Why do you consider VELCADE (bortezomib) for the treatment of previously untreated multiple myeloma?

Efficacy and safety experience with subcutaneous administration of VELCADE

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Why do you consider VELCADE® (bortezomib) for the treatment of previously untreated multiple myeloma?
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Dr. David Siegel

VELCADE® (bortezomib)+MP demonstrated greater overall survival (OS) and efficacy across key endpoints vs MP in previously untreated multiple myeloma

VELCADE (bortezomib)+MP* Delivered >1-year Sustained Overall Survival Advantage

  • Median OS of 56.4 months for VELCADE (bortezomib)+MP vs median OS of 43.1 months for MP (HR=0.695 [95% CI, 0.57-0.85]; p<0.05; 60.1-month median follow-up)
  • At a 3-year median follow-up, VELCADE+MP provided an overall survival advantage over MP that was not regained with subsequent therapies
    • Of the 69% of MP patients who received subsequent therapies, 50% received VELCADE or VELCADE-containing regimen1
  • Results achieved using twice-weekly followed by weekly dosing for a median of 50 weeks (54 weeks planned)1
  • The most commonly reported adverse reactions (ARs) for VELCADE+MP (n=340) vs MP alone (n=337) were thrombocytopenia (48% vs 42%), neutropenia (47% vs 42%), peripheral neuropathy (46% vs 1%), nausea (39% vs 21%), diarrhea (35% vs 6%), neuralgia (34% vs <1%), anemia (32% vs 46%), and leukopenia (32% vs 28%)


Learn more about the safety and tolerability of a 1-year course of VELCADE-based therapy

With Longer Duration of VELCADE (bortezomib), Responses Deepened

How does the duration of VELCADE® (bortezomib) treatment impact treatment outcomes in patients with multiple myeloma?
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Suzanne R. Fanning

28% of CRs were achieved after 24 weeks of therapy.2

  • Significantly superior response rates were demonstrated in the initial VISTA analysis (16.3-month median follow-up)
    • Overall response rate (ORR) was 69% with VELCADE (bortezomib)+MP vs 34% with MP (p<0.0000000001)
    • Complete response (IF-) was 30% with VELCADE+MP vs 4% with MP (p<0.0000000001)4
  • Discontinuations due to adverse reactions were 11% for VELCADE combination and 10% for MP alone5
  • A total of 25% of patients in the treatment group receiving VELCADE+MP experienced serious ARs vs 18% in the treatment group receiving MP. The most commonly reported serious ARs with VELCADE+MP vs MP alone included pneumonia (5% vs 4%), diarrhea (4% vs 0%), thrombocytopenia (3% vs 1%), vomiting (3% vs <1%), nausea (2% vs <1%), anemia (2% vs 2%), herpes zoster (2% vs <1%), and dehydration (2% vs <1%)6

Indications and Important Safety Information for VELCADE® (bortezomib)

  • INDICATIONS: VELCADE (bortezomib) is indicated for the treatment of patients with multiple myeloma and patients with mantle cell lymphoma.

  • CONTRAINDICATIONS: VELCADE is contraindicated in patients with hypersensitivity (not including local reactions) to bortezomib, boron, or mannitol, including anaphylactic reactions. VELCADE is contraindicated for intrathecal administration. Fatal events have occurred with intrathecal administration of VELCADE.

    VELCADE (bortezomib) is for subcutaneous or IV administration only. Because each route of administration has a different reconstituted concentration, caution should be used when calculating the volume to be administered.

    • Peripheral neuropathy, including severe cases, may occur. Patients should be monitored for symptoms and managed with dose modification or discontinuation. Patients with preexisting symptoms may experience worsening peripheral neuropathy (including ≥Grade 3). Starting with VELCADE subcutaneously may be considered for patients who either have preexisting or are at high risk for peripheral neuropathy.

    • Hypotension: Caution should be used when treating patients receiving antihypertensives, those with a history of syncope, and those who are dehydrated.

    • Cardiac toxicity, including acute development or exacerbation of congestive heart failure and new onset of decreased left ventricular ejection fraction, has occurred. Isolated cases of QT-interval prolongation have been reported. Patients with risk factors for, or existing, heart disease should be closely monitored.

    • Pulmonary toxicity: Acute respiratory distress syndrome (ARDS) and acute diffuse infiltrative pulmonary disease of unknown etiology have occurred (sometimes fatal). Pulmonary hypertension, in the absence of left heart failure or significant pulmonary disease, has been reported. In the event of new or worsening cardiopulmonary symptoms, consider interrupting VELCADE until a prompt and comprehensive diagnostic evaluation is conducted.

    • Posterior reversible encephalopathy syndrome has occurred. Consider MRI imaging for onset of visual or neurological symptoms; discontinue VELCADE if suspected.

    • Gastrointestinal toxicity, including nausea, diarrhea, constipation, and vomiting, has occurred and may require use of antiemetic and antidiarrheal medications or fluid replacement. Interrupt VELCADE (bortezomib) for severe symptoms.

