[Twi]

Velcade subcu injection - thigh/belly/arm?

by Twi on Fri Nov 16, 2012 12:57 pm

I have searched the forums for information regarding this and would like to revisit this topic again.

My mother (age 73, IgG kappa multiple myeloma diagnosed in May 2012) recently started weekly Velcade subcu injection along with a short IV of dex. She has had 2 treatments.

When the chemo room nurse went to give my Mom her first Velcade shot, she asked her where she wanted it. Having researched Vel/dex, I was aware that the makers of Velcade recommend belly/thigh. I brought the usual sites up, and the nurse said, nope, we give it wherever the patient wants it. My Mom chose her arm. She has very little subcutaneous fat anywhere on her body.

She has had no issues at all so far with the injection site - no redness, welts, itching, rash, etc. She does experience a significant burning sensation upon injection but so far that is short-lived.

I contacted Millenium, the maker of Velcade. They said all data they have on subcu Velcade is based ONLY on injections given in belly/thigh. They said that they could not comment one way or the other as to the efficacy of having the injection in the arm simply because they do not have any data to support any response to that question. She did say that there are such varying responses to subcu Velcade (some respond well, some do not, some are in the middle) that if one were to not respond well to Velcade subcu in the arm, that not responding could not specifically be attributed to the injection being in the arm. In short - they could give no definitive answer to my questions.

I am seeking out your experiences as well as the input of any multiple myeloma doctors who frequent this forum.

Are those of you who are having the subcu Velcade injection in your ARM having a good response?

What about those of you who switched from belly/thigh to arm - are you still having good results with your multiple myeloma markers?

Last question - for anyone who is on subcu Velcade/dex (and no other agents) - do you recall your time to response or how many cycles you went through before achieving partial/complete/any type of remission? Millenium also has no information on this - at least that they can give out to the lay person.

Thank you!

[Dr. Edward Libby]

Re: Velcade subcu injection - thigh/belly/arm?

by Dr. Edward Libby on Sat Nov 17, 2012 11:54 pm

Hello PurpleB,
This is an interesting question that comes up alot. From my perspective when one "fiddles" with the delivery technique (e.g. by moving the subcutaneous injection site to any part of the body) you risk having a response (and possibly a reaction) that does not correlate with the information that was gained from treating thousands of patients in the studies that led up to the approval of the drug.
In short the patient may have fewer side effects, more side effects or the same amount of side effects as giving it in the regions that were studied. In addition the absorption and effectiveness of the drug may be the same or different from that seen in the studies where the drug was always given in the belly or thigh. You simply do not know. Many hematologists/oncologists reasonably assume that things will be roughly the same in terms of side effects and response but you cannot be certain without studying the question.

So my short answer is that to get the results (in terms of both response and side effects) that previous research has shown one must give the drug as recommended.

[torimooney]

Re: Velcade subcu injection - thigh/belly/arm?

by torimooney on Thu Nov 22, 2012 1:42 am

Here's a question. I understand the Velcade is given in the belly or thigh because it is typically a fatty area. So if one has had a tummy tuck (fat removed from the area during the process) is the belly still the best area for Velcade sub q?