BORTDEXADARA Treatment
This handout gives general information about this cancer treatment.
You will learn:
-
who to contact for help
-
what the treatment is
-
how it is given
-
what to expect while on treatment
This handout was created by Ontario Health (Cancer Care Ontario) together with patients and their caregivers who have also gone through cancer treatment. It is meant to help support you through your cancer treatment and answer some of your questions.
This information does not replace the advice of your health care team. Always talk to your health care team about your treatment.
My cancer health care provider is: _____________________________________________
During the day I should contact: _______________________________________________
Evenings, weekends and holidays: _____________________________________________
This page gives general information about this cancer treatment.
You will learn:
-
who to contact for help
-
what the treatment is
-
how it is given
-
what to expect while on treatment
This information was created by Ontario Health (Cancer Care Ontario) together with patients and their caregivers who have also gone through cancer treatment. It is meant to help support you through your cancer treatment and answer some of your questions.
This information does not replace the advice of your health care team. Always talk to your health care team about your treatment.
BORTDEXADARA is the code name of your multiple myeloma treatment regimen.
A regimen is a combination of medications to treat cancer.
This regimen name is made up of one or more letters from the names of the 3 medications in your treatment.
Here are the names of the medications in this regimen:
BORT = BORTezomib
DEXA = DEXAmethasone
DARA = DARAtumumab
For most people, the first part of the treatment (BORTDEXADARA) lasts 24 weeks. The treatment is divided into 8 cycles. Each cycle is 3 weeks long.
After BORTDEXADARA is completed, daratumumab alone (DARA) continues every 4 weeks. Your health care team will tell you how many cycles you need.
Here is a picture of the schedule for BORTDEXADARA treatment:
Cycle 1 BORT DEXA DARA (3 weeks)
Cycle 2 BORT DEXA DARA (3 weeks)
Cycle 3 BORT DEXA DARA (3 weeks)
Cycle 4 BORT DEXA DARA (3 weeks)
Cycle 5 BORT DEXA DARA (3 weeks)
Cycle 6 BORT DEXA DARA (3 weeks)
Cycle 7 BORT DEXA DARA (3 weeks)
Cycle 8 BORT DEXA DARA (3 weeks)
Bortezomib and dexamethasone may be given on a schedule that is different from what is shown on the calendars below. Speak with your health care team to see if the below schedule applies to you.
Cycles 1 to 3:
During each 3-week cycle you will have bortezomib and daratumumab treatment on days 1, 8, and 15 at the hospital. You will take dexamethasone tablets on days 1, 8, and 15 at home.
Each cycle looks like this:
Day 1
Treatment Day:
Go to the hospital for BORTDEXADARA treatment
Take your dexamethasone
2
No Treatment
3
4
5
6
7
8
Treatment Day:
Go to the hospital for BORTDEXADARA treatment
Take your dexamethasone
9
No Treatment
10
11
12
13
14
15
Treatment Day:
Go to the hospital for BORTDEXADARA treatment
Take your dexamethasone
16
No Treatment
17
18
19
20
21
Cycles 4 to 8:
During each 3-week cycle you will have bortezomib and daratumumab treatment on day 1, then bortezomib only on days 8 and 15 at the hospital. You will take dexamethasone tablets on days 1, 8 and 15 at home.
Each cycle looks like this:
Day 1
Treatment Day: Go to the hospital for BORTDEXADARA treatment
Take your dexamethasone
2
No Treatment
3
4
5
6
7
8
Treatment Day: Go to the hospital for BORTDEXA
treatment
Take your dexamethasone
9
No Treatment
10
11
12
13
14
15
Treatment Day: Go to the hospital for BORTDEXA
treatment
Take your dexamethasone
16
No Treatment
17
18
19
20
21
After 8 cycles of BORTDEXADARA, daratumumab alone (DARA) continues every 4 weeks.
For information on what to expect during the DARA treatment, refer to the daratumumab patient information sheet.
Remember To:
-
Tell your health care team about all of the other medications you are taking.
-
Keep taking other medications that have been prescribed for you, unless you have been told not to by your health care team.
You will have a blood test to check for hepatitis B before starting treatment. See the Hepatitis B and Cancer Medications pamphlet for more information.
Bortezomib is given under your skin using a small needle (subcutaneous or Subcut) or through an IV (injected into a vein). Daratumumab is given through an IV. This is done at the hospital.
You will have a blood test before each treatment cycle to make sure it is safe for you to get treatment.
Dexamethasone is given as tablets that you swallow.
