# Bortezomib

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

## TL;DR

Bortezomib was the first proteasome inhibitor: it jams the cell's protein-recycling machine, which antibody-factory plasma cells cannot tolerate.

## Summary

Bortezomib is a reversible inhibitor of the chymotrypsin-like site of the 26S proteasome; the resulting unfolded-protein stress and NF-kappaB inhibition trigger apoptosis in plasma cells, which produce huge amounts of antibody and cannot tolerate a jammed protein-recycling system. It was the first proteasome inhibitor, approved in 2003 for relapsed myeloma and in 2008 for newly diagnosed disease. Subcutaneous weekly dosing cut peripheral neuropathy from around 50% to around 30% and is now preferred over intravenous twice-weekly schedules. It is part of VRd and Dara-VRd induction and of bortezomib-based regimens in mantle cell lymphoma and amyloidosis, and it is now generic. Thrombocytopenia and herpes zoster reactivation, which needs prophylaxis, are the other main issues. Bortezomib made proteasome inhibition a pillar of myeloma treatment and remains in most frontline regimens.

## Fields

- Kind: Treatment
- Status: approved
- Last checked: 2026-09-07
- Brand: Velcade
- Modality: Proteasome inhibitor
- Mechanism: Reversible inhibitor of the 26S proteasome chymotrypsin-like site; unfolded-protein stress and NF-κB inhibition trigger plasma-cell apoptosis.
- Approvals: US 2003: Relapsed myeloma (accelerated); US 2008: Newly diagnosed myeloma
- Dosing: Subcutaneous (preferred) or IV; 1.3 mg/m2 days 1, 4, 8, 11 (21-day) or weekly
- Toxicity (grade 3+): Peripheral neuropathy 6%; Thrombocytopenia 30%

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Bortezomib
- FDA label (DailyMed): https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=Bortezomib

