Bortezomib (Velcade), a landmark proteasome inhibitor, has been widely used in the treatment of multiple myeloma and other hematologic malignancies such as mantle cell lymphoma.

Dosage and Administration of Bortezomib (Velcade)

1. Recommended Starting Dose

(1) The recommended starting dose of bortezomib is 1.3 mg/m² per administration, which can be given via intravenous bolus (completed within 3–5 seconds) or subcutaneous injection.

(2) The reconstitution concentrations differ between the two routes of administration; careful calculation of the administration volume is required.

2. Dosing Regimens for Different Indications

(1) For the treatment of newly diagnosed multiple myeloma, it is used in combination with melphalan and prednisone for a total of 9 cycles: twice weekly for the first 4 cycles, and once weekly for the subsequent 5 cycles.

(2) For the treatment of newly diagnosed mantle cell lymphoma, it is used in combination with rituximab, cyclophosphamide, doxorubicin, and prednisone for a total of 6 cycles, administered twice weekly.

(3) For relapsed patients, retreatment may be considered, with the starting dose being the last tolerated dose.

3. Dose Adjustment Principles

(1) In patients with hepatic impairment, the starting dose should be reduced to 0.7 mg/m² in those with moderate to severe hepatic insufficiency.

(2) In patients with peripheral neuropathy, dose adjustment or treatment interruption should be made according to the grade of neurotoxicity.

(3) Hematologic toxicity may also occur with this drug; treatment interruption or dose reduction is required in the event of severe thrombocytopenia or neutropenia.

Precautions for Bortezomib (Velcade) Use

1. Contraindications and Cautions

(1) Contraindicated in patients with hypersensitivity to bortezomib, boron, or mannitol; intrathecal administration is strictly prohibited.

(2) Patients with pre-existing severe peripheral neuropathy, risk of heart failure, hypotension, or hepatic insufficiency should use this drug only under close medical evaluation.

2. Common Adverse Reactions and Management

(1) Peripheral neuropathy manifests as numbness, pain, or weakness in the hands and feet. Subcutaneous administration is recommended, and symptoms should be reported promptly.

(2) Hypotension is particularly common in dehydrated patients or those taking antihypertensive medications; adequate hydration should be maintained.

(3) Regular monitoring of complete blood counts, especially platelet and neutrophil counts, is necessary.

(4) This drug carries an infection risk, with particular attention to herpes zoster reactivation; prophylactic antiviral medication is recommended.

3. Drug Interactions

(1) Strong CYP3A4 inhibitors (e.g., ketoconazole) may increase bortezomib toxicity; close monitoring is required.

(2) Strong CYP3A4 inducers (e.g., rifampin) may reduce efficacy; concomitant use should be avoided.

Healthy Lifestyle Recommendations for Patients Receiving Bortezomib

1. Diet and Hydration Management

Common adverse reactions to bortezomib include nausea, vomiting, diarrhea, and constipation. Patients are advised to eat small, frequent meals, choose easily digestible foods, and ensure adequate daily water intake to prevent or promptly correct adverse reactions such as dehydration and hypotension caused by the medication.

2. Infection Prevention

(1) Develop a habit of frequent handwashing and avoid crowded places to effectively reduce the risk of infection.

(2) Seek immediate medical attention if symptoms such as fever or cough occur; oral and skin hygiene should not be neglected.

For more relevant information, please refer to the prescribing information for Bortezomib (Velcade).