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Composition of Velcade 3,5.
Velcade consists of bortezomib, additional substances – mannitol and nitrogen.
Bortezomib has an inhibitory effect on 26S-proteasomes. Thus, homeostasis is stabilized inside the cells of the body. Preventing the activity of the proteasome in the cell, the remedy helps to prevent selective proteolysis and affects signal transmission.
Velcade helps slow down the growth of pathological cells and the tumor as a whole.
Indications for using.
Velcade is recommended for the treatment of mantle cell lymphoma (subject to prior treatment) and multiple myeloma.
Mode of application.
The remedy Velcade is intended for intravenous or subcutaneous injections. For intravenous manipulation lyophilizate should be diluted to 1 mg / ml, for subcutaneous injections to – 2.5 mg / ml.
To raise the lyophilizate it is necessary, using only physiological solution. After dilution the preparation becomes transparent, colorless, without mechanical inclusions.
Before intravenous introduction to obtain a solution of 1 mg / ml, the remedy in the vial is diluted using 2.5 ml of saline. For the subcutaneous injection Velcade vial is diluted with 1.4 ml of saline solution, as a result, a solution with a concentration of 2.5 mg / ml. Subcutaneous introduction should be done every time in different areas (hips, abdomen). If allergic reactions are observed during subcutaneous manipulation, the concentration of the administered solution should be reduced to 1 ml / ml.
In the treatment of oncological pathology, only the Velcade solution is injected intravenous or a stream intravenous in 3-5 seconds. The treatment cycle consists of 4 manipulations in 14 days (1, 4, 8, 11 days). The dose of bortezomib should be calculated at 1.3 mg per m2 of the skin of the patient at one time. The minimum interval between manipulations should be 72 hours. After the 4th injection, you should do a 10-day break (12-21 days) and start the treatment cycle anew.
Evaluation of the effectiveness of treatment can be done after 3-5 cycles.
When prescribing treatment for more than 8 cycles, you can use maintenance therapy lasting 4 weeks. Injections are carried out on days 1, 8, 15 and 22, after a 13-day break (23-35 days).
In the absence of effectiveness from treatment with Velcade as a monotherapy, you can combine treatment with dexamethasone. The administration of dexamethasone should be carried out at 1, 2, 4, 5, 8, 9, 11 and 12-day for 20 mg.
With the development of hematological complications of grade 3 and 4 (except for neuropathy), treatment with Velcade should be temporarily stopped. After the patient feels normal, the treatment is continued with a reduced dose of 1-0.7 mg / m2).
With peripheral neuropathy of the first degree without pain, correction of the dose is not necessary. At the first degree with pain and second degree without disturbance of daily activity, the dose of bortezomib is reduced to 1 mg / m2. At grade 2 with pain and grade 3, the treatment is stopped until symptoms disappear, after – the dose is reduced to 0.7 mg / m2, and injections are given once a week. Patients with a fourth degree of peripheral neuropathy are contraindicated in treatment with Velcade.
Patients with moderate and severe liver failure with a bilirubin concentration between 1.5 – 3.0 x Congenital Adrenal Hyperplasia and more than a dose of Velcade are reduced to 0.7 mg / m2.
In complex therapy, Velcade is used with Prednisolone and Melphalan. Treatment is carried out in 9 cycles of 6 weeks. The first 4 cycles of Velcade are administered two times a week (1, 4, 8, 11, 22, 25, 29 and 32 days). From 5 to 9 cycle of the remedy is administered one time per week (1, 8, 22 and 29 days).