Chemo Experts, the easiest way to learn about cancer treatment
Find a Treatment:
Cancer Types
or
Treatments
listen

Tap along the timeline to move to different parts of the audio file.

Treatment Name: PBD (Panobinostat + Bortezomib + Dexametha­sone)

PBD (Panobinostat + Bortezomib + Dexametha­sone) is a Chemotherapy Regimen for Multiple Myeloma (MM)

How does PBD work?
Each of the medications in PBD is designed to kill or slow the growth of myeloma cells.

P – Panobinostat (Farydak®)
B – Bortezomib (Velcade®)
D – Dexamethasone

Goals of therapy:
PBD is given to decrease symptoms and slow the progression of multiple myeloma. It is not commonly given with the goal of curing the disease.

listen

Tap along the timeline to move to different parts of the audio file.

Schedule

Cycles 1 through 8

  • Panobinostat 20 mg oral capsule by mouth daily on Days 1, 3, 5, 8, 10, and 12.
  • Bortezomib 1.3 mg/m2 subcutaneous injection on Days 1, 4, 8, and 11
  • Dexamethasone 20 mg (five 4 mg oral tablets) by mouth daily on Days 1, 2, 4, 5, 8, 9, 11, and 12.
  • Example Schedule

Cycles 9 through 16

  • Panobinostat 20 mg oral capsule by mouth daily on Days 1, 3, 5, 8, 10, and 12
  • Bortezomib 1.3 mg/m2 subcutaneous injection on Days 1 and 8
  • Dexamethasone 20 mg (five 4 mg oral tablets) by mouth daily on Days 1, 2, 8, and 9

Bortezomib is given in an outpatient infusion center, allowing the person to go home afterwards. Panobinostat and dexamethasone are usually taken at home on the days listed above. Panobinostat prescriptions may be filled by a specialty pharmacy if your local pharmacist does not supply this drug.

PBD is repeated every 21 days, which is known as one Cycle. Treatment is divided into two phases: Phase 1 consists of eight cycles and if the treatment is working after eight cycles; then Phase 2, which consists of eight more cycles, will be given. Duration of therapy may last up to twelve months depending upon response, tolerability, and number of cycles prescribed.

listen

Tap along the timeline to move to different parts of the audio file.

Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects with PBD are shown here:

The incidence of muscle weakness, nerve pain, and/or decreased sense of touch reported from the clinical trial above was determined from patients who received bortezomib intravenously. When bortezomib is given subcutaneously (under the skin), the incidence of these side effects is much lower.

Approximately 24% of patients receiving PBD discontinue treatment due to unacceptable side effects. The most common side effects that lead to discontinuation are diarrhea, nerve pain, fatigue, muscle weakness, low platelet count, and pneumonia.

Side effect videos Side Effect Videos
DiarrheaDiarrheaFatigue Fatigue Nausea and VomitingNausea and VomitingConstipationConstipationBleedingBleedingPainPain

listen

Tap along the timeline to move to different parts of the audio file.

Monitoring

How often monitoring needed?  
Labs (blood tests) may be checked on Day 1 of each cycle as well as periodically during cycles.  Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), serum protein electrophoresis (SPEP), urine protein electrophoresis (UPEP), plus any others your doctor may order.

How often is imaging needed? 
An electrocardiogram (ECG, or "EKG") may be checked more than once during the first two Cycles, and at other points during treatment if necessary.

How might blood test results/imaging affect treatment?  
Depending upon the results, your doctor may advise to continue chemotherapy as planned, or delay or switch therapy.

listen

Tap along the timeline to move to different parts of the audio file.

ChemoExperts Tips

  • Bortezomib can cause reactivation of herpes simplex virus (HSV) or varicella zoster virus (VZV).  Prophylactic (preventative) anti-viral medications such as acyclovir (Zovirax®), valacyclovir (Valtrex®), or famciclovir (Famvir®) should be taken during treatment
  • Consider taking an anti-nausea medication 30 to 60 minutes BEFORE every dose of panobinostat if you experience nausea
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for multiple myeloma.  Ask your doctor if any studies are currently enrolling in your area.  If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for PBD (Panobinostat + Bortezomib + Dexametha­sone), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for PBD (Panobinostat + Bortezomib + Dexametha­sone). Depending upon your income, they may be able to help cover the cost of:

  • Panobinostat
  • Bortezomib
  • Dexamethasone

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as PBD (Panobinostat + Bortezomib + Dexametha­sone) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with PBD (Panobinostat + Bortezomib + Dexametha­sone)

Individual Drug Label Information

Panobinostat (Farydak®)

