BORTEMED

BORTEMED

Bortezomib 2mg
Net Qty- 1 Vial
Self-Life- 2 Years

Bortemed (Bortezomib 2mg) is a proteasome inhibitor used to treat multiple myeloma (MM) and mantle cell lymphoma (MCL). It works by blocking the proteasome, a protein complex that cancer cells need to survive, thereby inducing apoptosis (cell death). It is commonly sold under the brand  name Lenamed by MedOnco Pharma.

USE

Bortemed (Bortezomib 2mg) is a proteasome inhibitor used primarily in the treatment of multiple myeloma (MM) and mantle cell lymphoma (MCL). It works by blocking the 26S proteasome, a protein complex that regulates cell survival, leading to cancer cell apoptosis (cell death).

1. Primary Uses of Bortezomib 2mg

✅ Multiple Myeloma (MM)

  • First-line treatment for newly diagnosed MM, usually in combination with:
    • Lenalidomide + Dexamethasone (VRd regimen)
    • Cyclophosphamide + Dexamethasone (VCd regimen)
  • Used before stem cell transplantation (ASCT) to reduce tumor burden.
  • Maintenance therapy to prolong remission in relapsed/refractory MM.

✅ Mantle Cell Lymphoma (MCL)

  • Used for relapsed/refractory MCL, typically combined with:
    • Rituximab, Cyclophosphamide, Doxorubicin, and Prednisone (R-CHOP regimen)

✅ Other Off-Label Uses

  • Being explored for use in diffuse large B-cell lymphoma (DLBCL) and amyloidosis.

2. Mechanism of Action

  • Inhibits the 26S proteasome, preventing cancer cells from breaking down proteins, leading to protein accumulation and apoptosis.
  • Disrupts tumor microenvironment, reducing angiogenesis (blood vessel formation).
  • Enhances chemosensitivity when used in combination therapies.

3. Administration & Dosage

For Multiple Myeloma (IV or SC)

  • 1.3 mg/m² twice weekly on Days 1, 4, 8, and 11, followed by a 10-day rest in a 21-day cycle.
  • Given alone or in combination with other drugs like Lenalidomide & Dexamethasone.

For Mantle Cell Lymphoma

  • Same dosing as multiple myeloma, combined with chemotherapy (R-CHOP).

Route of Administration

  • Subcutaneous (SC) injection is preferred over IV to reduce the risk of neuropathy.

4. Key Benefits

✔ Improves survival rates in multiple myeloma and mantle cell lymphoma.
✔ Works well in combination therapies to enhance effectiveness.
✔ Can be used before stem cell transplantation (ASCT) to improve treatment outcomes.

Mechanism
of Action

Bortemed (Bortezomib 2mg) is a proteasome inhibitor that disrupts cancer cell function by preventing the degradation of proteins required for cell survival. This leads to accumulation of toxic proteins, causing apoptosis (cell death) in cancer cells, particularly in multiple myeloma (MM) and mantle cell lymphoma (MCL).

1. Proteasome Inhibition

  • The proteasome is a protein complex responsible for breaking down misfolded or damaged
    proteins     within the cell.
  • Bortezomib binds to and inhibits the 26S proteasome, preventing it from degrading proteins involved in cell cycle regulation and apoptosis inhibition.

2. Accumulation of Misfolded Proteins → Apoptosis

  • Inhibition of the proteasome leads to protein accumulation, causing endoplasmic reticulum (ER) stress.
  • This triggers unfolded protein response (UPR), which, when prolonged, initiates programmed cell death (apoptosis) in cancer cells.

3. Inhibition of NF-κB Pathway

  • NF-κB (nuclear factor-kappa B) is a protein complex that promotes cancer cell survival and inflammation.
  • Bortezomib prevents the activation of NF-κB, leading to:
    • Reduced cancer cell proliferation
    • Decreased angiogenesis (tumor blood vessel formation)
    • Increased chemosensitivity

4. Anti-Tumor Microenvironment Effect

  • Bortezomib disrupts the tumor microenvironment, preventing cellular interactions that support myeloma cell growth.
  • Reduces cytokine production (such as IL-6), which promotes cancer survival in multiple myeloma.

Key Takeaways

✔ Blocks proteasome activity, leading to toxic protein accumulation.
✔ Triggers apoptosis by inducing ER stress and protein overload.
✔ Inhibits NF-κB, reducing cancer growth and inflammation.
✔ Enhances chemotherapy response and prevents tumor-supporting interactions.

