Most patients receive pretransplant induction regimens that include bortezomib, and we were curious — after a landmark study several years ago demonstrated the feasibility of subcutaneous rather than intravenous (IV) bortezomib — whether this approach is used in induction treatment. We found that more than 80% of oncologists and the faculty generally administer bortezomib subcutaneously, mostly on a twice-weekly schedule, although Dr Vij notes that the equivalence in efficacy to IV treatment has been demonstrated only in the relapsed setting. Dr Munshi notes that when a rapid response is needed — for example, in patients with renal failure — IV administration might be preferred initially.

Moreau P et al. Subcutaneous versus intravenous administration of bortezomib in patients with relapsed multiple myeloma: A randomised, phase 3, non-inferiority study. Lancet Oncol 2011;12(5):431-40. Abstract

Arnulf B et al. Updated survival analysis of a randomized phase III study of subcutaneous versus intravenous bortezomib in patients with relapsed multiple myeloma. Haematologica 2012;97(12):1925. Abstract