bortezomib


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bortezomib

Velcade

Pharmacologic class: Proteasome inhibitor

Therapeutic class: Antineoplastic

Pregnancy risk category D

Action

Inhibits proteasomes (enzyme complexes that regulate protein homeostasis within cells). Reversibly inhibits chymotrypsin-like activity at 26S proteasome, leading to activation of signaling cascades, cell-cycle arrest, and apoptosis.

Availability

Powder for reconstitution (preservative-free): 3.5 mg (contains 35 mg of mannitol)

Indications and dosages

Multiple myeloma, patients with mantle cell lymphoma who have received at least one prior therapy

Adults: 1.3 mg/m2 I.V. or subcutaneously twice weekly for 2 weeks (days 1, 4, 8, and 11), followed by 10-day rest period (days 12 to 21). Allow at least 72 hours to elapse

between doses. One treatment cycle equals 21 days (3 weeks).

Dosage adjustment

• Moderate or severe hepatic impairment
• Peripheral neuropathy
• Grade 3 nonhematologic events
• Grade 4 hematologic events

Contraindications

• Hypersensitivity to drug, mannitol, or boron

Precautions

Use cautiously in:
• peripheral neuropathy, dehydration, hepatic or renal impairment
• history of syncope or cardiovascular disorders
• pregnant or breastfeeding patients
• children.

Administration

• Be aware that drug is for I.V. or subcutaneous use only. Because each route of administration has a different reconstituted concentration, use caution when calculating volume to be administered.
• Reconstitute drug in vial with 3.5 ml of normal saline for injection to yield a concentration of 1 mg/ml for I.V. use.
• Reconstitute drug in vial with 1.4 ml of normal saline for injection to yield a concentration of 2.5 mg/ml for subcutaneous use.
• Give by I.V. push over 3 to 5 seconds or subcutaneously.
• Reconstituted solution must be used within 8 hours.

Adverse reactions

CNS: headache, insomnia, dizziness, anxiety, peripheral neuropathy, reversible posterior leukoen-cephalopathy syndrome

CV: tachycardia, hypotension

EENT: throat tightness

GI: nausea, vomiting, diarrhea, abdominal pain, dyspepsia

Hematologic: eosinophilia, anemia, thrombocytopenia, neutropenia

Hepatic: hyperbilirubinemia, hepatitis, acute liver failure

Metabolic: dehydration, pyrexia

Respiratory: cough, dyspnea, upper respiratory tract infection, acute diffuse infiltrative pulmonary disease (pneumonitis, interstitial pneumonia, acute respiratory distress syndrome)

Skin: rash, pruritus, urticaria

Other: altered taste, increased or decreased appetite, fever, chills, edema, tumor lysis syndrome

Interactions

Drug-drug.CYP3A4 inducers (including amiodarone, carbamazepine, nevi-rapine, phenobarbital, phenytoin, and rifampin): possible decrease in bortezomid serum level and efficacy

CYP3A4 inhibitors (including amiodarone, cimetidine, clarithromycin, delavirdine, diltiazem, disulfiram, erythromycin, fluoxetine, fluvoxamine, nefazodone, nevirapine, propoxyphene, quinupristin, verapamil, zafirlukast, and zileuton): possible increase in bortezomib serum level and efficacy

Drug-diagnostic tests.Liver function

tests: increased levels

Drug-food.Grapefruit juice: increased bortezomib blood level, greater risk of toxicity

Patient monitoring

Monitor vital signs and temperature. Especially watch for tachycardia, fever, and hypotension.

Stay alert for and discontinue drug if posterior leukoencephalopathy (headache, seizures, lethargy, confusion, blindness) or tumor lysis syndrome occurs (irregular heartbeat, shortness of breath, high potassium level, high uric acid level, impairment of mental ability, kidney failure).

Closely monitor liver function tests and watch for signs and symptoms of hepatitis or liver failure.
• Monitor nutritional and hydration status for changes caused by GI adverse effects.
• Monitor CBC with white cell differential, and watch for signs and symptoms of blood dyscrasias.

Monitor respiratory status, watching for dyspnea, cough, and other signs and symptoms of upper respiratory tract infection.