Dosage and Administration

Bortemed (Bortezomib 2mg) is a proteasome inhibitor used for multiple myeloma (MM) and mantle cell lymphoma (MCL). It is administered either intravenously (IV) or subcutaneously (SC), with SC preferred to reduce neuropathy risk.

 

 

1. Dosage for Multiple Myeloma (MM)

✅ As First-Line Treatment (Induction Therapy)

  • Dose: 1.3 mg/m² twice weekly on Days 1, 4, 8, and 11 in a 21-day cycle.
  • Combination Therapy: Often used with lenalidomide + dexamethasone (VRd regimen) or cyclophosphamide + dexamethasone (VCd regimen).
  • Number of Cycles: Typically 4–6 cycles before stem cell transplantation (ASCT) or continued as maintenance.

✅ As Maintenance Therapy

  • Dose: Once weekly at 1.3 mg/m² for 3-4 cycles, then adjusted based on response.

2. Dosage for Mantle Cell Lymphoma (MCL)

  • Dose: 1.3 mg/m² twice weekly (Days 1, 4, 8, and 11) in a 21-day cycle.
  • Combination Therapy: Used with rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHOP regimen).
  • Duration: Usually 6 cycles, followed by observation or maintenance therapy.

3. Route of Administration

✅ Subcutaneous (SC) Injection (Preferred Method)

  • Why? SC administration reduces neuropathy risk while maintaining efficacy.
  • Injection Site: Rotate between thigh, abdomen, or upper arm to prevent irritation.

✅ Intravenous (IV) Bolus Injection

  • Used if SC is not feasible, but higher risk of neuropathy.
  • Given as a rapid IV push over 3–5 seconds.

4. Special Considerations

 

✔ Dose Adjustments may be needed in patients with neuropathy, low blood counts, or liver impairment.
✔ Hydration is recommended to prevent kidney damage due to tumor lysis syndrome (TLS).
✔ Supportive Medications (e.g., dexamethasone, antiviral prophylaxis) may be prescribed to manage side effects.

Common Side Effects

Bortemed (Bortezomib 2mg) is a proteasome inhibitor used to treat multiple myeloma (MM) and mantle cell lymphoma (MCL). While effective, it can cause various side effects, ranging from mild to severe. Below are the most common side effects and management strategies:

1. Peripheral Neuropathy (Nerve Damage)

  • Symptoms: Tingling, numbness, burning pain, weakness (usually in hands or feet).
  • Frequency: Common, especially with IV administration.
  • Management:
    • Switch to subcutaneous (SC) injection (reduces neuropathy risk).
    • Dose reduction or treatment break if symptoms worsen.
    • Medications: Pain relievers (gabapentin, pregabalin).

2. Low Blood Cell Counts (Myelosuppression)

  • Effects:
    • Neutropenia (low white blood cells) → Increased infection risk.
    • Thrombocytopenia (low platelets) → Risk of bleeding & bruising.
    • Anemia (low red blood cells) → Fatigue, weakness, breathlessness.
  • Management:
    • Regular blood tests (CBC).
    • Growth factors (e.g., G-CSF for neutropenia).
    • Platelet transfusion if severe thrombocytopenia.
    • Iron supplements for anemia.

3. Fatigue and Weakness

  • Cause: Due to low blood cell counts and the drug’s effects on metabolism.
  • Management:
    • Rest & avoid overexertion.
    • Hydration & nutritious diet.
    • Light exercise to improve energy levels.

4. Gastrointestinal (GI) Issues

  • Symptoms: Diarrhea, nausea, vomiting, constipation, loss of appetite.
  • Management:
    • Diarrhea → Stay hydrated, anti-diarrheal medications (e.g., loperamide).
    • Nausea/Vomiting → Take anti-nausea drugs (e.g., ondansetron).
    • Constipation → Increase fiber, fluids, and consider a mild laxative.

5. Low Blood Pressure (Hypotension)

  • Symptoms: Dizziness, fainting, blurry vision.
  • Cause: Bortezomib affects autonomic nervous system regulation.
  • Management:
    • Drink plenty of fluids.
    • Stand up slowly from sitting or lying positions.
    • Avoid dehydration & monitor blood pressure regularly.

