Episode 372: Pharmacology 101: Proteasome Inhibitors

“The proteasome itself, it really helps us unfold or get rid of misfolded proteins or degradations of different cells. We used to have garbage disposals in our sinks, and we used to put food product in there. If your garbage disposal is clogged, then everything backs up. So that’s kind of what’s really going on in the cell itself, is that I’m building up these unnecessary proteins that we should be getting rid of, and it actually causes apoptosis or cell death,” ONS member Daniel Verina, DNP, RN, ACNP-BC, nurse practitioner for the multiple myeloma program at Mount Sinai Medical Center in New York, NY, told Lenise Taylor, MN, RN, AOCNS^®, BMTCN^®, oncology clinical specialist at ONS, during a conversation about the proteasome inhibitor drug class.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

Earn 0.75 contact hours (including 40 minutes of pharmacotherapeutic content) of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by July 18, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: Learner will report an increase in knowledge related to the use of proteasome inhibitors in the treatment of cancer.

Episode Notes 

• Complete this evaluation for free NCPD. 
• ONS Podcast™ Pharmacology 101 series
• ONS Voice article: AI Multiple Myeloma Model Predicts Individual Risk, Outcomes, and Genomic Implications
• ONS books:
  • Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition)
  • Clinical Guide to Antineoplastic Therapy: A Chemotherapy Handbook (fourth edition)
  • Guide to Cancer Immunotherapy (second edition)
  • Multiple Myeloma: A Textbook for Nurses (third edition)
• Clinical Journal of Oncology Nursing article: Optimizing Transitions of Care in Multiple Myeloma Immunotherapy: Nurse Roles
• Oncology Nursing Forum articles:
  • Changes in Health-Related Quality of Life During Multiple Myeloma Treatment: A Qualitative Interview Study
  • Facilitators of Multiple Myeloma Treatment: A Qualitative Study
• ONS Guidelines™ and Symptom Interventions
  • Adherence to Oral Anticancer Medication
  • Peripheral neuropathy
• ONS Hematology, Cellular Therapy, and Stem Cell Transplantation Learning Library
• American Society of Hematology
• International Myeloma Foundation
• Leukemia and Lymphoma Society
• Multiple Myeloma Research Foundation

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email [e-mail].

Highlights From This Episode

“When we look at the administration, we also want to make sure that we’re looking at the blood counts, right? Because proteasome inhibitors are well known for causing thrombocytopenia and neutropenia. So making sure that the patients do meet eligibility for the treatment for that day, and do they have anemia or lower red blood cell counts. You want to make sure that, because of these therapies, that the patient has no symptoms or infections going into each therapy for that day.” TS 10:19

“[Bortezomib], interesting enough, it can cause hypotension, cardiac failure, and sometimes pulmonary edema. Switching that up a little bit, what makes it slightly different, carfilzomib … a lot of times we saw, even in the clinical trial, that there was a lot of hypertension or cardiomyopathies, or arrythmias that we saw with carfilzomib and different dosages that they have indicated from the FDA. So again, monitoring the hypertension … or heart failure.” TS 15:16

“We also want to keep in mind another adverse effect, and especially in myeloma—our patients come in the door already immunocompromised just by the disease state alone. But now I’m giving them therapies that can drop their neutrophil count, so neutropenia and thrombocytopenia, so they are at a higher risk of having serious infections, even including like pneumonia or having outbreaks of herpes zoster or shingles.” TS 16:50

“If the patient has shortness of breath or symptoms, hold the therapy. I think that’s one of my biggest messages when it comes to cancer treatments and educating other healthcare providers, or even educating our patients and their caregivers or the care partners with them, is that we need to sometimes hold the therapy for safety.” TS 22:02

“I say keep a log, keep a book. Let me know when the symptoms happen. Are they happening the day of treatment? Are they happening two days later from the treatment? Are they happening a week later from the treatment? And being able to kind of guide which therapy is causing some of these adverse events or side effects alone. So, making them have calendars. When did you take the drug, when did you get your last infusion or your last [subcutaneous] injection? Always talk to your care team, whether it’s in the academic center or next to your house in the community.” TS 26:17

“It’s us learning how to listen to the patient going forward. We have tasks to do—we all have tasks to do in our lives—but we have to take a breath, be mindful who’s in front of us, listen to them first, and then be able to talk to them and care for them upfront and see what the symptoms are. I think that’s what we need to do. We have to take a breath in cancer.” TS 39:35