The positive effects of one-hour intravenous administration of bortezomib on peripheral neuropathy in multiple myeloma patients.

Joo Young Jung,Hyo Jung Kim,Dae Young Zang,Dae Ro Choi,Ho Young Kim,Boram Han

doi:10.1155/2014/237698

Abstract

Bortezomib-induced peripheral neuropathy (BiPN) in multiple myeloma (MM) patients is a common and serious side effect. Currently, it has been reported that subcutaneous (SC) administration of bortezomib decreases the incidence of BiPN as compared to standard intravenous (IV) bolus injection without any differences in efficacy. However, there are reports of severe injection site reaction following SC administration of bortezomib. The aim of this study was to evaluate the response rate and incidence of BiPN following one-hour IV infusion of bortezomib. The data was retrospectively collected from MM patients who had been treated with IV administration of bortezomib for one hour. Twenty-three patients were evaluated (median age 72 years, 13 males). The median number of treatment cycles was 5 (range 2–10). The cumulative bortezomib dose was 26.0 mg/m2 (14.3–66.3) and percent of actual per expected cumulative dose was 90% (50–100). The overall response (complete response plus partial response) rate was 65%. The incidence of BiPN was 57% (n = 13) and incidence of severe neuropathy was 4% (n = 1). One-hour IV infusion of bortezomib was an effective regimen for MM with reduced incidence of severe BiPN. This route of administration of bortezomib could be an alternative mode of delivery for patients with severe injection site reactions following SC administration.

Highlights

With respect to patient outcomes in multiple myeloma (MM), there have been significant improvements after the discovery of novel induction agents, including bortezomib [1, 2]
Patients excluded from the study were as follows: (1) patients with dementia or other neurologic deficits which prevent expression of subjective neurologic symptoms, (2) patients who received less than 2 cycles of chemotherapy and could not measure the treatment response, and to these patients bortezomib-induced peripheral neuropathy (BiPN) should not be the reason of treatment cessation, and (3) patients diagnosed with peripheral neuropathy grade 3 or more according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) ver4.0 [10], before starting the bortezomib-based chemotherapeutic regimen
Twelve were relapsed or refractory MM (RRMM) patients to previous lines of chemotherapy, and among them 3 patients had been exposed to bortezomib

Summary

Introduction

With respect to patient outcomes in multiple myeloma (MM), there have been significant improvements after the discovery of novel induction agents, including bortezomib [1, 2]. Intravenous (IV) bolus injection of bortezomib, which is the standard mode of administration has limitations because of bortezomib-induced peripheral neuropathy (BiPN) [3, 4]. BiPN is one of the most common, often reversible, but significant side effects of bortezomib therapy, which leads to dose modification [3,4,5,6]. The typical form of neuropathy is largely sensory rather than motor and is in the feet rather than in the hands. The pathogenesis underlying BiPN is not precisely understood, most investigators agree that bortezomib induces sensory nerve injury in a dosedependent manner. The most significant risk factor of the onset or aggravation of BiPN is preexisting peripheral neuropathy

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