6. Increased Risk of Infections

  • Cause: Neutropenia reduces the immune system’s ability to fight infections.
  • Management:
    • Practice good hygiene & avoid sick people.
    • Take prescribed antiviral (acyclovir) & antibacterial medications.
    • Seek medical attention if fever >100.4°F (38°C).

7. Skin Rash & Injection Site Reactions

  • Symptoms: Redness, swelling, irritation at SC injection site.
  • Management:
    • Rotate injection sites to prevent irritation.
    • Use anti-itch creams or antihistamines for mild rash.
    • Report severe skin reactions to the doctor immediately.

Key Takeaways

✔ Peripheral neuropathy is common—SC injection is preferred over IV to reduce risk.
✔ Blood count monitoring is essential to manage neutropenia, thrombocytopenia, & anemia.
✔ Hydration & diet changes help with fatigue, GI issues, and hypotension.
✔ Infection prevention is critical—report any fever or flu-like symptoms.

Monitoring

Bortemed (Bortezomib 2mg) is a proteasome inhibitor used for multiple myeloma (MM) and mantle cell lymphoma (MCL). Due to its potential side effects, regular monitoring is essential to ensure treatment effectiveness and safety. Below are the key monitoring parameters and their importance.

 

1. Blood Count Monitoring (CBC – Complete Blood Count)

Why?

Bortemed (Bortezomib 2mg) can cause myelosuppression, leading to low blood cell counts, which increases the risk of infections, bleeding, and fatigue.

What to Monitor?

  • Neutropenia (Low White Blood Cells) → Increased infection risk.
  • Thrombocytopenia (Low Platelets) → Increased bleeding/bruising risk.
  • Anemia (Low Red Blood Cells) → Fatigue, weakness, breathlessness.

Frequency

  • Before starting treatment.
  • Weekly during the first cycles.
  • Monthly after stabilization.

Management

  • Growth factors (G-CSF) for neutropenia.
  • Platelet transfusions if thrombocytopenia is severe.
  • Iron supplements or blood transfusions if anemia worsens.

2. Peripheral Neuropathy Monitoring

Why?

Bortemed (Bortezomib 2mg) can cause nerve damage, leading to numbness, tingling, or pain in hands and feet.

What to Monitor?

  • Symptoms of neuropathy (tingling, burning, weakness).
  • Sensory or motor impairments affecting daily activities.

Frequency

  • Before treatment, then every cycle.

Management

  • Reduce dose or switch to once-weekly dosing if neuropathy worsens.
  • Switch from IV to SC administration (SC reduces neuropathy risk).
  • Use medications like gabapentin or pregabalin for nerve pain.

3. Liver and Kidney Function Tests (LFTs & Renal Panel)

Why?

Bortezomib is metabolized by the liver and excreted by the kidneys, so dysfunction can lead to drug accumulation and toxicity.

What to Monitor?

  • Liver function (AST, ALT, bilirubin).
  • Kidney function (Creatinine, BUN, eGFR).

Frequency

  • Baseline tests before treatment.
  • Every cycle during treatment.

Management

  • Dose adjustments in patients with hepatic or renal impairment.
  • Hydration & supportive therapy if kidney function declines.

4. Blood Pressure and Cardiac Monitoring

Why?

Bortemed (Bortezomib 2mg) can cause low blood pressure (hypotension), dizziness, and, in rare cases, heart-related side effects.

What to Monitor?

  • Blood pressure (BP) readings.
  • Signs of heart failure (shortness of breath, swelling in legs, chest pain).

Frequency

  • Before treatment, then at each visit.

Management

  • Monitor hydration to avoid dehydration-related hypotension.
  • Adjust BP medications if needed.
  • Stop treatment if severe cardiac toxicity occurs.

5. Infection Risk Monitoring

Why?

Bortemed (Bortezomib 2mg) causes neutropenia, increasing the risk of severe infections.

What to Monitor?

  • Fever (>100.4°F or 38°C).
  • Sore throat, cough, or any infection symptoms.

Frequency

  • Daily self-monitoring by the patient.
  • Regular doctor visits every cycle.

Management

  • Prophylactic antiviral therapy (acyclovir).
  • Prompt antibiotics for suspected infections.

6. Blood Sugar Monitoring (for Diabetic Patients)

Why?

