Bortezomib for previously untreated multiple myeloma

Abstract

Introduction: The paradigm of antimyeloma treatment has rapidly changed since the introduction of the first-in-class proteasome inhibitor bortezomib and the immunomodulatory drugs thalidomide and lenalidomide.

Areas covered: This manuscript discusses the most recent data on the frontline use of bortezomib and bortezomib-based combinations in multiple myeloma. Preclinical data, pharmacokinetics and pharmacodynamics of bortezomib are summarized, as well as published clinical trials of its use as a first-line treatment for transplant-eligible and elderly myeloma patients. Additionally, the use of bortezomib in particular myeloma subgroups, including patients with high-risk cytogenetics and renal insufficiency, is discussed. Finally, the prevention and management of bortezomib-induced side effects, including the latest data on weekly dosing for untreated elderly patients, is focused on.

Expert opinion: Bortezomib has become an important backbone of frontline myeloma treatment. Nevertheless, continued efforts to implement newer dosing regimens and to identify new partner drugs for bortezomib remain an important challenge.

Keywords:

• bortezomib
• frontline treatment
• multiple myeloma
• peripheral neuropathy
• pharmacodynamics
• pharmacokinetics
• subcutaneous

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