Page 75 - Heart Transplant Protocol

Heart Function Service: Heart Transplant Protocols

Protocols for the Administration of Bortezomib (Velcade®)

Description:
Bortezomib is a boronic acid dipeptide derivative and specific/selective inhibitor of the 26S
proteasome, a multi-catalytic protease present in all eukaryotic cells. Bortezomib inhibits
proteasomes, enzyme complexes which regulate protein homeostasis within the cell.
Specifically, it reversibly inhibits chymotrypsin-like activity at the 26S proteasome, leading to
activation of signaling cascades, cell-cycle arrest, and apoptosis.

Indication:
Treatment of multiple myeloma; treatment of relapsed or refractory mantle cell lymphoma.
Non-labeled use for B cell mediated rejection.

Dose:
1.3 mg/m²/dose IV or SQ
3
3
Platelets should be ≥70,000/mm , ANC should be ≥1000/mm prior to therapy initiation
Premedication: NONE

Frequency:
1.3 mg/m² twice weekly for two weeks (days 1, 4, 8, and 11). This is followed by a 10-day rest period
(days 12 to 21); this 3-week period is a treatment cycle. At least 3 days should elapse between
consecutive doses of Bortezomib.

Dose Adjustment:
Dose modification due to Toxicity, excluding Neuropathy & Hepatic Impairment

Toxicity Dose modification/delay
Platelets ≤30,000/mm or ANC ≤750/mm on Withhold bortezomib by 1 dose
3
3
bortezomib day(s) (except day 1)
2
If after holding the dose, platelets is still Reduce dose by 0.3mg/m /dose (1.3
3
3
2
2
≤30,000/mm or ANC is still ≤750/mm mg/m /dose reduced to 1 mg/m /dose; 1
2
2
mg/m /dose reduced to 0.7 mg/m /dose)
Grade 4 hematological toxicity† (hemoglobin: Withhold bortezomib until toxicity resolves.
life-threatening consequences; urgent May reinitiate bortezomib at a reduced dose
3
2
2
intervention indicated; platelets <25,000/mm ; (1.3 mg/m /dose reduced to 1 mg/m /dose; 1
2
2
3
3
WBC<1,000/mm ; ANC<500/ mm ) mg/m /dose reduced to 0.7 mg/m /dose)
†see detail in NCI Common Terminology Criteria CTCAE v4.0

Updated November 9, 2017 75