Bortemed (Bortezomib 2mg), especially with dexamethasone, can worsen blood sugar control.

What to Monitor?

  • Fasting blood glucose in diabetic patients.
  • Symptoms of hyperglycemia (increased thirst, urination, blurred vision).

Frequency

  • Before treatment, then weekly in diabetic patients.

Management

  • Adjust diabetes medications as needed.
  • Lifestyle modifications (diet & exercise).

Key Takeaways

 

✔ Monitor blood counts (CBC) to detect neutropenia, thrombocytopenia, and anemia.
✔ Assess for peripheral neuropathy to prevent severe nerve damage.
✔ Check liver and kidney function to prevent toxicity.
✔ Monitor blood pressure and cardiac function to avoid complications.
✔ Prevent infections with prophylactic medications and early detection.

Precautions

Bortemed (Bortezomib 2mg) is a proteasome inhibitor used in multiple myeloma (MM) and mantle cell lymphoma (MCL). While effective, it requires strict precautions to minimize risks and improve treatment outcomes. Below are the key precautions to follow:

1. Route of Administration – Prefer Subcutaneous (SC) Over Intravenous (IV)

✔ Why?

  • IV administration increases the risk of peripheral neuropathy.
  • SC administration is preferred as it reduces nerve damage and maintains efficacy.

✔ Precaution

  • Rotate injection sites (abdomen, thigh, upper arm) to prevent irritation.
  • Monitor for skin reactions at the injection site.

2. Peripheral Neuropathy Risk

✔ Why?

  • Bortezomib can cause nerve damage, leading to tingling, numbness, burning pain, and weakness.

✔ Precaution

  • Monitor for symptoms of neuropathy before and during treatment.
  • If neuropathy worsens:
    • Switch from IV to SC injection.
    • Reduce dose or adjust treatment frequency.
    • Use pain management medications (gabapentin, pregabalin).

3. Blood Count Monitoring – Risk of Myelosuppression

✔ Why?

  • Bortemed (Bortezomib 2mg) can cause low blood counts (myelosuppression), leading to:
    • Neutropenia (low WBCs) → Increased risk of infection.
    • Thrombocytopenia (low platelets) → Increased bleeding risk.
    • Anemia (low RBCs) → Fatigue and weakness.

✔ Precaution

  • Regular blood tests (CBC) to monitor WBC, platelet, and RBC levels.
  • Avoid contact with sick individuals to prevent infections.
  • Report any unexplained bruising, bleeding, or fever immediately.
  • Consider platelet transfusions if thrombocytopenia is severe.

4. Infection Risk – Avoid Live Vaccines

✔ Why?

  • Neutropenia increases the risk of severe infections.

✔ Precaution

  • Practice good hygiene and avoid crowded places.
  • Do not receive live vaccines (e.g., MMR, yellow fever, varicella).
  • Use prophylactic antibiotics or antivirals (acyclovir) if necessary.
  • Report fever (>100.4°F or 38°C) or persistent infections immediately.

5. Blood Pressure and Cardiac Precautions

✔ Why?

  • Bortemed (Bortezomib 2mg) may cause low blood pressure (hypotension), dizziness, and heart complications.

✔ Precaution

  • Monitor blood pressure regularly (especially in patients with a history of heart disease).
  • Avoid dehydration – drink plenty of fluids.
  • Stand up slowly to prevent dizziness and fainting.
  • Report any chest pain, shortness of breath, or swelling in legs immediately.

6. Liver and Kidney Function Monitoring

✔ Why?

  • Bortemed (Bortezomib 2mg) is metabolized by the liver and excreted by the kidneys.
  • Patients with liver disease or kidney impairment may experience drug buildup and toxicity.

✔ Precaution

  • Liver function tests (AST, ALT, bilirubin) and kidney function tests (creatinine, BUN, eGFR) should be done before and during treatment.
  • Dose adjustments may be needed for patients with liver or kidney disease.

7. Tumor Lysis Syndrome (TLS) Precautions

✔ Why?

  • Bortemed (Bortezomib 2mg) can cause rapid cancer cell breakdown, leading to electrolyte imbalances and kidney damage.

✔ Precaution

  • Hydrate well before and during treatment.
  • Monitor kidney function and electrolyte levels (potassium, calcium, uric acid).
  • Use allopurinol if TLS risk is high.

