Subcutaneous Versus Intravenous Bortezomib

Barbee, Meagan S.; Harvey, R. Donald; Lonial, Sagar; Kaufman, Jonathan L.; Wilson, Nicole M.; McKibbin, Trevor; Hutcherson, Donald; Surati, Minal; Valla, Kelly; Shah, Katherine Sanvidge

doi:10.1177/1060028013503122

Cited by 34 publications

(18 citation statements)

References 18 publications

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“…SC administration also eliminates the need for IV access, reduces infusion chair times, cost and is preferred by patients. [30] The additional adverse effects of SC over IV administration are limited to a very low incidence of severe local site reactions. [17]…”

Section: Discussionmentioning

confidence: 99%

Neuropathy and efficacy of once weekly subcutaneous bortezomib in multiple myeloma and light chain (AL) amyloidosis

et al. 2017

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IntroductionRandomized studies have shown that bortezomib (BTZ) can be given weekly via intravenous (IV) route or twice weekly via subcutaneous (SC) route with lower neuropathy risk and no loss of anti-myeloma efficacy compared to original standard IV twice weekly schedule. Weekly SC should therefore yield the best therapeutic index and is widely used but has not been compared to established administration schedules in the context of a clinical trial.MethodsComprehensive electronic medical record review was done for disease control and neuropathy symptoms of 344 consecutive patients who received their first BTZ-containing regimen for myeloma or AL amyloidosis before or after we changed to SC weekly in December 2010. Univariate and multivariable analyses were carried out that adjusted for age, underlying disease, concurrently used anticancer agents, underlying conditions predisposing to neuropathy, and number of prior regimens compared SC weekly to other schedules.ResultsFifty-three patients received BTZ SC weekly, 17 SC twice weekly, 127 IV weekly and 147 IV twice weekly. Risk for neuropathy of any grade was higher with other schedules compared to SC weekly (44.3% vs. 26.9%, p = 0.001) while response rate was similar (72.1% vs. 76.6%, respectively, p = 0.15). Multivariable analyses upheld higher neuropathy risk (Odds ratio 2.45, 95% CI 1.26–4.76, p = 0.008) while the likelihood of not achieving a response (= partial response or better) was comparable (Odds ratio 1.25, 95% CI 0.58–2.71, p = 0.56) for other schedules compared to SC weekly, respectively. Lower neuropathy risk translated into longer treatment duration when BTZ was started SC weekly (p = 0.001).ConclusionsWeekly SC BTZ has activity comparable to other schedules and causes low rates of neuropathy.

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Section: Discussionmentioning

confidence: 99%

Neuropathy and efficacy of once weekly subcutaneous bortezomib in multiple myeloma and light chain (AL) amyloidosis

et al. 2017

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“…Barbee et al [19] surveyed MM patients in the clinic regarding their preferences on the route of administration between SC and IV bolus. Interestingly, not all patients preferred SC.…”

Section: Discussionmentioning

confidence: 99%

The Positive Effects of One-Hour Intravenous Administration of Bortezomib on Peripheral Neuropathy in Multiple Myeloma Patients

Jung

Kim

Han

et al. 2014

BioMed Research International

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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.

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“…These data indicate that SC bortezomib is associated with a higher median dose intensity per month, fewer dose reductions within 16 weeks, and longer time to dose reduction compared with IV bortezomib in previously untreated MM patients. Despite all of these findings, a very recent study conducted by Barbee et al41 was the first study to quantify the difference in efficiency practice variables and patient preferences regarding SC versus IV bortezomib in patients with MM. The study was divided into two parts consisting of mutually exclusive patients.…”

Section: Another Strategy To Improve Tolerability: Sc Administrationmentioning

confidence: 99%

Subcutaneous bortezomib for multiple myeloma treatment: patients’ benefits

Petrucci¹,

Finsinger²,

Chisini³

et al. 2014

PPA

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The use of novel agents such as thalidomide, lenalidomide, and bortezomib has considerably improved the outcome of multiple myeloma patients. Besides greater biological activity, these drugs unfortunately have also been associated with greater toxicity. To evaluate the positive effect on the quality of life of patients, driven by both the tolerability and antimyeloma activity of bortezomib, we analyzed data that have been published concerning different strategies used to improve its tolerability as once weekly and/or subcutaneous administration.

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Subcutaneous Versus Intravenous Bortezomib

Abstract: Subcutaneous administration of bortezomib is more time efficient for the patient and institution and is preferred by patients compared to intravenous bortezomib.

Cited by 34 publications

References 18 publications

Neuropathy and efficacy of once weekly subcutaneous bortezomib in multiple myeloma and light chain (AL) amyloidosis

Neuropathy and efficacy of once weekly subcutaneous bortezomib in multiple myeloma and light chain (AL) amyloidosis

The Positive Effects of One-Hour Intravenous Administration of Bortezomib on Peripheral Neuropathy in Multiple Myeloma Patients

Subcutaneous bortezomib for multiple myeloma treatment: patients’ benefits

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Subcutaneous Versus Intravenous Bortezomib

Abstract: Subcutaneous administration of bortezomib is more time efficient for the patient and institution and is preferred by patients compared to intravenous bortezomib.

Cited by 34 publications

References 18 publications

Neuropathy and efficacy of once weekly subcutaneous bortezomib in multiple myeloma and light chain (AL) amyloidosis

Neuropathy and efficacy of once weekly subcutaneous bortezomib in multiple myeloma and light chain (AL) amyloidosis

The Positive Effects of One-Hour Intravenous Administration of Bortezomib on Peripheral Neuropathy in Multiple Myeloma Patients

Subcutaneous bortezomib for multiple myeloma treatment: patients&rsquo; benefits

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Subcutaneous bortezomib for multiple myeloma treatment: patients’ benefits