    • Thrombocytopenia/Neutropenia: Manage with dose and/or schedule modifications. Complete blood counts should be monitored frequently during treatment. There have been reports of gastrointestinal and intracerebral hemorrhage. Support with transfusions and supportive care, according to published guidelines.

    • Tumor lysis syndrome: Closely monitor patients with high tumor burden and take appropriate precautions.

    • Hepatic toxicity: Monitor hepatic enzymes during treatment. Upon occurrence, interrupt therapy with VELCADE to assess reversibility.

    • Embryo-fetal risk: Women should avoid breast-feeding or becoming pregnant while on VELCADE.

    • Patients with diabetes may require close monitoring and adjustment of the antidiabetic medications.

  • DRUG INTERACTIONS: Closely monitor patients receiving VELCADE (bortezomib) in combination with strong CYP3A4 inhibitors. Avoid concomitant use of strong CYP3A4 inducers.


    • Previously untreated multiple myeloma (MM): In the phase 3 study of VELCADE administered intravenously with melphalan and prednisone (MP) vs MP alone, the most commonly reported adverse reactions (ARs) were thrombocytopenia (48% vs 42%), neutropenia (47% vs 42%), peripheral neuropathy (46% vs 1%), nausea (39% vs 21%), diarrhea (35% vs 6%), neuralgia (34% vs <1%), anemia (32% vs 46%), and leukopenia (32% vs 28%).

    • Relapsed MM subcutaneous vs IV: In the phase 3 study of VELCADE (bortezomib) administered subcutaneously vs intravenously in relapsed MM, safety data were similar between the two treatment groups. The most commonly reported ARs in the subcutaneous vs IV treatment groups were peripheral neuropathy (37% vs 50%) and thrombocytopenia (30% vs 34%). The incidence of serious ARs was similar in the subcutaneous treatment group (20%) and the IV treatment group (19%). The most commonly reported serious ARs were pneumonia and pyrexia (each 2%) in the subcutaneous treatment group and pneumonia, diarrhea, and peripheral sensory neuropathy (each 3%) in the IV treatment group.

    • Previously untreated mantle cell lymphoma (MCL): In a phase 3 study of VELCADE administered intravenously with rituximab, cyclophosphamide, doxorubicin, and prednisone (VR-CAP) vs vincristine, rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHOP), the most commonly reported ARs were neutropenia (87% vs 71%), thrombocytopenia (72% vs 17%), leukopenia (48% vs 36%), anemia (44% vs 29%), lymphopenia (28% vs 12%), peripheral neuropathy (30% vs 27%), diarrhea (25% vs 5%), nausea (23% vs 12%), and pyrexia (20% vs 10%).

    • Relapsed MM and MCL: In the integrated analysis of 1163 patients in phase 2 and 3 studies of VELCADE administered intravenously, the most commonly reported ARs were nausea (49%), diarrhea NOS (46%), fatigue (41%), peripheral neuropathy NEC (38%), and thrombocytopenia (32%). A total of 26% of patients experienced serious ARs. The most commonly reported serious ARs included diarrhea, vomiting, and pyrexia (each 3%); nausea, dehydration, and thrombocytopenia (each 2%); and pneumonia, dyspnea, peripheral neuropathies NEC, and herpes zoster (each 1%).

  • Please see full Prescribing Information available at www.VELCADE.com

View full U.S. Prescribing Information


VISTA TRIAL: a randomized, open-label, international phase 3 trial (N=682) evaluating the efficacy and safety of VELCADE administered intravenously in combination with melphalan+prednisone (MP) vs MP in previously untreated multiple myeloma. After progressive disease was established, all patients were eligible to receive subsequent therapies.1 The primary endpoint was TTP. Secondary endpoints were CR, ORR, PFS, and overall survival. At a prespecified interim analysis (median follow-up 16.3 months), VELCADE+MP resulted in significantly superior results for TTP (median 20.7 months with VELCADE+MP vs 15.0 months with MP [p=0.000002]), PFS, overall survival, and ORR. Further enrollment was halted, and patients receiving MP were offered VELCADE in addition. Updated analyses were performed.

Responses were based on criteria established by the European Group for Blood and Marrow Transplantation.2

References: 1. Mateos M-V, Richardson PG, Schlag R, et al. Bortezomib plus melphalan and prednisone compared with melphalan and prednisone in previously untreated multiple myeloma: updated follow-up and impact of subsequent therapy in the phase III VISTA trial. J Clin Oncol. 2010;28(13):2259-2266. 2. Harousseau J-L, Palumbo A, Richardson PG, et al. Superior outcomes associated with complete response in newly diagnosed multiple myeloma patients treated with nonintensive therapy: analysis of phase 3 VISTA study of bortezomib plus melphalan-prednisone versus melphalan-prednisone. Blood. 2010;116(19):3743-3750. 3. San Miguel JF, Schlag R, Khuageva NK, et al. VISTA Trial Investigators. Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. N Engl J Med. 2008;359(9):906-917. 4. Data on file 42, Millennium Pharmaceuticals, Inc. 5. Data on file 53, Millennium Pharmaceuticals, Inc. 6. Data on file 48, Millennium Pharmaceuticals, Inc.

Important Safety Information for VELCADE® (bortezomib)