8. Gastrointestinal (GI) Side Effects – Manage Nausea, Vomiting, and Diarrhea

✔ Why?

  • Bortemed (Bortezomib 2mg) can cause nausea, vomiting, diarrhea, and constipation.

✔ Precaution

  • Stay hydrated and consider electrolyte replacement if diarrhea occurs.
  • Take anti-nausea medications (ondansetron) if needed.
  • Eat small, frequent meals to prevent nausea.
  • Use fiber-rich foods or stool softeners for constipation.

9. Blood Sugar Monitoring in Diabetic Patients

✔ Why?

  • Bortemed (Bortezomib 2mg), especially when used with dexamethasone, can worsen blood sugar control in diabetic patients.

✔ Precaution

  • Monitor blood glucose levels regularly.
  • Adjust diabetes medications as needed.

Key Takeaways

✔ Use subcutaneous (SC) injection to reduce neuropathy risk.
✔ Monitor blood counts to manage neutropenia, thrombocytopenia, and anemia.
✔ Prevent infections by avoiding live vaccines and practicing good hygiene.
✔ Monitor blood pressure and cardiac function to prevent hypotension and heart complications.
✔ Liver and kidney function tests are essential for safe dosing.
✔ Stay hydrated to prevent tumor lysis syndrome and kidney damage.
✔ Manage GI side effects with medications and dietary adjustments.

Drug Interactions

Bortemed (Bortezomib 2mg) is a proteasome inhibitor used for multiple myeloma (MM) and mantle cell lymphoma (MCL). It interacts with several medications, which can affect its efficacy, toxicity, and side effects. Below are the key drug interactions to consider:

1. CYP3A4 & CYP2C19 Inhibitors (Increased Bortezomib Toxicity)

✔ Why?

  • Bortezomib is metabolized by CYP3A4 & CYP2C19 enzymes.
  • Inhibitors of these enzymes increase bortezomib levels, leading to higher toxicity risk (neuropathy, low blood counts).

✔ Examples of CYP3A4 & CYP2C19 Inhibitors

  • Antifungals: Ketoconazole, Itraconazole, Voriconazole
  • Antibiotics: Clarithromycin, Erythromycin
  • HIV Medications: Ritonavir, Indinavir
  • Grapefruit Juice (natural CYP3A4 inhibitor)

✔ Management

  • Avoid CYP3A4 inhibitors or monitor for increased toxicity.
  • Dose reduction may be needed if toxicity symptoms appear.

2. CYP3A4 Inducers (Decreased Bortezomib Effectiveness)

✔ Why?

  • Inducers speed up bortezomib metabolism, lowering drug levels and reducing effectiveness.

✔ Examples of CYP3A4 Inducers

  • Anticonvulsants: Carbamazepine, Phenytoin, Phenobarbital
  • Tuberculosis Drugs: Rifampin, Rifabutin
  • Herbal Supplements: St. John’s Wort

✔ Management

  • Avoid CYP3A4 inducers, as they may make Bortezomib less effective.
  • Consider alternative medications if CYP3A4 inducers are required.

3. Blood Thinners (Increased Bleeding Risk)

✔ Why?

  • Bortezomib causes thrombocytopenia (low platelets), increasing the risk of bleeding when combined with anticoagulants.

✔ Examples of Blood Thinners

  • Warfarin
  • Heparin
  • Aspirin & NSAIDs (e.g., Ibuprofen, Naproxen)
  • Direct Oral Anticoagulants (DOACs): Apixaban, Rivaroxaban

✔ Management

  • Monitor platelet counts regularly.
  • Avoid unnecessary NSAID use to prevent GI bleeding.
  • Adjust anticoagulant doses if needed.

4. Drugs That Increase Neuropathy Risk

✔ Why?

  • Bortezomib-induced peripheral neuropathy can worsen when combined with other neurotoxic drugs.

✔ Examples of Neurotoxic Drugs

  • Platinum-Based Chemotherapy: Cisplatin, Oxaliplatin
  • Taxanes: Paclitaxel, Docetaxel
  • Isoniazid (for TB treatment)
  • Certain HIV Medications: Didanosine, Stavudine

✔ Management

  • Monitor for neuropathy symptoms (tingling, numbness, burning pain).
  • Consider switching to subcutaneous (SC) bortezomib, which reduces neuropathy risk.
  • Reduce bortezomib dose if neuropathy worsens.

