Can bortezomib be safely injected in the comfort of patients own home?

This article investigated the safety and effectiveness of subcutaneous (under the skin) injection at home of bortezomib (Velcade) in elderly and frail patients on the bortezomib–melphalan–prednisone (VMP) regimen. The authors concluded that domestic injection of bortezomib is safe and can significantly improve the quality of life of patients.  

Multiple myeloma (MM) is a cancer of plasma cells. These are a type of white blood cell normally responsible for producing antibodies. The current approach for elderly patients includes 9 cycles of chemotherapy with the VMP regime. However, most or all elderly patients are too frail to make it into the hospital and have poor venous access for the administration of the medication. 

An alternative treatment method is an out-patient program with subcutaneous (SC) injection of bortezomib. However, the effectiveness and safety of subcutaneous bortezomib in a comfortable home setting avoiding unnecessary transfer to the hospital are still under investigation.

This study involved 63 frail patients with MM. Patients received bortezomib SC injections at home and prednisone and melphalan tablets. Patients were followed up for an average of 34.5 months.

Overall, 59 patients (93.6%) received all the doses of the VMP cycles at home. Out of 45 patients who completed at least two cycles, the overall response rate was 72%. 32% of these patients had a complete remission (no evidence of disease), 22% had a very good partial remission (some disease still present) and 18% had partial remissions. Another 18% of these patients had a stable control of disease, while one patient progressed (cancer kept growing) after five cycles. 

The most common side effects reported included low platelet count (cells involved in blood clotting), anemia, nausea, diarrhea, vomiting, lung infection, and herpes zoster (a painful skin rash with blisters). 

The authors concluded that the subcutaneous injection of bortezomib in the patients' home setting is safe and effective in patients with MM. 

This study included a very small number of patients from a single medical institution.