during pregnancy. If you can become pregnant, you will need a pregnancy test before starting Velcade, and you should use effective birth control during treatment and for seven months after your last dose.

If you have a partner who can become pregnant, you should use effective birth control during treatment and for four months after your last dose. Do not breastfeed during treatment and for two months after your last dose.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Velcade?

In previously untreated multiple myeloma, Velcade used with melphalan and prednisone delayed the time until the disease got worse to a median of 20.7 months, compared with 15.0 months with melphalan and prednisone alone. Median overall survival was 56.4 months with the Velcade combination, compared with 43.1 months without Velcade.

In relapsed multiple myeloma after one to three prior treatments, median time to progression was 6.2 months with Velcade versus 3.5 months with high-dose dexamethasone, and response rates were 38 percent versus 18 percent. Velcade is currently most commonly used in combination with other agents, such as lenalidomide, daratumumab, and dexamethasone. A common regimen is VRd or D-VRd in newly diagnosed patients, with response rates of 70 percent to 87.9 percent.

What tests or monitoring are needed with Velcade for multiple myeloma?

Complete blood counts are monitored frequently during treatment, and complete blood counts and platelet counts should be checked before each dose. Before starting a cycle of Velcade with melphalan and prednisone for previously untreated multiple myeloma, platelet count should be at least 70 x 10^9/L, and absolute neutrophil count should be at least 1 x 10^9/L. People with moderate or severe liver impairment need a lower starting dose, and people on oral diabetes medicines may need close blood sugar monitoring.