-
Swallow dexamethasone tablets whole. Take them with a full glass of water either during or just after a meal.
-
If possible, take dexamethasone tablets in the morning right after eating breakfast.
To Prevent Infection from Herpes Zoster virus (shingles)
You may be given medication to take before your treatment to prevent infection from the Herpes Zoster virus.
- These are called anti-virals (such as acyclovir or valacyclovir)
To Prevent Infection from Bacteria
You may be given medication to take before your treatment to prevent infection.
- These are called antibiotics (such as trimethoprim-sulfamethoxazole).
To Prevent Hepatitis B Flare Ups
If you have ever been infected with hepatitis B, there is a risk that this treatment can cause it to flare up (come back). Tell your health care team if you have had hepatitis B. You may need to take medication to prevent a hepatitis B flare-up.
To Prevent an Allergic Reaction
You will be given medications before your treatment to help prevent allergic reactions before they start.
- There are different types of medications to stop allergic reactions. They are:
- antihistamines (such as diphenhydramine or Benadryl®)
- analgesics/antipyretics (such as acetaminophen or Tylenol®)
- H2 blockers (such as ranitidine or famotidine)
- corticosteroids (such as dexamethasone)
- medications to help prevent breathing problems. These medications reduce the swelling or narrowing of your airways (such as montelukast or inhalers)
To Prevent Nausea and Vomiting
You may be given medications to help prevent nausea (feeling like throwing up) and vomiting (throwing up) before they start.
- These are called anti-nausea medications and include medications such as prochlorperazine (Stemetil®), ondansetron (Zofran®), granisetron (Kytril®) or others.
To Prevent Tumor Lysis Syndrome (TLS)
TLS can happen when a large number of cancer cells die quickly and your body cannot get rid of them fast enough. TLS can make you very sick. Ask your health care team if you are at risk for TLS.
If you are at risk for TLS, you may be given medications before your BORTDEXADARA treatment to help prevent it.
- These are called anti-uricemics (such as allopurinol), or others.
-
DO tell your health care team about any other medical conditions that you have such as low or high blood pressure, bleeding problems, problems with nerves in hands and feet (numbness or tingling), heart, liver, lung or kidney problems, or any allergies.
-
DO tell your health care team about any serious infections that you have now or have had in the past.
-
DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.
-
DO monitor your blood sugar regularly if you are taking any medications for diabetes. This treatment may cause changes in your blood sugar levels.
-
DO talk to your health care team about your risk of getting other cancers and heart problems after this treatment.
-
DO tell your health care team if you have any new pain, numbness or tingling of your hands or feet. This is especially important if you are having trouble doing tasks (like doing up buttons, writing, walking) or if you have severe pain or numbness.
-
DO NOT take any other medications, such as vitamins (especially vitamin C), over-the-counter (non-prescription) drugs, or natural health products (such as green tea or any drinks or food that contains green tea) without checking with your health care team. Green tea and vitamin C supplements may make your treatment not work as well.
-
DO NOT start any complementary or alternative therapies, such as acupuncture or homeopathic medications, without checking with your health care team.
-
DO NOT eat or drink grapefruit, starfruit, Seville oranges or their juices (or products that contain these) while on this treatment. They may increase side effects.
-
DO NOT smoke or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.
-
DO tell your health care team about any other medical conditions that you have such as low or high blood pressure, bleeding problems, problems with nerves in hands and feet (numbness or tingling), heart, liver, lung or kidney problems, or any allergies.
-
DO tell your health care team about any serious infections that you have now or have had in the past.
-
DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.
-
DO monitor your blood sugar regularly if you are taking any medications for diabetes. This treatment may cause changes in your blood sugar levels.
-
DO talk to your health care team about your risk of getting other cancers and heart problems after this treatment.
-
DO tell your health care team if you have any new pain, numbness or tingling of your hands or feet. This is especially important if you are having trouble doing tasks (like doing up buttons, writing, walking) or if you have severe pain or numbness.
-
DO NOT take any other medications, such as vitamins (especially vitamin C), over-the-counter (non-prescription) drugs, or natural health products (such as green tea or any drinks or food that contains green tea) without checking with your health care team. Green tea and vitamin C supplements may make your treatment not work as well.
-
DO NOT start any complementary or alternative therapies, such as acupuncture or homeopathic medications, without checking with your health care team.
-
DO NOT eat or drink grapefruit, starfruit, Seville oranges or their juices (or products that contain these) while on this treatment. They may increase side effects.
-
DO NOT smoke or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.
Yes, the medications in this regimen can interact with other medications, vitamins, foods and natural health products. Interactions can make the treatment not work as well or cause severe side effects.
