{"entity":{"id":"bortezomib","kind":"drug","name":"Bortezomib","aka":[],"tldr":"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.","status":"approved","asOf":"2026-09-07","wikipedia":"https://en.wikipedia.org/wiki/Bortezomib","links":[{"label":"FDA label (DailyMed)","url":"https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=Bortezomib"}],"tags":[],"related":["green-tea-egcg"],"cancers":["multiple-myeloma","myeloma-transplant-eligible","plasma-cell-leukaemia"],"sections":[],"technologies":["kinase-inhibitors"],"targets":[],"drugs":[],"companies":["takeda","johnson-johnson"],"institutions":[],"pathways":["ubiquitin-proteasome-system"],"terms":[],"trials":["nct06868654","nct06464991","nct06956170","nct05572515","nct05623020","nct06152575","nct05519085","nct04975997","nct06413498","nct06158841","nct06208150","nct06868667","nct02343042","nct03314181","nct04414475","nct04133636","nct03989414","nct04068597","nct06577025","nct07227311","nct07018050","nct02773030"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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":[{"region":"US","year":2003,"indication":"Relapsed myeloma (accelerated)"},{"region":"US","year":2008,"indication":"Newly diagnosed myeloma"}],"mechanismSteps":[],"dosing":{"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"},"toxicity":[{"event":"Peripheral neuropathy","anyGradePct":38,"grade3PlusPct":6,"note":"subcutaneous (MMY-3021)"},{"event":"Thrombocytopenia","grade3PlusPct":30}],"access":[],"regulatoryEvents":[{"date":"2003-05-13","type":"accelerated-approval","region":"US","note":"Accelerated approval on a surrogate endpoint, with a confirmatory trial required.","indication":"Multiple myeloma patients who received at least two prior therapies and demontrated disease progression on the last therapy"},{"date":"2005-03-25","type":"conversion","region":"US","note":"Confirmed: the accelerated approval of 2003 converted to traditional approval 1.9 years after it was granted.","indication":"Multiple myeloma patients who received at least two prior therapies and demontrated disease progression on the last therapy"}]},"route":"/drugs/bortezomib/","neighbours":{"technology":[{"id":"acupuncture-chemotherapy-neuropathy","kind":"technology","name":"Acupuncture for chemotherapy-induced neuropathy","route":"/technologies/acupuncture-chemotherapy-neuropathy/"},{"id":"green-tea-egcg","kind":"technology","name":"Green tea and EGCG extracts","route":"/technologies/green-tea-egcg/"},{"id":"cipn-recovery-and-treatment","kind":"technology","name":"Nerve damage from chemotherapy: what recovers, and what helps","route":"/technologies/cipn-recovery-and-treatment/"},{"id":"scrambler-therapy","kind":"technology","name":"Scrambler therapy (Calmare) for chemotherapy nerve pain","route":"/technologies/scrambler-therapy/"},{"id":"kinase-inhibitors","kind":"technology","name":"Small-molecule kinase 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