Therapeutic Classification: antineoplastics
Pharmacologic Classification: proteasome inhibitors
Absorption: IV administration results in complete bioavailability.
Distribution: Widely distributed to tissues.
Metabolism/Excretion: Mostly metabolized by the liver via the CYP2C19, CYP3A4, and CYP1A2 isoenzymes, and to a lesser extent by the CYP2D6 and CYP2C9 isoenzymes; excretion pathway unknown.
Half-Life: 9–15 hr.
Previously Untreated Multiple Myeloma
- IV SC (Adults ): 1.3 mg/m2 twice weekly for Cycles 1–4 (days 1, 4, 8, 11, 22, 25, 29, and 32; no treatment during cycle 3), then once weekly for Cycles 5–9 (days 1, 8, 22, and 29; no treatment during Cycle 7); further cycles/doses depend on response and toxicity.
Hepatic Impairment
- IV (Adults ): Moderate or severe hepatic impairment: 0.7 mg/m2 per injection for the first cycle, then may ↑ to 1 mg/m2 per injection or ↓ further to 0.5 mg/m2 per injection, based on tolerability.
Previously Untreated Mantle Cell Lymphoma
- IV SC (Adults ): 1.3 mg/m2 twice weekly on days 1, 4, 8, and 11, followed by a 10-day rest (days 12–21); repeat for 5 additional cycles; further cycles/doses depend on response and toxicity.
Hepatic Impairment
- IV (Adults ): Moderate or severe hepatic impairment: 0.7 mg/m2 per injection for the first cycle, then may ↑ to 1 mg/m2 per injection or ↓ further to 0.5 mg/m2 per injection, based on tolerability.
Relapsed Multiple Myeloma and Mantle Cell Lymphoma
- IV SC (Adults ): 1.3 mg/m2 twice weekly for 2 wk (days 1, 4, 8, and 11), followed by a 10-day rest; further cycles/doses depend on response and toxicity. Patients with multiple myeloma who have previously responded to bortezomib therapy and who have relapsed ≥6 mo after prior bortezomib therapy can be started on their last tolerated dose; dose should be given twice weekly (days 1, 4, 8, and 11) every 3 wk for a maximum of 8 cycles.
Hepatic Impairment
- IV (Adults ): Moderate or severe hepatic impairment: 0.7 mg/m2 per injection for the first cycle, then may ↑ to 1 mg/m2 per injection or ↓ further to 0.5 mg/m2 per injection, based on tolerability.
