Patient information Bortezomib (Velcade) treatment for myeloma Your doctors have suggested that you are likely to benefit from a form of anti-cancer treatment called bortezomib (Velcade). They have weighed the expected benefits, in terms of bringing your myeloma under control, against the possibility of side effects. Your doctor will discuss these with you. If you are still unsure about the benefits then please ask. This fact sheet explains what you can expect from the treatment. What is bortezomib? Bortezomib is a new type of drug called a proteasome inhibitor. A proteasome is a type of enzyme which can be found in all our cells. It helps to regulate the growth and function of proteins in the cells. Myeloma cells have been found to be very sensitive to proteasome inhibitors. Bortezomib stops the proteasome from working causing the myeloma cells to die. Healthy cells may also be affected but can recover in the time between injections. Treatment plan Bortezomib is given over a three week (21 day) period. This is referred to as a cycle of treatment. It is given as an injection under the skin (subcutaneous) in your tummy or leg. This is usually done during a visit to Bud Flanagan Outpatient Department. Day 1 is the day you start treatment. You will be given the bortezomib on days 1, 4, 8, and 11. You will have a blood test before each injection to check that it is safe for you to have the treatment. During the third week you will not have any bortezomib. This is known as the rest week and will last for 10 days. The first cycle is then complete. You may receive between six and eight cycles of bortezomib. After four cycles you may have a bone marrow biopsy to see how the treatment is working. You will also be given dexamethasone (a steroid) to take with the bortezomib. You will need to take these on days 1, 2, 4, 5, 8, 9, 11 and 12. Your doctor will discuss this with you. You may also be given other tablets to minimise any side effects of the treatment. They are as follows: Aciclovir: to prevent herpes type infections like shingles. Lansoprazole: to protect the lining of your stomach from the steroids as they can irritate it. Fluconazole: to prevent you from getting fungal infections in your mouth. Myeloma Unit. Page 1 of 5
Co-trimoxazole: Allopurinol: a type of antibiotic to prevent you from getting certain types of chest infections. to prevent the build up of uric acid during the first few weeks of treatment. Side effects of bortezomib treatment All drugs can have some side effects and this includes bortezomib. The more common side effects are: Low blood count this treatment temporarily reduces the rate at which blood cells are produced in your bone marrow. This may cause: o anaemia (low red cell count) you may need blood transfusions. o neutropenia (low white cell count), which may increase your risk of developing an infection. o thrombocytopenia (low platelet count), which may increase your tendency to bruising and bleeding you may need platelet transfusions. This factsheet should be read together with the booklet Chemotherapy your questions answered. The booklet offers general information about chemotherapy and details about many of these side effects and how to manage them. If you have not yet received this booklet, please ask for it and any others mentioned in this factsheet. If you feel unwell at any time or have a temperature (38ºC/100ºF or higher) you should contact the hospital immediately as you may need to be admitted for intravenous antibiotics. If you feel unwell you should always check your temperature. Do not take paracetamol as this will mask any infection. For further information please refer to the Royal Marsden booklet Chemotherapy your questions answered. Numbness and tingling in the hands and feet this is called peripheral neuropathy and can be caused by the bortezomib. You must tell a member of the haematology team if walking or holding objects becomes difficult. It may improve over time once the treatment has stopped. Tiredness or lethargy you may become tired more easily after normal activities during your treatment. This is quite normal. Your tiredness should resolve in time. Loss of appetite you may find that you lose your appetite. Tell a member of the haematology team so they can refer you to a dietitian for advice. Constipation or diarrhoea bortezomib can cause either of these. Your doctor can prescribe medication for constipation. Tell the doctor or nurse if you have diarrhoea more than four times in 24 hours. Drink plenty of fluids. Dizziness (postural hypotension) bortezomib sometimes causes a temporary drop in blood pressure, so you may feel dizzy or light headed if you stand too Myeloma Unit. Page 2 of 5
