Tolerability of Velcade (Bortezomib) subcutaneous administration using a maximum volume of 3 mL per injection site.
Subcutaneous injection is now commonly used as a standard for bortezomib administration. The bortezomib (Velcade(®)) product monograph recommends that intravenous injections be prepared at a concentration of 1 mg/mL, while subcutaneous injections may be prepared at a concentration of 2.5 mg/mL. Many institutions and subcutaneous administration guidelines use 2 mL as the maximum volume for subcutaneous injection. Using 2 mL as the maximum volume for injection would mean that many patients receiving bortezomib will receive two injections during each visit with common dosing parameters. In this prospective study evaluating a change to subcutaneous administration, bortezomib 1 mg/mL was administered subcutaneously at a higher maximum of 3 mL per injection site. For 57 individual patients, 339 doses were administered. Skin reactions were noted in 42% with all reactions being Grade 1 or 2. Patients tolerated subcutaneous injections well and only four patients were switched back to intravenous route. This is the first time that subcutaneous bortezomib of a volume up to a maximum of 3 mL (bortezomib 3 mg) per injection site has been reported. This higher single dose is well tolerated with limited skin reactions, no significant hypotension and facilitates ease of administration with only 5 patients needing two injections per visit. If the maximum volume for injection was kept at 2 mL, a total of 46 patients would have received two injections per visit.
Dept. of Pharmacy, Princess Margaret Cancer Centre, UHN Toronto, ON Pamela.Ng@uhn.ca.
Pamela
P
Ng
Dept. of Nursing, Princess Margaret Cancer Centre, UHN, Toronto, ON.
Diana
D
Incekol
Dept. of Pharmacy, Princess Margaret Cancer Centre, UHN Toronto, ON.
Roy
R
Lee
Dept. of Nursing, Princess Margaret Cancer Centre, UHN, Toronto, ON.
Emma
E
Paisley
Dept. of Pharmacy, Princess Margaret Cancer Centre, UHN Toronto, ON.
Celina
C
Dara
Dept. of Nursing, Princess Margaret Cancer Centre, UHN, Toronto, ON.
Ian
I
Brandle
Dept. of Nursing, Princess Margaret Cancer Centre, UHN, Toronto, ON.
Marina
M
Kaufman
Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, UHN, Toronto, ON.
Christine
C
Chen
Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, UHN, Toronto, ON.
Suzanne
S
Trudel
Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, UHN, Toronto, ON.
Rodger
R
Tiedemann
Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, UHN, Toronto, ON.
Donna
D
Reece
Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, UHN, Toronto, ON.
Vishal
V
Kukreti
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D000069286:Bortezomib / Q000008:administration & dosage* / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D003875:Drug Eruptions / Q000175:diagnosis; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged
D000970:Antineoplastic Agents; D000069286:Bortezomib
3 mL; Subcutaneous; bortezomib; injection; maximum volume