## Connected records

- technologies: [Acupuncture for chemotherapy-induced neuropathy](https://onco.cc/technologies/acupuncture-chemotherapy-neuropathy/), [Green tea and EGCG extracts](https://onco.cc/technologies/green-tea-egcg/), [Nerve damage from chemotherapy: what recovers, and what helps](https://onco.cc/technologies/cipn-recovery-and-treatment/), [Scrambler therapy (Calmare) for chemotherapy nerve pain](https://onco.cc/technologies/scrambler-therapy/), [Small-molecule kinase inhibitors](https://onco.cc/technologies/kinase-inhibitors/)
- cancers: [Acute myeloid leukaemia in children](https://onco.cc/cancers/aml-paediatric/), [High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL)](https://onco.cc/cancers/all-paediatric-high-risk/), [HIV-associated (AIDS-related) lymphomas](https://onco.cc/cancers/hiv-associated-lymphoma/), [Mantle cell lymphoma](https://onco.cc/cancers/mantle-cell-lymphoma/), [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/), [Plasmablastic lymphoma](https://onco.cc/cancers/plasmablastic-lymphoma/), [Relapsed or refractory multiple myeloma](https://onco.cc/cancers/myeloma-relapsed-refractory/), [Waldenström macroglobulinaemia](https://onco.cc/cancers/waldenstrom/)
- companies: [Dr. Reddy's Laboratories](https://onco.cc/companies/dr-reddys/), [Johnson & Johnson](https://onco.cc/companies/johnson-johnson/), [Takeda](https://onco.cc/companies/takeda/)
- pathways: [B-cell receptor / BTK signalling (to NF-κB)](https://onco.cc/pathways/bcr-signalling/), [Ubiquitin-proteasome system & protein homeostasis](https://onco.cc/pathways/ubiquitin-proteasome-system/)
- trials: [A Phase III Study of Eque-cel in Subjects With Len-refractory RRMM (FUMANBA-03)](https://onco.cc/trials/nct06464991/), [A Study Comparing Anitocabtagene Autoleucel to Standard of Care Therapy in Participants With Relapsed/ Refractory Multiple Myeloma](https://onco.cc/trials/nct06413498/), [A Study Comparing AZD0120, a Dual-targeted CAR-T Against B-cell Maturation Antigen (BCMA) and CD19, Versus Standard Regimens in Participants With Rela](https://onco.cc/trials/nct07391657/), [A Study Comparing Talquetamab Plus Pomalidomide, Talquetamab Plus Teclistamab, and Elotuzumab, Pomalidomide, and Dexamethasone or Pomalidomide, Bortez](https://onco.cc/trials/nct06208150/), [A Study Comparing Teclistamab Monotherapy Versus Pomalidomide, Bortezomib, Dexamethasone (PVd) or Carfilzomib, Dexamethasone (Kd) in Participants With](https://onco.cc/trials/nct05572515/), [A Study of Combination Therapy With Venetoclax, Daratumumab and Dexamethasone (With and Without Bortezomib) in Participants With Relapsed or Refractor](https://onco.cc/trials/nct03314181/), [A Study of Different Sequences of Cilta-cel, Talquetamab in Combination With Daratumumab and Teclistamab in Combination With Daratumumab Following Ind](https://onco.cc/trials/nct06577025/), [A Study of JNJ-68284528, a Chimeric Antigen Receptor T Cell (CAR-T) Therapy Directed Against B-cell Maturation Antigen (BCMA) in Participants With Mul](https://onco.cc/trials/nct04133636/), [A Study of Selinexor (Seli) + Low-dose Dexamethasone (LDD) in Penta-refractory Multiple Myeloma (MM), Seli and Bortezomib + LDD in Triple-class Refrac](https://onco.cc/trials/nct04414475/), [A Study to Determine Dose, Safety, Tolerability and Efficacy of CC-220 Monotherapy, and in Combination With Other Treatments in Subjects With Multiple](https://onco.cc/trials/nct02773030/), [A Study to Determine the Recommended Dose and Regimen and to Evaluate the Safety and Preliminary Efficacy of CC-92480 in Combination With Standard Tre](https://onco.cc/trials/nct03989414/), [A Study to Evaluate Mezigdomide, Bortezomib and Dexamethasone (MEZIVd) Versus Pomalidomide, Bortezomib and Dexamethasone (PVd) in Participants With Re](https://onco.cc/trials/nct05519085/), [A Study to Evaluate the Efficacy and Safety of Belantamab Mafodotin in Combination With Standard of Care in Participants With Relapsed-Refractory Mult](https://onco.cc/trials/nct07227311/), [A Study to Learn About the Effects of the Combination of Elranatamab, Daratumumab and Lenalidomide Compared With Daratumumab, Bortezomib, Lenalidomide](https://onco.cc/trials/nct05623020/), [AALL1231](https://onco.cc/trials/aall1231/), [AAML1031](https://onco.cc/trials/aaml1031/), [All Japanese Population: Belantamab Mafodotin Plus Pomalidomide and Dexamethasone (Pd) Versus Bortezomib Plus Pd in Relapsed/Refractory Multiple Myelo](https://onco.cc/trials/nct06956170/), [CARTITUDE-6](https://onco.cc/trials/cartitude-6/), [CASSIOPEIA](https://onco.cc/trials/cassiopeia/), [CEPHEUS](https://onco.cc/trials/cepheus/), [China Subpopulation: Evaluation of Efficacy and Safety