Common chemotherapy side effects of bortezomib and how to alleviate them

Bortezomib is a first-in-class proteasome inhibitor widely used in the treatment of hematological malignancies such as multiple myeloma and mantle cell lymphoma. As a new type of targeted chemotherapy drug, although the side effects of bortezomib are easier to control than traditional cytotoxic chemotherapy drugs, it may still cause a series of chemotherapy-related adverse reactions in practical applications. Understanding the common types of side effects and scientific mitigation measures can help patients better adhere to treatment and improve their quality of life and treatment compliance.

1. Common side effects 1: Peripheral neuropathy

Peripheral neuropathy is one of the most common and characteristic side effects of bortezomib. It manifests as numbness, tingling, burning sensation, and hypoesthesia in the limbs, which sometimes affects the patient's walking and daily activities. The incidence rate can reach 30%-40% , especially when the cumulative dose is higher, the risk increases.

Mitigation measures:

Early monitoring: Patients should inform their doctor before each cycle if symptoms such as numbness and tingling occur. Once they occur, the severity needs to be assessed in a timely manner.

Dosage adjustment: Mild symptoms can continue to be treated but close observation is required; moderate to severe symptoms usually require lowering the dose or extending the dosing interval, and in severe cases, medication can be suspended.

Adjuvant treatment: You can consider using vitamins B1, B6, folic acid, gabapentin or pregabalin and other drugs to relieve the symptoms of neuropathy. If necessary, refer to the neurology department for further treatment.

Adjustment of administration method: Subcutaneous injection of bortezomib is less likely to cause neurotoxicity than intravenous injection, and subcutaneous injection is often chosen in clinical practice.

2. Common side effects 2: Gastrointestinal reactions

Some patients experience gastrointestinal symptoms such as nausea, vomiting, diarrhea or constipation after taking bortezomib. Although most are mild to moderate, if not treated in time, it will affect nutritional intake and overall treatment tolerance.

Mitigation measures:

Preventive medication: Antiemetics (such as ondansetron) can be used before treatment to reduce the occurrence of nausea and vomiting.

Dietary adjustment: It is recommended to eat light, easy-to-digest foods, eat small amounts frequently, and avoid greasy and irritating foods.

Hydration: Patients with diarrhea should replenish sufficient fluids and electrolytes to avoid dehydration.

Pharmaceutical intervention: Montmorillonite powder or loperamide can be used for diarrhea, and mild laxatives such as lactulose can be considered for constipation.

3. Common side effects 3: Bone marrow suppression

Bortezomib can cause a decrease in white blood cell, red blood cell and platelet counts, and may lead to neutropenia, anemia, bleeding tendency and other symptoms. This risk is even more prominent when combined with other chemotherapy drugs.

Mitigation measures:

Regular blood routine monitoring: Blood cell counts must be tested before each cycle to detect bone marrow suppression in a timely manner.

Supportive treatment: Depending on the type of cytopenia, recombinant human granulocyte stimulating factor (such asG-CSF), erythropoietin (EPO) or blood transfusion can be given.

Prevention of infection: People with leukopenia should pay special attention to infection protection, avoid going to crowded places, keep their mouth and skin clean, and seek medical treatment in time if they have a fever.

4. Common side effects 4: Fatigue and weakness

Many patients experience decreased physical strength, fatigue, or lack of concentration during treatment with bortezomib. This condition may be related to drug metabolic burden, bone marrow suppression, and psychological stress.

Mitigation measures:

Regular work and rest and moderate exercise: Ensuring adequate sleep and performing light activities such as walking can help improve your physical condition.

Nutritional support: Supplementing a high-protein, vitamin-rich diet can help restore physical strength.

Psychological counseling: Anxiety and depression are also important causes of fatigue. If necessary, psychological intervention or antidepressant drugs can be carried out.

5. Common side effects 5: Increased risk of infection

Bortezomib may suppress immune function and increase the risk of infection, especially in the leukocytopenia stage. Pneumonia, herpes zoster, and urinary tract infections are more common.

Mitigation measures:

Antiviral prevention: Acyclovir can be used prophylactically in the early stages of treatment to reduce the occurrence of herpes zoster.

Pay attention to hygiene: maintain personal hygiene, hand hygiene and oral care to reduce infection routes.

Once infected, take medication promptly: When symptoms such as fever, cough, frequent urination, etc. occur, you need to see a doctor promptly and receive anti-infective treatment.

6. Other less common side effects and treatment suggestions

In addition, bortezomib may also cause abnormal liver function, hypotension, arrhythmia and other less common side effects that require vigilance. Some patients may develop hyponatremia, hypoglycemia, or metabolic disorders, and electrolytes and liver and kidney function should be closely monitored.

For these adverse reactions, doctors usually develop an individualized adjustment plan based on the patient's basic medical history and current medication, and if necessary, suspend or change the treatment plan.

Overall, although bortezomib is an effective targeted anti-tumor drug, it still has certain chemotherapy side effects, especially neurotoxicity, gastrointestinal discomfort, and bone marrow suppression, which are common. Fortunately, most of these adverse reactions are reversible and can be controlled through dose adjustment, supportive treatment and standardized care. Patients should maintain close communication with their doctors during medication, report symptoms of discomfort in a timely manner, and cooperate with monitoring and intervention to ensure both treatment effectiveness and safety to the greatest extent.

Reference materials:https://www.drugs.com/

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