Velcade (bortezomib) is a targeted cancer medicine used to treat:

• Multiple myeloma (a type of blood cancer affecting plasma cells in the bone marrow)
• Mantle cell lymphoma (a type of non-Hodgkin's lymphoma)

Bortezomib belongs to a class called proteasome inhibitors. Cancer cells, particularly plasma cells in multiple myeloma, are highly dependent on the proteasome (a cellular machinery that breaks down unwanted proteins). By blocking the proteasome, bortezomib causes toxic proteins to build up inside cancer cells, triggering their death.

Velcade is given as an injection, either subcutaneously (under the skin) or intravenously (into a vein), by medical staff in a hospital or cancer centre. The subcutaneous route is now preferred as it reduces the risk of nerve-related side effects while maintaining effectiveness.

It is given on specific days of each treatment cycle (for example, days 1, 4, 8, and 11 of a 21-day cycle). The exact schedule depends on the treatment regimen used.

You will not self-administer this medicine.

Your injections are scheduled by your oncology team. Contact them if you need to reschedule an appointment.

In a clinical setting, any dosing error is managed immediately by medical staff.

Storage is managed by the treating clinic. Velcade vials are stored at room temperature (below 30°C) and protected from light.

Side effects are common, and some can be significant.

Very common side effects:

• Peripheral neuropathy: tingling, numbness, or burning pain in the hands and feet. This is one of the most significant and limiting side effects of bortezomib. Subcutaneous administration reduces this risk. Tell your doctor if you notice any new sensory changes
• Fatigue
• Nausea and vomiting
• Diarrhoea and constipation
• Low platelets (thrombocytopenia): check platelet count before each dose
• Low white blood cells (neutropenia)

Serious side effects:

• Severe peripheral neuropathy: can cause permanent nerve damage. Dose reduction or stopping may be needed
• Cardiac toxicity: heart function monitoring may be needed
• Shingles (herpes zoster) reactivation: antiviral prophylaxis (e.g., aciclovir) is routinely given during treatment

Blood tests before each dose assess platelet counts and other parameters.

• Strong CYP3A4 inhibitors or inducers: can affect bortezomib exposure
• Oral hypoglycaemic agents (for diabetes): bortezomib can cause hypoglycaemia or hyperglycaemia. Blood sugar monitoring is required

Tell your oncologist about all medicines including over-the-counter and herbal products.

Why do I need to take antiviral medicine during Velcade treatment?

Bortezomib and other myeloma treatments can reactivate the varicella-zoster virus (the same virus that causes chickenpox), causing shingles. Shingles during cancer treatment can be severe and affect nerve function. Antiviral medicines such as aciclovir or valaciclovir are routinely given as prevention during Velcade therapy. Take these as prescribed and do not stop them without checking with your oncologist.

What should I do if I develop tingling in my hands or feet?

Tell your oncology team straight away. Peripheral neuropathy is common with bortezomib and can progress if not managed. Early reporting allows your team to reduce the dose or change to subcutaneous administration (if not already using this route), which can reduce severity. In some cases, treatment may need to be paused or adjusted. Do not wait for your next appointment if you notice new numbness, tingling, or pain.

Ace provides accurate and independent information medically reviewed on prescription medications. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.