of Belantamab Mafodotin, Bortezomib and Dexamethasone Versus Daratumumab, Bortezomib and Dexame](https://onco.cc/trials/nct06868654/), [DETERMINATION](https://onco.cc/trials/determination/), [DREAMM-7](https://onco.cc/trials/dreamm-7/), [IFM 2009](https://onco.cc/trials/ifm-2009/), [IMROZ](https://onco.cc/trials/imroz/), [Japan Expansion Cohort: Evaluation of Efficacy and Safety of Belantamab Mafodotin, Bortezomib and Dexamethasone Versus Daratumumab, Bortezomib and Dex](https://onco.cc/trials/nct06868667/), [MagnetisMM-32: A Study to Learn About the Study Medicine Called Elranatamab in People With Multiple Myeloma (MM) That Has Come Back After Taking Other](https://onco.cc/trials/nct06152575/), [Open-label Study Comparing Iberdomide, Daratumumab and Dexamethasone (IberDd) Versus Daratumumab, Bortezomib, and Dexamethasone (DVd) in Participants ](https://onco.cc/trials/nct04975997/), [PERSEUS](https://onco.cc/trials/perseus/), [Phase II Study of QLS32015 Combination Therapy in the Treatment of Multiple Myeloma](https://onco.cc/trials/nct07018050/), [Selinexor and Backbone Treatments of Multiple Myeloma Patients](https://onco.cc/trials/nct02343042/), [Study Assessing Activity of Intravenous (IV) Etentamig Monotherapy Versus Standard Available Therapies in Adult Participants With Relapsed or Refracto](https://onco.cc/trials/nct06158841/), [Study of AZD0120 in Newly Diagnosed Multiple Myeloma Ineligible for ASCT](https://onco.cc/trials/nct07764978/), [Study to Evaluate CCS1477 (Inobrodib) in Haematological Malignancies](https://onco.cc/trials/nct04068597/), [Zevalin and Velcade in Relapsed/Refractory Mantle Cell Lymphoma](https://onco.cc/trials/nct01497275/)
- pairings: [CD38 antibody added to PI-IMiD-dex (quadruplet induction)](https://onco.cc/pairings/cd38-plus-triplet/)
- terms: [Infection prophylaxis in lymphoma: PJP, herpes, fungal risk and vaccination](https://onco.cc/terms/lymphoma-tx-pjp-and-infection-prophylaxis/), [M-protein, immunofixation and serum free light chains](https://onco.cc/terms/m-protein-free-light-chains/), [Peripheral neuropathy (chemotherapy-induced)](https://onco.cc/terms/peripheral-neuropathy/), [Proteasome inhibitor (bortezomib, carfilzomib, ixazomib)](https://onco.cc/terms/proteasome-inhibitor/), [The lymphoma regimen alphabet: R-CHOP, pola-R-CHP, DA-EPOCH-R, ABVD, BEACOPP and the rest](https://onco.cc/terms/lymphoma-tx-regimen-alphabet/), [VRd and Dara-VRd (myeloma induction regimens)](https://onco.cc/terms/vrd/), [What the NHS in England funds for lymphoma, appraisal by appraisal](https://onco.cc/terms/lymphoma-tx-uk-access/)
- targets: [Proteasome (PSMB5)](https://onco.cc/targets/proteasome/)
- people: [Aaron Ciechanover](https://onco.cc/people/aaron-ciechanover/), [Avram Hershko](https://onco.cc/people/avram-hershko/), [Kenneth C. Anderson](https://onco.cc/people/kenneth-anderson/), [Paul G. Richardson](https://onco.cc/people/paul-richardson/), [Sundar Jagannath](https://onco.cc/people/sundar-jagannath/)
- key papers: [AALL1231: bortezomib in newly diagnosed T-cell acute lymphoblastic leukaemia and lymphoma, with cranial radiotherapy removed](https://onco.cc/key-papers/paper-aall1231-bortezomib-t-all-teachey-jco-2022/), [AAML1031: bortezomib with standard chemotherapy for children with acute myeloid leukaemia does not improve outcomes](https://onco.cc/key-papers/paper-aaml1031-bortezomib-aplenc-haematologica-2020/), [CARTITUDE-4: cilta-cel CAR-T versus standard combinations after one to three prior lines of myeloma therapy](https://onco.cc/key-papers/paper-cartitude-4-cilta-cel-nejm-2023/), [CASSIOPEIA: daratumumab added to bortezomib, thalidomide and dexamethasone before and after transplant in newly diagnosed myeloma](https://onco.cc/key-papers/paper-cassiopeia-lancet-2019/), [CEPHEUS: daratumumab quadruplet for newly diagnosed myeloma patients not having a transplant, with MRD-negativity as the main endpoint](https://onco.cc/key-papers/paper-cepheus-dara-vrd-natmed-2025/), [IFM 2006 prospective trial: bortezomib-based induction and transplantation for primary plasma cell leukaemia](https://onco.cc/key-papers/paper-royer-plasma-cell-leukaemia-ifm-jco-2016/), [IFM 2009: lenalidomide, bortezomib and dexamethasone with or without upfront transplantation for myeloma](https://onco.cc/key-papers/paper-ifm-2009-attal-nejm-2017/), [PERSEUS: daratumumab added to bortezomib-lenalidomide-dexamethasone around autologous transplant in newly diagnosed myeloma](https://onco.cc/key-papers/paper-perseus-dara-vrd-transplant-nejm-2024/)
- institutions: [Technion, Israel Institute of Technology](https://onco.cc/institutions/technion/)

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