Bortezomib (Velcade) was the first in class, reversible proteosome inhibitor that is given parentetal.
The subcutaneous route is as effective as the IV route, but is associated with the risk of peripheral neuropathy.
Patients treated with bortezomib or other PI/ should be taking acyclovir or valacyclovir to suppress herpes virus reactivation.
Proteosome inhibitors are critical components of any regimen used to treat patients with high-risk myeloma or patients with renal failure.
Carfilzomib is a epoxy-ketone tetrapeptide that irreversibly binds and inhibits the proteosome.
It is administered intravenously and approved for relapsed and refractory myeloma patients who’ve been previously treated with lenalidomde and bortezomib.