Velcade
Evidence Grade A — Regulatory approved. 11482 published studies. 1000 registered clinical trials.
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Bortezomib (sold as Velcade) is a cancer treatment that fundamentally changed how multiple myeloma — a blood cancer of the bone marrow — is managed. It was the first drug in an entirely new class that works by blocking the cell's internal protein recycling system, causing cancer cells to essentially choke on their own waste. Before treatments like bortezomib, most myeloma patients survived about three years; many now live a decade or more.
11,482 published studies: 9058 human, 485 animal, 1723 in-vitro, 2065 reviews
Bortezomib is marketed as Velcade (approved May 2003) for multiple myeloma and mantle cell lymphoma. Generic versions are available. Originally given intravenously, subcutaneous injection is now preferred as it causes significantly less nerve damage.
The VISTA trial established bortezomib-based combination therapy as standard for newly diagnosed myeloma patients ineligible for transplant, with median time to disease progression of 24 months versus 16.6 months with older chemotherapy. Peripheral neuropathy (numbness and tingling in hands and feet) is the main dose-limiting side effect, affecting up to 30% of patients. Bortezomib transformed myeloma from a disease with a median survival of approximately 3 years to one where many patients live a decade or more with sequential treatments.
Like carfilzomib, bortezomib disables the proteasome — the cell's protein recycling system. Myeloma cells produce vast quantities of antibody proteins and rely heavily on the proteasome to dispose of defective copies. When bortezomib blocks the proteasome, these waste proteins accumulate rapidly, triggering a stress response that overwhelms the cancer cell. Bortezomib also blocks the NF-kappaB pathway, which myeloma cells use to resist self-destruction. Unlike carfilzomib's permanent bond, bortezomib's attachment is reversible, which may contribute to its different side effect profile.
Bortezomib has over 20 years of clinical data from dozens of large trials. The VISTA trial established bortezomib-based combination therapy as the standard approach for newly diagnosed myeloma patients, extending the time before disease worsened from about 17 months (with older chemotherapy) to 24 months. Both intravenous and subcutaneous injection routes are available, with subcutaneous now preferred because it significantly reduces the main dose-limiting side effect: peripheral neuropathy (numbness and tingling in hands and feet, affecting up to 30-40% of patients). While bortezomib remains a backbone of myeloma treatment worldwide, second-generation drugs in the same class (such as carfilzomib and ixazomib) offer different side effect profiles and are increasingly used alongside or instead of bortezomib for certain patient groups. Generic versions are now available, making it more accessible globally.
Bortezomib and Rituximab in Treating Patients With Relapsed or Refractory B-Cell Non-Hodgkin's Lymphoma
Ketoconazole Administration: How it is Affected by the Body and Broken Down and How it Acts on the Body When Used With Velcade
A Study to Further Assess Safety and Effectiveness Data of the Bortezomib(Velcade)/Melphalan/Prednisone (BMP) Regimen in Previously Untreated and Transplant Ineligible Multiple Myeloma Patients
Technology Platform and System Construction of Clinical Evaluation Studies on New Drugs of Hematological Malignancy
Bortezomib Before Donor Stem Cell Transplant in Treating Patients With Multiple Myeloma
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