The Chemotherapy Regime Of Bortezomib Valcade Nursing Essay
Chemotherapy Regime. I will critically discuss the use of this regime and its mode of action in relation to the cell cycle. I will identify the short and long term side effects of this regime and explore on particular side effect analysing the impact of this side effect on patients and their families. The management of the chosen side effect will be explored using available evidence based research alongside the professional and ethical dimensions of practise.
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Get Help Now!Bortezomib is a proteosome inhibitor approved for use in Multiple Myeloma patients and is the first proteasome inhibitor licenced to use (Rajkumar, 2005). Dexamethasone is a steroid taken in tablet form on the same day as the Bortezomib and on the day after.
According to Armand et al (2007) a proteosome is a large multi protein particle present in all eukaryotic cells and is the primary element of the cells protein degradation pathway. The proteosome is vital to cell cycle processes such as regulation and apoptosis. Adams (2004) informs us that the blockade of proteosome activity results in cell death and that tumour cells appear to be noticeably more sensitive to proteosome inhibition than regular cells. Unlike in previous standard chemotherapy, which Morgan (2003) states “has an ability to inhibit the process of cell division and an inability to distinguish between normal and malignant cells”.
Ling et al (2002) explains that Bortezomib acts in the G2-M section of the cell cycle (Image 1) causing cell cycle arrest and apoptosis, at the final check point before mitosis occurs. Bortezomib is a molecule that explicitly and reversibly hinders the 26S proteosome which is the enzyme that plays a key role in a cell by regulating protein degradation.
This process maintains the balance of proteins in the cell cycle, therefore inhibition of the 26S proteosome results in a loss of control of this process, leading to a build-up of cell cycle and regulatory proteins, thus causing apoptosis (Adams 2004). According to Landowski et al (2005) recent reports suggest that Bortezomib also deregulates intra cellular calcium metabolism, which also causes apoptosis.
Field-Smith (2006) informs that Bortezomib is usually given as an intravenous infusion in the outpatient setting, with a 72 hour gap between infusions to allow recovery of the proteasome inhibition in the normal cells. So as to prevent excessive side
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