A 58-year-old woman with multiple myeloma is started on bortezomib-based therapy. She develops painful burning paresthesias in a stocking distribution. The MOST likely culprit agent and the recommended modification is:
- A Thalidomide-induced neuropathy; switch to lenalidomide
- B Bortezomib-induced peripheral neuropathy; switch from IV to subcutaneous administration and dose-reduce ✓
- C Dexamethasone-induced myopathy; reduce steroid dose
- D Lenalidomide-induced DVT; start anticoagulation
Correct answer: B. Bortezomib-induced peripheral neuropathy; switch from IV to subcutaneous administration and dose-reduce
Explanation
Bortezomib causes a predominantly sensory, painful peripheral neuropathy that is dose-limiting. Switching from intravenous to subcutaneous bortezomib significantly reduces neuropathy rates (incidence ~33% IV vs ~24% SC) while maintaining efficacy, as demonstrated in the MMY-3021 trial. Dose reduction or discontinuation may also be necessary. Thalidomide also causes neuropathy, but bortezomib is the agent described here.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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