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Managing and avoiding bortezomib toxicity
Northwest Cancer Specialists, Portland, OR
Bortezomib, the only currently approved proteasome inhibitor, is used in the treatment of relapsed/refractory multiple myeloma and mantle cell lymphoma. The most frequent toxicities of bortezomib are gastrointestinal symptoms, thrombocytopenia, asthenia (fatigue, malaise, and weakness), and peripheral neuropathy. Thrombocytopenia, the most common grade 3/4 toxicity, usually resolves before the next cycle of bortezomib therapy begins. Peripheral neuropathy may be managed by modifying the dose and schedule of bortezomib administration. Gastrointestinal complaints (nausea, vomiting, diarrhea, and constipation) are managed symptomatically. Careful attention to avoiding dehydration and hypotension has a role in mitigating fatigue, and adjustments in the patient’s other medications may be needed. Modifications in the dose and scheduling of bortezomib, now being investigated, promise to improve the therapeutic ratio of this valuable drug.
| Commun Oncol 2007;4:480–484 | full text |  130 kb |