Journal Mobile Options
Table of Contents
Vol. 85, No. 4, 2013
Issue release date: November 2013
Oncology 2013;85:223-227

Bortezomib Administered Subcutaneously Is Well Tolerated in Bortezomib-Based Combination Regimens Used in Patients with Multiple Myeloma

Lamm W. · Drach-Schauer B. · Eder S. · Drach J.
aClinical Division of Oncology, Department of Internal Medicine I, and bClinical Divison of Bone Marrow Transplantation, Department of Medicine I, Medical University of Vienna, Vienna, Austria

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Objective: Bortezomib (Btz) has emerged as a standard of care in the treatment of patients with multiple myeloma (MM), but Btz-induced peripheral neuropathy (PNP) has a particularly negative impact on patients' quality of life. According to a recent study, PNP was significantly less frequent with subcutaneous administration of Btz. Here, we report our experience regarding the efficacy and tolerability of standard combination regimens in MM with subcutaneous Btz. Methods: 14 consecutive patients with newly diagnosed MM were included in this analysis. Btz was used in different combination regimens (Btz with dexamethasone with/without thalidomide or Btz combined with melphalan and prednisone). Standard criteria were applied to evaluate response and toxicity. Results: Hematological toxicities occurred only at grades 1-2 and included anemia (71%) and thrombocytopenia (21%). Nonhematologic side effects at grades 1-2 were local skin reactions at the subcutaneous injection site, which were self-limited. No notable gastrointestinal toxicity was observed with subcutaneous Btz, and therefore routine use of intravenous hydration and antiemetics was abandoned. Overall response rate for transplant-eligible patients was 86%. Conclusions: Our results confirm the improved toxicity profile of the subcutaneous administration of Btz in various standard Btz-based combination regimens. In addition, patient management with subcutaneous administration has been markedly ameliorated at our center. © 2013 S. Karger AG, Basel

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Bird JM, Owen RG, DʼSa, Snowden JA, Pratt G, Ashcroft J, Yong K, Cook G, Feyler S, Davies F, Morgan G, Cavenagh J, Low E, Behrens J, Haemato-oncology Task Force of British Committee for Standards in Haematology (BCSH) and UK Myeloma Forum: Guidelines for the diagnosis and management of multiple myeloma 2011. Br J Haematol 2011;154:32-75.
  2. Frelay J, Bray F, Sankila R, Parkin DM: EUCAN: Cancer Incidence, Mortality and Prevalence in the European Union 1998, version 5.0. IARC Cancer Base No 4. Lyon, IARC Press, 1999.
  3. Myeloma Trialists‘ Collaborative Group: Combination chemotherapy versus melphalan plus prednisone as treatment for multiple myeloma: an overview of 6,633 patients from 27 randomized trials. J Clin Oncol 1996;16:3832-3842.

    External Resources

  4. Attal M, Harousseau JL, Stoppa AM, Sotto JJ, Fuzibet JG, Rossi JF, Casassus P, Maisonneuve H, Facon T, Ifrah N, Payen C, Bataille R: A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma: Intergroupe Francais du Myelome. N Engl J Med 1996;335:91-97.
  5. Child JA, Morgan GJ, Davies FE, Owen RG, Bell SE, Hawkins K, Brown J, Drayson MT, Selby PJ, Medical Research Council Adult Leukaemia Working Party: High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 2003;348:1875-1883.
  6. Engelhardt M, Kleber M, Udi J, Wäsch R, Spencer A, Patriarca F, Knop S, Bruno B, Gramatzki M, Morabito F, Kropff M, Neri A, Sezer O, Hajek R, Bunjes D, Boccadoro M, Straka C, Cavo M, Polliack A, Einsele H, Palumbo A: Consensus statement from European experts on the diagnosis, management and treatment of multiple myeloma: from standard therapy to novel approaches. Leuk Lymphoma 2010;51;1424-1443.
  7. Millenium Pharmaceuticals: Velcade (bortezomib) for Injection. Prescribing Information (rev 10). Cambridge, Millenium Pharmaceuticals, 2009.
  8. Antoine JC, Camdessanche JP: Peripheral nervous system involvement in patients with cancer. Lancet Neurol 2007;6:75-86.
  9. Richardson PG, Sonneveld P, Schuster MW, Stadtmauer EA, Facon T, Harrouseau JL, Ben-Yehuda D, Lonial S, Goldschmidt H, Reece D, Bladè J, Boccadoro M, Cavenagh JD, Boral AL, Esseltine DL, Wen PY, Amato AA, Anderson KC, San Miguel J: Reversibility of symptomatic peripheral neuropathy with bortezomib in the phase III APEX trial in relapsed multiple myeloma: impact of a dose-modification guideline. Br J Haematol 2009;144:895-903.
  10. Moreau P, Coiteux V, Hulin C, Leleu X, van de Velde H, Acharya M, Harrouseau JL: Prospective comparison of subcutaneous versus intravenous administration of bortezomib in patients with multiple myeloma. Haematologica 2008;93:1908-1911.
  11. Moreau P, Pylypenko H, Grosicki S, Karamanesht I, Leleu X, Grishunina M, Rekhtman G, Masliak Z, Robak T, Shubina A, Arnulf B, Kropff M, Cavet J, Esseltine DL, Feng H, Girgis S, van de Velde H, Deraedt W, Harrousseau JL: Subcutaneous versus intravenous administration of bortezomib in patients with relapsed multiple myeloma: a randomised, phase 3, non-inferiority study. Lancet Oncol 2011;12:431-440.
  12. Blade J, Samson D, Reese D, Apperley J, Björkstrand B, Gahrton G, Gertz M, Giralt S, Jagannath S, Vesole D: Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haematopoietic stem cell transplantation. Myeloma Subcommittee of the EBMT. European Group for Blood and Marrow Transplant. Br J Haematol 1998;102:1115-1123.
  13. Sonneveld P, Schmidt-Wolf IG, van der Holt B, El Jarari L, Bertsch U, Salwender H, Zweegman S, Vellenga E, Broyl A, Blau IW, Weisel KC, Wittebol S, Bos GM, Stevens-Kroef M, Scheid C, Pfreundschuh M, Hose D, Jauch A, van der Velde H, Raymakers R, Schaafsma MR, Kersten MJ, van Marwijk-Kooy M, Duehrsen U, Lindemann W, Wijermans PW, Lokhorst HM, Goldschmidt HM: Bortezomib induction and maintenance treatment in patients with newly diagnosed multiple myeloma: results of the randomized phase III HOVON-65/GMMG-HD4 trial. J Clin Oncol 2012;30:2946-2955.
  14. Einsele H, Liebisch P, Langer C, et al: Velcade, intravenous cyclophosphamide and dexamethasone (VCD) induction for previously untreated multiple myeloma (German DSMM Xia trial) (abstract 131). Blood 2009;114:59.

    External Resources

  15. San Miguel JF, Schlag R, Khuageva NK, Dimopoulos MA, Shpilberg O, Kropff M, Spicka I, Petrucci MT, Palumbo A, Samoilova OS, Dmoszynska A, Abdulkadyrov KM, Schots R, Jiang B, Mateos MV, Anderson KC, Esseltine DL, Liu K, Cakana A, van de Velde H, Richardson PG: Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. N Engl J Med 2008;359:906-917.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50