5. Antihypertensives (Risk of Severe Hypotension)

✔ Why?

  • Bortezomib can lower blood pressure (hypotension), which can be worsened by antihypertensive
    medications    .

✔ Examples of Antihypertensives

  • Beta-Blockers: Metoprolol, Atenolol, Propranolol
  • Calcium Channel Blockers: Amlodipine, Diltiazem, Verapamil
  • ACE Inhibitors: Lisinopril, Enalapril

✔ Management

  • Monitor blood pressure regularly.
  • Adjust antihypertensive doses if needed.
  • Stay hydrated to prevent dizziness and fainting.

6. Oral Hypoglycemic Agents (Blood Sugar Fluctuations)

✔ Why?

  • Bortezomib can cause both high and low blood sugar, especially in diabetic patients.
  • Risk increases when used with diabetes medications.

✔ Examples of Diabetes Medications

  • Metformin
  • Insulin
  • Sulfonylureas: Glipizide, Glyburide

✔ Management

  • Monitor blood glucose levels closely.
  • Adjust diabetes medications as needed.
  • Inform your doctor if you experience dizziness, excessive hunger, or sweating (signs of blood sugar imbalance).

7. Immunosuppressive Agents (Increased Infection Risk)

✔ Why?

  • Bortezomib suppresses the immune system, increasing the risk of infections when combined with other immunosuppressive drugs.

✔ Examples of Immunosuppressants

  • Corticosteroids: Dexamethasone, Prednisone
  • Chemotherapy Agents: Cyclophosphamide, Rituximab
  • Organ Transplant Drugs: Tacrolimus, Cyclosporine

✔ Management

  • Monitor for signs of infection (fever, sore throat, cough).
  • Avoid live vaccines during treatment.

Key Takeaways

✔ Avoid CYP3A4 inhibitors (ketoconazole, ritonavir) to prevent toxicity.
✔ Avoid CYP3A4 inducers (rifampin, phenytoin) to maintain effectiveness.
✔ Monitor for increased bleeding risk when taking warfarin, aspirin, or NSAIDs.
✔ Be cautious with neuropathy-inducing drugs (cisplatin, paclitaxel) to prevent nerve damage.
✔ Adjust blood pressure medications to prevent severe hypotension.
✔ Monitor blood sugar in diabetic patients.
✔ Avoid live vaccines and closely monitor infections when on immunosuppressants.

Clinical Effectiveness

Bortemed (Bortezomib 2mg) is a proteasome inhibitor widely used in the treatment of multiple myeloma (MM) and mantle cell lymphoma (MCL). It has demonstrated strong clinical effectiveness in both newly diagnosed and relapsed cases, particularly when used in combination therapy.

 

1. Clinical Effectiveness in Multiple Myeloma (MM)

✅ Newly Diagnosed Multiple Myeloma (NDMM)

  • Standard first-line therapy in combination with:
    • Lenalidomide + Dexamethasone (VRd regimen)
    • Cyclophosphamide + Dexamethasone (VCd regimen)
    • Daratumumab + Bortezomib + Dexamethasone (DVd regimen)
  • Effectiveness in Clinical Trials:
    • Studies show that Bortezomib-based regimens significantly improve progression-free
      survival (PFS)       and overall survival (OS) compared to traditional chemotherapy.
    • PFS: ~36–42 months with VRd (compared to 20–30 months with older regimens).
    • OS: Patients on Bortezomib-based therapy show longer survival rates, especially when followed by autologous stem cell transplantation (ASCT).

✅ Relapsed/Refractory Multiple Myeloma (RRMM)

  • Used after relapse, often in combination with:
    • Pomalidomide + Bortezomib + Dexamethasone (PVd regimen)
    • Carfilzomib + Bortezomib + Dexamethasone (KVd regimen)
  • Effectiveness:
    • Overall response rate (ORR): ~70-80% in combination therapy.
    • Median survival after relapse: Significantly prolonged when used in combination regimens.
    • Better tolerated in subcutaneous (SC) administration, reducing neuropathy risk.

