Bortezomib
Bortezomib was the first proteasome inhibitor: it jams the cell's protein-recycling machine, which antibody-factory plasma cells cannot tolerate.
Approved 2003 (relapsed), 2008 (frontline). Subcutaneous weekly dosing cut neuropathy from ~50% to ~30%. Part of VRd and Dara-VRd induction and of bortezomib-based regimens in mantle cell lymphoma and amyloidosis. Generic.
- Route
- Subcutaneous (preferred) or IV
- Schedule
- 1.3 mg/m2 days 1, 4, 8, 11 (21-day) or weekly
- Monitoring
- Peripheral neuropathy, herpes zoster prophylaxis, thrombocytopenia
- Medicare
- Part B (clinician-administered)
Given by infusion or injection in a clinic or hospital outpatient department, so it is a Part B drug: Medicare pays 80% after the Part B deductible and the patient owes 20% coinsurance, uncapped in Original Medicare unless a Medigap policy applies. Subcutaneous or IV in the clinic; HCPCS J9041. Generic bortezomib since 2022.
- Commercial insurance
- covered on label
Multi-source generic; covered under the medical benefit without prior authorisation in most plans, as part of standard regimens. Prior authorisation is uncommon now that generics exist.
- Assistance programmes
- Takeda Oncology Here2Assist
- PAN Foundation — Disease-specific co-pay and premium funds; open and closed funds change monthly.
- HealthWell Foundation
- CancerCare Co-Payment Assistance Foundation
- Patient Advocate Foundation Co-Pay Relief
- Leukemia & Lymphoma Society financial support
Sources: Medicare.gov: Chemotherapy · Medicare.gov: Prescription drugs (outpatient, Part B). Not medical or financial advice; verify with your plan.
- Appraised for
- Multiple myeloma at first relapse
- Notes
- Untreated myeloma with thalidomide: TA228 (2011). Induction before transplant: TA311 (2014). Mantle cell lymphoma: TA370. Generic since 2019. TA129 introduced the first NHS response-based rebate scheme.
- NHS England
- Routinely funded for the appraised indication (or via managed access)
Sources: NICE TA129 · SMC advice: bortezomib. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
Approvals
| Region | Year | Indication |
|---|---|---|
| US | 2003 | Relapsed myeloma (accelerated) |
| US | 2008 | Newly diagnosed myeloma |
| Adverse event | Any grade | Grade 3+ |
|---|---|---|
| Peripheral neuropathy | 38% | 6% |
| Thrombocytopenia | — | 30% |
subcutaneous (MMY-3021). Events listed without rates were not read from a primary source; see the label. Blank cells mean the figure was not sourced, not that it is zero.
Trials
topRecruiting now (live from ClinicalTrials.gov)
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CEPHEUS extends the quadruplet standard to patients who are not going to transplant, closing the gap between transplant-eligible and ineligible populations. It is also one of the first phase 3 trials to be designed around MRD-negativity as the primary endpoint, which could shorten future myeloma trials by years. Frailer patients still need dose-adapted approaches.
PERSEUS, with the earlier GRIFFIN and CASSIOPEIA trials, made a four-drug daratumumab quadruplet the standard for fit patients heading to transplant. It also introduced MRD-directed stopping of the antibody, a step towards treatment that is deep but not indefinite. Whether transplant itself remains necessary on top of a quadruplet is now the open question.
CARTITUDE-4 is the first randomised trial to show that a CAR-T improves survival in myeloma, and it moved cilta-cel into second-line use (FDA approval 2024). For patients whose disease returns after first-line lenalidomide, a one-off cell therapy now competes with continuous drug combinations. Capacity, cost and the need for bridging therapy still limit who actually receives it.
Latest papers
topQuery for this drug: (TITLE:"Bortezomib" OR ABSTRACT:"Bortezomib" OR TITLE:"Velcade" OR ABSTRACT:"Velcade") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Bortezomib, not a curated reading list.
Pages like this
not linked directly; found by shared links- ProductLenalidomide
Shares Kenneth C. Anderson, Paul G. Richardson, CEPHEUS, IMROZ.
- ProductDaratumumab
Shares CEPHEUS, PERSEUS, CD38 antibody added to PI-IMiD-dex (quadruplet induction), VRd and Dara-VRd (myeloma induction regimens).
- ProductIxazomib
Shares Proteasome inhibitor (bortezomib, carfilzomib, ixazomib), Takeda, Ubiquitin–proteasome system & protein homeostasis, Multiple myeloma.
- ProductCarfilzomib
Shares Sundar Jagannath, Waldenström macroglobulinaemia, Ubiquitin–proteasome system & protein homeostasis, Multiple myeloma.
- TermMRD negativity (myeloma, 10⁻⁵ / 10⁻⁶)
Shares PERSEUS, PERSEUS: daratumumab added to bortezomib-lenalidomide-dexamethasone around autologous transplant in newly diagnosed myeloma, CEPHEUS: daratumumab quadruplet for newly diagnosed myeloma patients not having a transplant, with MRD-negativity as the main endpoint, CARTITUDE-4: cilta-cel CAR-T versus standard combinations after one to three prior lines of myeloma therapy.
- Key paperMAIA: adding daratumumab to lenalidomide-dexamethasone for older patients with newly diagnosed myeloma who cannot have a transplant
Shares CD38 antibody added to PI-IMiD-dex (quadruplet induction), CEPHEUS: daratumumab quadruplet for newly diagnosed myeloma patients not having a transplant, with MRD-negativity as the main endpoint, Johnson & Johnson, Multiple myeloma.
- ProductIsatuximab
Shares IMROZ, CD38 antibody added to PI-IMiD-dex (quadruplet induction), Multiple myeloma.
- TermImmunomodulatory drugs (IMiDs) and CELMoDs
Shares Proteasome inhibitor (bortezomib, carfilzomib, ixazomib), VRd and Dara-VRd (myeloma induction regimens), Multiple myeloma.