NEW PROPOSED DOSE MODIFICATION GUIDELINE FOR BORTEZOMIB

Severity of PN Signs and Symptoms
Grade 1 (parasthesias, weakness, and/or loss of reflexes) without pain or loss of function
Modification of Bortezomib Dose and Regimen
Reduce current bortezomib dose by one level (1.3 1.0 -> 0.7 mg/m2) OR for patients receiving a twice-weekly schedule, change to a once-a-week schedule using the same dose
Consider starting with 1.3 mg/m2 once per week in patients with history of prior PN

Severity of PN Signs and Symptoms
Grade 1 with pain or
Grade 2 with no pain but limiting instrumental activities of daily living
Modification of Bortezomib Dose and Regimen
For patients receiving twice-weekly bortezomib, reduce current dose by one level, or change to once-per-week schedule using the same dose
For patients receiving bortezomib on a once-per-week schedule: reduce current dose y one level, OR consider temporary discontinuation. Upon resolution (grade</=1), restart once-per-week dosing at lower dose level in cases of favorable benefit-to-risk ratio

Severity of PN Signs and Symptoms
Grade 2 with pain
Grade 3 limiting self care and activities of daily living, or
Grade 4 disabling
Modification of Bortezomib Dose and Regimen
Discontinue bortezomib