2. Clinical Effectiveness in Mantle Cell Lymphoma (MCL)

  • Bortezomib is effective in relapsed/refractory MCL when used in combination
    therapy:
    • Rituximab + Bortezomib + Cyclophosphamide + Doxorubicin + Prednisone (VR-CAP
      regimen)      .
  • Clinical Trial Data:
    • VR-CAP regimen showed a 96% improvement in progression-free survival (PFS) compared to traditional R-CHOP chemotherapy.
    • Median PFS: ~24 months (compared to 14 months with R-CHOP).
    • Overall survival is significantly improved in relapsed/refractory patients.

3. Mechanism Behind Its Effectiveness

  • Blocks the 26S proteasome, leading to accumulation of misfolded proteins and cancer cell death.
  • Inhibits NF-κB pathway, reducing tumor survival and angiogenesis.
  • Enhances immune response when combined with other chemotherapy agents.

Key Takeaways

 

✔ Highly effective in both newly diagnosed and relapsed multiple myeloma.
✔ Prolongs survival and delays disease progression in multiple myeloma and mantle cell lymphoma.
✔ Combination therapies enhance response rates, particularly with lenalidomide, dexamethasone, and rituximab.
✔ Subcutaneous administration reduces neuropathy risk, making it safer for long-term use.

Tips for Patients

Bortemed (Bortezomib 2mg) is a proteasome inhibitor used to treat multiple myeloma (MM) and mantle cell lymphoma (MCL). While effective, it can cause side effects that require careful management.
Below are essential tips to help patients during Bortezomib treatment.

1. How to Take Bortezomib Properly

✔ Route of Administration:

  • Subcutaneous (SC) injection is preferred over intravenous (IV) to reduce neuropathy risk.
  • If receiving IV, report any numbness, tingling, or burning sensations immediately.

✔ Dosing Schedule:

  • Bortezomib is typically given twice weekly for 2 weeks, followed by a 10-day rest period.
  • Do not miss an appointment—timing is crucial for treatment effectiveness.

2. Managing Common Side Effects

✅ Peripheral Neuropathy (Tingling, Numbness, or Pain in Hands & Feet)

  • Choose SC injection instead of IV to lower risk.
  • Monitor symptoms and report worsening tingling, numbness, or pain to your doctor.
  • Avoid alcohol and smoking, as they can worsen neuropathy.
  • Wear comfortable shoes and avoid extreme temperatures (hot or cold).

✅ Low Blood Cell Counts (Infection, Anemia, Bleeding Risk)

  • Get regular blood tests (CBC) to check for low white blood cells, platelets, and red blood cells.
  • Prevent infections:
    • Wash hands regularly.
    • Avoid sick people.
    • Do not take live vaccines.
    • Report fever, chills, or sore throat immediately.
  • Avoid injuries:
    • Be careful when using sharp objects.
    • Report unusual bruising or bleeding.

✅ Fatigue & Weakness

  • Rest often and avoid overexertion.
  • Stay hydrated and eat a balanced diet (rich in proteins and vitamins).
  • Light exercise (like walking) can help maintain energy levels.

✅ Nausea, Vomiting, or Diarrhea

  • Take anti-nausea medication if prescribed.
  • Eat small, frequent meals with bland foods.
  • Stay hydrated—drink plenty of fluids and electrolytes.
  • For diarrhea: Avoid caffeine, spicy foods, and dairy.

✅ Low Blood Pressure & Dizziness

  • Stand up slowly to prevent falls.
  • Drink enough fluids to prevent dehydration.
  • Monitor blood pressure if you’re on medication for hypertension.

3. Lifestyle Tips

✔ Stay Hydrated: Drink at least 8 glasses of water daily.
✔ Eat a Healthy Diet: Include protein, fruits, and vegetables to support recovery.
✔ Avoid Alcohol & Smoking: They can worsen neuropathy and fatigue.
✔ Manage Stress: Yoga, meditation, or light activities may help.

4. When to Call Your Doctor 🚨

  • Fever (≥100.4°F or 38°C), chills, or signs of infection.
  • Severe fatigue or dizziness that doesn’t improve.
  • Unusual bruising or bleeding.
  • Severe nausea, vomiting, or persistent diarrhea.
  • Worsening neuropathy symptoms (numbness, tingling, or pain in hands and feet).

Key Takeaways

✔ Subcutaneous injection is preferred to reduce neuropathy.
✔ Monitor for low blood cell counts and avoid infections & bleeding risks.
✔ Stay hydrated, eat well, and rest to manage fatigue and nausea.
✔ Call your doctor immediately if you experience severe side effects.