Tell your health care team about all of your:
- prescription and over-the-counter (non-prescription) medications
- natural health products such as vitamins, herbal teas, homeopathic medicines, and other supplements
Check with your health care team before starting or stopping any of them.
- Daratumumab may affect certain lab tests, such as the test for matching your blood type. This may happen for up to 6 months after your last daratumumab dose. Be sure your health care team and person doing the blood test know you are receiving or have received this medication within 6 months.
- Anti-inflammatory medications such as ibuprofen (Advil® or Motrin®), naproxen (Aleve®) or Aspirin®.
- Over-the-counter products such as dimenhydrinate (Gravol®)
- Natural health products such as St. John’s Wort
- Alcoholic drinks
- Tobacco
- All other drugs, such as marijuana or cannabis (medical or recreational)
-
Always check your temperature to see if you have a fever before taking any medications for fever or pain (such as acetaminophen (Tylenol®) or ibuprofen (Advil®)).
-
Fever can be a sign of infection that may need treatment right away.
-
If you take these medications before you check for fever, they may lower your temperature and you may not know you have an infection.
-
How to check for fever:
Keep a digital (electronic) thermometer at home and take your temperature if you feel hot or unwell (for example, chills, headache, mild pain).
-
You have a fever if your temperature taken in your mouth (oral temperature) is:
-
38.3°C (100.9°F) or higher at any time
-
-
OR
-
38.0°C (100.4°F) or higher for at least one hour.
-
If you do have a fever:
-
Try to contact your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
-
Ask your health care team for the Fever pamphlet for more information.
If you do not have a fever but have mild symptoms such as headache or mild pain:
- Ask your health care team about the right medication for you. Acetaminophen (Tylenol®) is a safe choice for most people.
Talk to your health care team before you start taking ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or ASA (Aspirin®), as they may increase your chance of bleeding or interact with your cancer treatment.
Talk to your health care team if you already take low dose aspirin for a medical condition (such as a heart problem). It may still be safe to take.
Talk to your health care team about:
-
How this treatment may affect your sexual health.
-
How this treatment may affect your ability to have a baby, if this applies to you.
This treatment may harm an unborn baby. Tell your health care team if you or your partner are pregnant, become pregnant during treatment, or are breastfeeding.
- If there is any chance of pregnancy happening, you and your partner together must use 2 effective forms of birth control at the same time while you are on treatment. Talk to your health care team about which birth control options are best for you, and how long you should use them after your last treatment dose.
- Do not breastfeed while on this treatment. Talk to your health care team about how long to wait before you start breastfeeding after your last treatment dose, if this applies to you.
Bortezomib and daratumumab are given and stored at the hospital.
Dexamethasone:
-
Keep tablets in the original packaging at room temperature in a dry place, away from heat and light.
-
Keep out of sight and reach of children and pets.
-
Do not throw out any unused tablets at home. Bring them to your pharmacy to be thrown away safely.
The following table lists side effects that you may have when getting BORTDEXADARA treatment. The table is set up to list the most common side effects first and the least common last. You may not have all of the side effects listed and you may have some that are not listed.
Read over the side effect table so that you know what to look for and when to get help. Refer to this table if you experience any side effects while on BORTDEXADARA treatment.
| Very Common Side Effects (50 or more out of 100 people) | |
| Side effect and what to do | When to contact health care team |
|
Fatigue What to look for?
What to do?
Ask your health care team for the Fatigue pamphlet for more information. |
Talk to your health care team if it does not improve or if it is severe |
|
Infection, low neutrophils (May be severe) When neutrophils are low, you are at risk of getting an infection more easily. Ask your health care team for the Neutropenia (Low white blood cell count) pamphlet for more information. When your immune system is weakened, bacteria, viruses, or fungi that would not normally be harmful may cause an infection. If you have had hepatitis, you may get this infection again when the immune system is weakened. This happens rarely. What to look for?
You have a fever if your temperature taken in your mouth (oral temperature) is:
OR
What to do?
If your health care team has told you that you have low neutrophils:
If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you must get emergency medical help right away. |
If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you MUST get emergency medical help right away. |
|
Nausea and vomiting (More likely with BORT) What to look for?
What to do? To help prevent nausea:
If you have nausea or vomiting:
|
Talk to your health care team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours or if it is severe
|
| Common Side Effects (25 to 49 out of 100 people) | |
| Side effect and what to do | When to contact health care team |
|
Constipation
To help prevent constipation:
To help treat constipation:
See the Constipation Pamphlet for more information. |
Talk to your health care team if it does not improve or if it is severe |
|
Allergic reaction What to look for?
