Velcade®, thalidomide and dexamethasone (VTD) and myeloma Infoguide

This Infoguide provides information about Velcade® (bortezomib), thalidomide and dexamethasone (VTD), a treatment combination used in myeloma.

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VTD is a treatment combination for myeloma. It is often referred to as ‘chemotherapy’ or ‘chemo’, but it is
actually a combination of three different types of drugs:

  • Velcade® (bortezomib) – a proteasome inhibitor;
  • Thalidomide – an immunomodulatory drug;
  • Dexamethasone – a steroid.

These three drugs have different but synergistic and complementary mechanisms of action. This means they work in different ways but when given together they are much more effective at killing myeloma cells than if they were given alone.

Velcade works by switching off the ‘dustbin’ within cells, causing them to become full of waste and die. It affects myeloma cells more than healthy cells.

Velcade can be given either through an infusion into a vein or by a small injection under the skin. Injecting Velcade under the skin has become much more popular since it was found to reduce a
common side effect of Velcade.

Fatigue, painful tingling or numbness in the hands and feet, nausea and vomiting and diarrhoea/constipation are common side effects of Velcade. Side effects can be prevented or managed with a range of supportive treatments or with dosing adjustments.

Green tea and vitamin C may stop Velcade from working. Patients should therefore avoid drinking green tea and taking vitamin C supplements when on VTD treatment.

Thalidomide works in several ways, but mainly by encouraging the body’s natural defence system to attack myeloma cells. Thalidomide is a tablet that is taken every day during your VTD treatment.

Drowsiness, skin rashes, odd or tingling sensations in the hands or feet, constipation and/or diarrhoea can be side effects of thalidomide. It can also cause blood clots, particularly in the legs. Side effects can be prevented or managed with a range of supportive treatments or with dosing adjustments.

Thalidomide can interfere with other drugs and herbal remedies, and so you should always tell your doctor about anything else you are taking.

Dexamethasone is a steroid drug that helps to kill myeloma cells. As steroids are anti-inflammatory drugs, dexamethasone can also help to reduce the pain associated with myeloma bone disease.

Dexamethasone is a tablet that is generally taken on the same day as Velcade and the day after.

Mood changes, insomnia, indigestion, feeling hungry more often and getting infections more easily can all be side effects of dexamethasone. Side effects can be prevented or managed with a range of supportive treatments or with dosing adjustments.

VTD is approved for use on the NHS as an induction treatment prior to high-dose therapy and stem cell transplantation (HDTSCT) as part of initial treatment for younger and/or fitter myeloma patients.