PDF of Forum 1012I recently heard about administering bortezomib (Velcade) subcutaneously. Are there any recommendations on this? —Robert Darnell, RN, OCN

Subcutaneous administration of bortezomib (Velcade) was compared to IV administration of the drug in the phase 3 MMY-3021 noninferiority study.1 A 52% response rate was demonstrated in each arm after 10 cycles, including 23% and 22% complete response or near-complete response with subcutaneous and IV administration, respectively. Results included time to progression, median 9.7 months versus 9.6 months (hazard ratio [HR] 0.872, P = .462); progression-free survival, median 9.3 months versus 8.4 months (HR 0.846, P = .319); and overall survival at 1-year, 76.4% versus 78% (P = .788). Incidence of peripheral neuropathy was significantly lower with subcutaneous administration versus IV administration (all grades: 38% vs. 53%, P = .44; grade ≥2: 24% vs. 41%, P = .012; grade ≥3: 6% vs. 16%, P = .026).1

The researchers concluded subcutaneous administration of bortezomib is noninferior to IV administration of bortezomib, and can be used as a treatment option in patients.1 The subcutaneous route did not impact efficacy and improved tolerability in regard to peripheral neuropathy. If the subcutaneous route is used, note that reconstitution and subsequent concentration is different depending on the route of administration. The final concentration of bortezomib is 2.5 mg/ml for subcutaneous administration versus 1 mg/ml for IV administration. —Sandra Cuellar, PharmD, BCOP

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1. Arnulf B, Pylypenko H, Grosicki S, et al. Updated survival analysis of a randomized, phase 3 study of subcutaneous versus intravenous bortezomib in patients with relapsed multiple myeloma [published online ahead of print June 11, 2012]. Haematologica. 2012.

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