Patient teaching

Inform patient that drug can cause serious blood dyscrasias. Teach him which signs and symptoms to report right away.
• Tell patient that drug may cause other significant adverse reactions. Reassure him he will be closely monitored.
• Instruct patient to move slowly when sitting or standing up to avoid dizziness or light-headedness from sudden blood pressure drop.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Advise patient to minimize adverse GI effects by eating small frequent servings of healthy food and ensuring adequate fluid intake.
• Tell patient to immediately report signs and symptoms of upper respiratory tract infection.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and foods mentioned above.

bortezomib

a miscellaneous antineoplastic.
indications This drug is used to treat multiple myeloma when at least two other treatments have failed.
contraindications Pregnancy and known hypersensitivity to this drug, boron, or Mannitol prohibit its use.
adverse effects Adverse effects of this drug include hypotension, edema, anemia, fatigue, malaise, weakness, arthralgia, bone pain, muscle cramps, myalgia, back pain, abdominal pain, constipation, diarrhea, dyspepsia, nausea, vomiting, anorexia, anxiety, insomnia, dizziness, headache, peripheral neuropathy, rigors, paresthesia, cough, pneumonia, dyspnea, upper respiratory infection, dehydration, weight loss, herpes zoster, rash, pruritus, and blurred vision. Life-threatening side effects include neutropenia and thrombocytopenia.

bortezomib

A proteasome inhibitor which induces apoptosis in cancer cells, and inhibits binding to stromal cells and production of growth and survival factors.

Indications
Treatment-refractory myeloma (35% response rate), mantle cell lymphoma.
 
Adverse effects
Thrombocytopaenia, fatigue, peripheral neuropathy, neutropaenia. 

bortezomib

The first of a new class of anticancer drugs that act by inhibition of the action of PROTEASOMES. When proteasomes in tumour cells are inhibited, these cells become greatly sensitized to the action of cytotoxic drugs. The drug has been found to produce a 35 per cent response rate in patients with relapsed and refractive multiple MYELOMATOSIS. A brand name is Velcade.
References in periodicals archive ?
sup][13],[14],[15],[16],[17],[18],[19] The proteasome inhibitor bortezomib has anti-viral activity for some kinds of viruses despite anti-tumor activity.
As the number of myeloma patients treated with bortezomib increases, so is awareness of bortezomib-related side effects.
The researchers will next consider a study to compare the combination of elotuzumab and bortezomib against standard therapy to see if the combination achieves better results.
The trial found that those treated with carfilzomib in combination with dexamethasone lived nearly twice as long without their cancer progressing than the adult patients who had been treated with the current standard of care, bortezomib plus dexamethasone.
The contract is continuous supply of medicines containing bortezomib 3.
85 percent of patients had prior bortezomib exposure and18 percent were bortezomib refractory, 92 percent had previous lenalidomide exposure, 48 percent had prior thalidomide exposure and 12 percent had prior carfilzomib exposure.
The expanded indication is based on daratumumab in combination with lenalidomide (an immmunomodulatory agent) and dexamethasone, or bortezomib (a PI) and dexamethasone.
Response Rates to Single-agent Carfilzomib in Patients Refractory or Intolerant to both Bortezomib and Immunomodulators in Trial PX-171-003-A1
The US Food and Drug Administration has granted approval to Denmark-based Genmab for its DARZALEX (daratumumab) in combination with lenalidomide and dexamethasone, or bortezomib and dexamethasone, intended for the treatment of patients with multiple myeloma who have received at least one prior therapy, it was reported yesterday.
al, pre-published online April 4, 2012, Zalicus researchers, in collaboration with the Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, have discovered that adenosine A2A and beta-2 adrenergic receptor agonists are highly synergistic and selective novel agents that enhance glucocorticoid activity in B-cell malignancies such as multiple myeloma and, importantly, can synergize in combination with current multiple myeloma treatment regimens such as melphalan, lenalidomide, bortezomib and doxorubicin.
AbbVie, a global biopharmaceutical company, today announced the initiation of a Phase 3 clinical trial to study the safety and efficacy of venetoclax in combination with bortezomib and dexamethasone in patients with relapsed or refractory multiple myeloma who are considered sensitive or nave to proteasome inhibitors and have received one to three prior lines of therapy.