# Proteasome inhibitor (bortezomib, carfilzomib, ixazomib)

Source: https://onco.cc/terms/proteasome-inhibitor/  
OnCo record `proteasome-inhibitor` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Drugs that block the cell's protein-recycling machine. Myeloma cells make huge amounts of antibody protein and choke on the backlog when the proteasome is blocked; normal cells cope far better.

## Summary

Bortezomib (2003) was the first, given subcutaneously to limit neuropathy; carfilzomib is irreversible and more potent but has cardiovascular toxicity; ixazomib is oral. They pair with immunomodulatory drugs and dexamethasone in VRd/KRd induction, in relapsed combinations with daratumumab or isatuximab, and bortezomib is also used in mantle cell lymphoma and AL amyloidosis. Resistance and the shift to CD38 antibodies, CAR-T and bispecifics have reduced their role at relapse, but they remain in nearly every first-line regimen.

## Fields

- Kind: Term
- Last checked: 2026-09-09
- Also known as: proteasome inhibitors; proteasome inhibition; PI-based

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Proteasome_inhibitor
- Wikipedia: https://en.wikipedia.org/wiki/Proteasome_inhibitor

## Connected records

- terms: [Immunomodulatory drugs (IMiDs) and CELMoDs](https://onco.cc/terms/imid/), [Peripheral neuropathy (chemotherapy-induced)](https://onco.cc/terms/peripheral-neuropathy/), [VRd and Dara-VRd (myeloma induction regimens)](https://onco.cc/terms/vrd/)
- cancers: [Multiple myeloma](https://onco.cc/cancers/multiple-myeloma/), [Newly diagnosed multiple myeloma, transplant-eligible](https://onco.cc/cancers/myeloma-transplant-eligible/), [Newly diagnosed multiple myeloma, transplant-ineligible](https://onco.cc/cancers/myeloma-transplant-ineligible/), [Plasma cell leukaemia](https://onco.cc/cancers/plasma-cell-leukaemia/), [Relapsed or refractory multiple myeloma](https://onco.cc/cancers/myeloma-relapsed-refractory/)
- fronts: [Targeted Therapy](https://onco.cc/fronts/targeted-therapy/)
- drugs: [Bortezomib](https://onco.cc/drugs/bortezomib/), [Ixazomib](https://onco.cc/drugs/ixazomib/)

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