Bortezomib, melphalan and prednisolone (VMP)

Bortezomib, melphalan and prednisolone (VMP) is a cancer drug combination. It is a treatment for myeloma.

What is VMP?

VMP is the name of a cancer drug combination that includes:

• V - bortezomib (Velcade)
• M - melphalan
• P - prednisolone

It is a treatment for myeloma if you are unable to have thalidomide or a bone marrow transplant.

How does VMP work?

Bortezomib is a type of targeted cancer drug called a proteasome inhibitor.

Proteasomes are in cells. They help to break down proteins that the cell doesn't need. Bortezomib blocks the proteasomes so the proteins build up inside the cell. The cell then dies.   

Melphalan is one of a group of drugs called alkylating agents. It sticks to one of the cancer cell's DNA strands. DNA is the genetic code that is in the nucleus of all animal and plant cells. It controls everything the cell does. The cell cannot then grow and divide into 2 new cells.

Prednisolone helps the other drugs to work better and kills myeloma cells.

How do you have VMP?

You have bortezomib as an injection under the skin. You take melphalan and prednisolone as tablets.

Injection under the skin

You usually have injections under the skin (subcutaneous injection) into the stomach or thigh.

You might have stinging or a dull ache for a short time after this type of injection but they don't usually hurt much. The skin in the area may go red and itchy for a while.

Taking your tablets

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking a cancer drug, or if you miss a dose.

You should take prednisolone tablets after a meal as they can irritate your stomach. Taking them in the morning might help to stop difficulty in sleeping (insomnia).

You should keep melphalan tablets in the fridge.

How often do you have VMP?

You have VMP as cycles of treatment. A cycle is the time between one round of treatment and the start of the next. Each cycle is 35 days (5 weeks). You usually have up to 8 cycles of treatment.

You usually have a cycle of VMP in the following way:

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of VMP?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of getting an infection 

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale 

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nosebleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Rarely, you might bleed from other parts of the body. Tell your healthcare team if you notice this.

Numbness or tingling in fingers or toes 

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your healthcare team if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

You might also have an unusual feeling or sensation like burning, prickling or aching in your arms or legs.

Pain in different parts of the body

You might feel pain in your muscles, joints, tummy or nerves (neuralgia). Speak to your doctor or nurse about what painkillers you can take to help with this.

Rarely, you might get pain at the site of injection.

High temperature (fever)

If you get a high temperature, let your healthcare team know straight away. Ask them if you can take paracetamol to help lower your temperature.

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can prescribe a laxative.

Diarrhoea 

Contact your advice line if you have diarrhoea. For example, 2 or more extra loose bowel movements than usual each day. If you have a stoma, you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Loss of appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Tiredness and weakness (fatigue)

Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• breathlessness and cough
• blood pressure changes - high blood pressure might cause headaches and low blood pressure means you might feel light headed or dizzy
• eye problems such as swelling, eyesight changes and infection. Rarer problems include blurred or double vision, pain, dry eye or leaking fluid (discharge). Let your team know if this happens.
• kidney changes causing them not to work as well. Other problems might include going to the toilet more or less often, and you may not empty your bladder properly, but this is rare. You have regular blood tests to check for any kidney changes.
• taste changes and weight loss
• indigestion symptoms include heartburn, bloating and burping
• fluid build up of different parts of the body (oedema)
• difficulty in sleeping (insomnia)
• mood changes such as feeling very low (depressed), anxious, restless or confused. Rarely you might have memory problems.
• lack of fluid in the body (dehydration)
• mouth sores and ulcers that can be painful. Your mouth might also get dry or you may get throat pain.
• blood in your poo (stool) due bleeding in the stomach or bowel
• liver changes - you will have regular blood tests to monitor this
• muscle problems that might include cramps, twitching, wasting and weakness
• headaches, rarely you might get a migraine
• dizziness
• temporary loss of consciousness (fainting)
• changes in levels of minerals and salts in your body - you will have regular blood tests to check for this
• swelling of the tummy (abdomen)
• skin changes that can make the skin dry, red, itchy, thinner in areas or you may get a rash. You might also find wounds take longer to heal.
• hair thinning
• developing symptoms such as a swollen or puffy face, acne, thicker more visible facial hair due to too much of a hormone called cortisol in your body
• changes to blood sugar levels – you might have regular blood and urine tests to check this
• thinning of the bones, making them more brittle that increases the risk of them breaking (fracturing)
• chills
• wind (flatulence)
• feeling generally unwell (malaise)
• feeling giddy or unbalanced (vertigo)

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

• heart problems such as a change in rhythm, how well your heart pumps blood around the body, chest pain or fluid around the heart.
• changes to the levels of chemicals in the blood due to breakdown of cancer cells (tumour lysis syndrome) – you have regular blood tests to check this
• hiccups
• blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms
• hearing changes such as hearing loss or ringing in your ears (tinnitus)
• stroke
• difficulty concentrating
• high levels of thyroid hormones (hyperthyroidism) – you might feel irritable, tired, or sensitive to heat
• episodes of feeling warm and reddening of the skin (flushing)
• runny nose
• a second cancer some years after treatment has finished
• an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness - some allergic reactions can be life-threatening, alert your nurse or doctor if notice any of these symptoms
• trembling or shaking (tremor)
• a rare disorder of the nerves causing headache, fits, confusion and changes in vision - contact your health team straight away. This condition is reversible.
• fits (seizures)
• loss or changes to your sense of smell
• inflammation of your blood vessels. Symptoms can vary depending on which blood vessels are affected. General symptoms include feeling very tired, loss of appetite, weight loss, a high temperature, and aches and pains (vasculitis).
• voice changes could include you sounding more horse, rough or raspy
• inflammation of your pancreas – symptoms include severe tummy pain, feeling or being sick, a high temperature or you may have loose poo
• a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening.
• digestive system  problems such as a hole or blockage in the bowel, or inflammation of different parts of the digestive system. Other problems include the nerves and muscle not working properly to pass food through.

Other side effects

If you have side effects that aren’t listed on this page, you can look at the individual drug pages:

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink 

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception 

This drug may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment with this drug and for at least 3 months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Breastfeeding

Don’t breastfeed during this treatment. This is because the drugs may come through in your breast milk.

Treatment for other conditions 

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.