The treatment choices for patients with newly diagnosed myeloma have been evolving and are now significantly different from options available just 5 years ago. Subsequently, the role of the oncology nurse in managing patients with myeloma has also changed significantly.

The proteasome inhibitor (PI) bortezomib for the treatment of myeloma was originally used to treat patients with relapsed disease. Today, this agent is used to treat patients with newly diagnosed disease who are both transplant-eligible and transplant-ineligible. In addition, bortezomib is considered an important backbone therapy for all stages of the disease, according to a review article published in Cancer Management and Research.1

“In the early studies, dose intensity was considered important (twice weekly dosing via intravenous route). More recent studies have shown a less intensive regimen (weekly dosing via subcutaneous route) enables patients to stay on therapy for many months,” said review author Faith Davies, MD, who is with the Myeloma Institute at the University of Arkansas for Medical Sciences, Little Rock, Arkansas.

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Bortezomib was the first PI to demonstrate antimyeloma properties and it was approved in 2003. Dr Davies and her colleagues reviewed some of the key trials that support the use of bortezomib in myeloma in a variety of patients, including those on dialysis. “Although bortezomib has been used for a number of years for the treatment of myeloma, a number of recent studies have confirmed its continuing central place in the disease management. The aim of this article is to try and explain how the evidence for its use has developed and to put some of the newer studies in context,” Dr Davies told Oncology Nurse Advisor.

For example, newer studies are showing that there may be an advantage with triple therapy with bortezomib compared with dual therapy with bortezomib. However, with these combination therapies, it is vital that proactive steps are taken to prevent grade toxicities (grade 1) from becoming higher grade (grade 2 or 3).