What to do?
|
Get emergency medical help right away for severe symptoms |
|
Neuropathy (Tingling, numb toes or fingers) (May be severe) What to look for?
What to do?
In rare cases, it may continue long after treatment ends. If you continue to have bothersome symptoms, talk to your health care team for advice. |
Talk to your health care team, especially if you have trouble doing tasks like doing up buttons, writing, moving, or if you have severe pain or numbness. |
|
Low platelets in the blood (May be severe) When your platelets are low you are at risk for bleeding and bruising. Ask your health care team for the Low Platelet Count pamphlet for more information. What to look for?
What to do? If your health care team has told you that you have low platelets:
If you have signs of bleeding:
If you have bleeding that does not stop or is severe (very heavy), you must get emergency medical help right away. |
Talk to your health care team if you have any signs of bleeding. If you have bleeding that doesn’t stop, or is severe (very heavy), you MUST get emergency medical help right away. |
|
Low Appetite, weight loss What to look for?
What to do?
See our loss of appetite pamphlet for more information.
|
Talk to your health care team if it does not improve or if it is severe |
|
Diarrhea (More likely with BORT) What to look for?
What to do? If you have diarrhea:
Ask your health care team for the diarrhea pamphlet for more information. |
Talk to your health care team if no improvement after 24 hours of taking diarrhea medication or if severe (more than 7 times in one day).
|
|
Headache, mild joint, muscle pain or cramps What to look for?
What to do?
Ask your health care team for the Pain pamphlet for more information.
|
Talk to your health care team if it does not improve or if it is severe |
| Less Common Side Effects (10 to 24 out of 100 people) | |
| Side effect and what to do | When to contact health care team |
|
Rash; dry, itchy skin (May be severe) What to look for?
To prevent and treat dry skin:
Rash may be severe in some rare cases and cause your skin to blister or peel. If this happens, get emergency medical help right away. |
Talk to your health care team if it does not improve or if it is severe |
|
Cough and feeling short of breath (May be severe)
What to look for?
What to do?
If you have a severe cough with chest pain, trouble breathing or you are coughing up blood, get medical help right away. |
Talk to your health care team. If you are not able to talk to your health care team for advice, and you have a fever or severe symptoms, you MUST get emergency medical help right away. |
|
Swelling inside your nose What to look for?
What to do? Talk to your health care team if it does not improve or if it is severe. |
Talk to your health care team if it does not improve or if it is severe |
|
Mild swelling What to look for?
What to do? To help prevent swelling:
If you have swelling:
|
Talk to your health care team if it does not improve or if it is severe |
|
Pains or cramps in the belly What to look for?
What to do?
|
Talk to your health care team if it does not improve or if it is severe |
|
Dizziness (More likely with BORT) What to look for?
What to do?
|
Talk to your health care team if it does not improve or if it is severe |
|
Too much or too little salt in your body What to look for?
What to do? Get emergency medical help right away for severe symptoms. |
Get emergency medical help right away for severe symptoms |
|
Low blood pressure (More likely with BORT) What to look for?
What to do?
Your blood pressure may drop when the medication is being given to you. Let your health care team know right away if you start to feel dizzy or lightheaded. |
Talk to your health care team if it does not improve or if it is severe |
|
Side effects of taking steroids (With dexamethasone) What to look for?
What to do?
|
Talk to your health care team if it does not improve or if it is severe |
Other rare, but serious side effects are possible with this treatment.
If you have any of the following, talk to your cancer health care team or get emergency medical help right away:
-
New pain or swelling in your arm or leg
-
Sudden confusion, trouble speaking or difficulty moving your arms or legs
-
Weakness on one side of your body
-
Any changes in your vision
-
Going pee less than usual and unusual weight gain
-
Muscle twitching, severe weakness or tiredness
-
Severe bloating or feeling of fullness
-
Severe pain in the centre of your belly that may spread to your back
-
Yellowish skin or eyes, unusually dark pee
-
Seizure
-
New problems with balance, memory problems, personality changes
-
Irregular heartbeat or chest pain
For more information on how to manage your symptoms ask your health care provider, or visit: https://www.cancercareontario.ca/symptoms.
December 2023 Updated "How will this treatment affect sex, pregnancy and breast feeding?" section
For more links on how to manage your symptoms go to www.cancercareontario.ca/symptoms.
The information set out in the medication information sheets, regimen information sheets, and symptom management information(for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.
A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.