quickly. You may be given intravenous fluids before your bortezomib injection to try and stop this from happening. Tell your doctor if you are taking medication for blood pressure and if you feel dizzy or light-headed. Reaction at injection site you may have a local reaction at the site of where you receive the injection. This maybe some redness, swelling or irritation. Please inform a member of the team looking after you if this is a problem. Side effects of steroids: as dexamethasone is a steroid there are a number of side effects you may experience when taking this. Most of these will go away once treatment is finished. Other than those mentioned above, you may notice the following: o Fluid retention you may notice swelling of your ankles (ankle oedema). Usually, this is mild and goes away when treatment ends. o Mood changes, euphoria or difficulty in sleeping You may find it helpful to discuss with your doctor, which time of day is best to take your steroids. It is usually best to avoid taking them in the evening if possible. o Blurred vision tell your doctor if this happens. o Irritation of the lining of the stomach dexamethasone may cause stomach pain, however you will be given drugs to prevent this from happening. It may also cause increased appetite and weight gain. o Steroid induced diabetes this may be permanent. It is important that you contact the hospital if you experience any of these side effects (see contact details below). With certain side effects, a treatment break or dose reduction may be necessary. You may find the booklet Chemotherapy your questions answered helpful for information about, and managing some of these side effects. Fertility, pregnancy and breast feeding We don t know what effect bortezomib has on fertility or a developing baby. Therefore we recommend the following advice given for chemotherapy drugs. o Fertility chemotherapy can damage the testes or ovaries. This may affect your ability to conceive (or father a child). Infertility can be temporary or more permanent. Sometimes in women chemotherapy can lead to premature menopause. If relevant to you, you may want to discuss the issue of fertility with your doctor before treatment is started. o Pregnancy during chemotherapy and for up to a year afterwards, if sperm or eggs are produced they may be abnormal. Treatment can also harm an unborn child. We recommend that you or your partner use a barrier method of contraception during treatment and for one year afterwards. If you know you are pregnant before starting treatment or become pregnant during treatment, you must tell your doctor immediately. Myeloma Unit. Page 3 of 5
o Breast feeding there is a risk of harm to a child who is being breastfed since the drugs may be concentrated in the milk. It is very important that women do not breast feed while receiving chemotherapy. We have listed the most common side effects of this chemotherapy. You may experience some or several of these side effects listed above and they may be mild, moderate or severe. Some can occasionally be life-threatening. As with all drugs there may be other side effects not mentioned here that you may experience. Because of the risk of side-effects it is important that you: Always tell your doctor if you suffer from any of these side effects, or if you have experienced any new symptoms since your last visit. Your doctor can help you by giving you medication or advice, to reduce or stop these side effects from occurring in the future. Always tell your doctor about any other medicine you are taking or planning to take, including herbal and complementary therapies. Always consult your doctor before having any other procedure, for example, dental work or vaccinations. Blood clots Some cancers increase the risk of developing blood clots. Chemotherapy drugs can also cause an increase in the risk of patients developing blood clots whilst they are on treatment. When a blood clot forms in a deep vein, usually the leg, it is called a deep vein thrombosis (DVT). This can cause the leg to swell. If a part of the clot breaks free, it may travel to the lungs, causing shortness of breath or chest pain. This is called a pulmonary embolus (PE). Blood clots can also happen in the arteries leading to a heart attack, stroke or disruption to the blood supply to a limb. Blood clots can be life threatening and treatment with blood-thinning drugs (anticoagulants) is usually given to help dissolve the clot and prevent further problems. Please inform your doctor immediately if you are worried you may have a blood clot. Airline travel is also associated with an increased risk of blood clots. It is important that you inform your hospital team of any travel plans whilst you are on treatment. Myeloma Unit. Page 4 of 5
Contact numbers If you have any questions about your treatment or side effects or if you feel unwell you must contact the hospital for advice. Clinical Nurse Specialist Myeloma: 0208 661 3657 Bud Flanagan Out Patients: 0208 661 3773 Bud Flanagan East: 0208 661 3776 Bud Flanagan West: 0208 661 3144 Site Practitioner on call/night sisters: 0208 642 6011 Bleep 017 or The Pharmacy Medicines Helpline: 020 8770 3821 Email: medicines.information@rmh.nhs.uk Myeloma Unit. Page 5 of 5