  • Panobinostat is an oral capsule
  • This medication has FDA Box Warnings for cardiovascular ischemic events (heart attack, chest pain), cardiac arrhythmias, and severe diarrhea
  • Panobinostat can be taken with or without food with a large glass of water. Always swallow capsules whole and do not open, crush or chew the capsules
  • If you miss a dose, that dose may be taken if it has been less than 12 hours after the scheduled time
  • Do not repeat the dose if vomiting occurs
  • Panobinostat should be stored at room temperature in a cool and dry place. Do not remove capsules from blister pack until immediately before the scheduled dose
  • Dosage adjustments may be required for liver function, low blood counts, uncontrolled diarrhea or nausea/vomiting
  • May interact with grapefruit or grapefruit juice, star fruit, and pomegranate or pomegranate juice and these should be avoided
  • Avoid over-the-counter natural products such as St. John’s Wort
General Panobinostat (Farydak) Side Effects
  • Can cause low platelet count, red blood cell count, and white blood cell count leading to increase risk of bleeding, fatigue, and infection
  • May cause abnormalities in blood potassium, calcium, phosphate, sodium, or magnesium
  • Nausea and vomiting can be common. Be sure to always have an adequate supply of anti-nausea medications
  • May decrease liver function
  • Decreased appetite may be experienced. Talk to a dietician about meal options that may be right for you
  • Click on the panobinostat (Farydak) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue BleedingBleeding

See DailyMed package insert.

Bortezomib (Velcade®)

  • Bortezomib can be given either as an intravenous (I.V.) infusion or more commonly as a subcutaneous (under the skin, “SubQ”) injection
  • Dosage adjustments may be required for liver dysfunction, low blood counts, or nerve pain
  • Will cause death if administered into the spinal fluid
  • Green tea and green tea extracts may decrease the effectiveness of bortezomib and these should be avoided.
  • Avoid dietary supplementation with ascorbic acid (Vitamin C), which also includes multivitamins that contain ascorbic acid. Normal dietary intake of ascorbic acid does NOT need to be changed
  • Avoid over-the-counter natural products such as St. John’s Wort
General Bortezomib (Velcade) Side Effects 
  • May cause or worsen nerve pain and is more common if bortezomib is given intravenously than subcutaneously
  • Can cause decreases in platelets, red blood cells, and white blood cells leading to increase risk of bleeding, fatigue, and infection
  • May cause reactivation of herpes simplex virus (HSV) or varicella zoster virus (VZV). Prophylactic anti-viral medications should be taken during therapy with bortezomib
  • Can worsen symptoms of heart failure
  • May cause redness or irritation around injection site if given subcutaneously
  • Click on the bortezomib (Velcade) package insert below for reported side effects and possible drug interactions

Side Effect Videos
DiarrheaDiarrheaFatigue Fatigue BleedingBleedingConstipationConstipationPainPain

See DailyMed package insert.

Dexamethasone (Decadron®)

  • Dexamethasone is supplied as an oral tablet or oral liquid
  • Dexamethasone may increase the risk of infection. Depending upon how much dexamethasone is taken, antibiotics may be prescribed to help prevent infection
  • Should be taken with food and with a large glass of water to avoid stomach irritation or ulcers
  • Should be taken before 6 p.m. when possible, to avoid trouble falling asleep
  • May decrease the response to vaccines; vaccines may need to be repeated at a later date to obtain maximal response
  • If taken daily for several days or weeks, the dose of dexamethasone may need to be gradually decreased (tapered) to avoid withdrawal symptoms
  • If you miss a dose, take the next dose as soon as possible
  • Should be stored at room temperature
General Dexamethasone (Decadron) Side Effects
  • May cause high blood sugar, weight gain, irritability, high blood pressure, difficulty sleeping, stomach ulcers, bone loss, muscle weakness
  • Click on the dexamethasone (Decadron) package insert below for reported side effects and potential drug Interactions
See DailyMed package insert.

Share this page:

References

San-Miguel JF, Hungria V, Yoon S, et al. Panobinostat plus bortezomib and dexamethasone versus placebo plus bortezomib and dexamethasone in patients with relapsed or relapsed and refractory multiple myeloma: a multicentre, randomised, double-blind phase 3 trial. Lancet Oncol. 2014;15:1195-1206.

Created: August 4, 2015 Updated: April 18, 2016

What is Multiple Myeloma (MM)?

Multiple Myeloma is a disease of the white blood cells, called plasma cells, found in the blood or bone marrow. Plasma cells are a type of white blood cell known as a B-lymphocyte.

Sometimes plasma cells form collections on bone and weaken or destroy it. These are known as "lytic lesions". Multiple Myeloma is a rare condition with an unknown cause. The stage can vary at diagnosis and throughout treatment. Staging is based on the international staging system (ISS). The type and effectiveness of the treatment may depend upon the stage.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What is Tumor Lysis Syndrome?

Tumor lysis syndrome occurs when many cancer cells die quickly and release their contents into the bloodstream. Many times the body has the ability to flush these substances out through the kidneys or metabolize them via the liver. However, sometimes the body needs medicines to help eliminate these substances and to prevent organ damage.

Example Schedule

Panobinostat 20 mg oral capsule by mouth daily on Days 1, 3, 5, 8, 10, and 12. For example, on a Mon, Wed, Friday of the first week, and again Mon, Wed, Friday of the second week (at home)
Bortezomib 1.3 mg/m2 subcutaneous injection on Days 1, 4, 8, and 11 (at an infusion center)
Dexamethasone 20 mg (five 4 mg oral tabs) by mouth daily on Days 1, 2, 4, 5, 8, 9, 11, and 12. For example, on a Mon, Tues, Thurs, Friday of the first week, and again Mon, Tues, Thurs, Friday of the second week (at home)

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium