bortezomib + ketoconazole

This is a **combination of two drugs: bortezomib and ketoconazole**. - **Bortezomib** is a reversible small molecule inhibitor of the 26S proteasome, leading to accumulation of ubiquitinated proteins, cell cycle arrest, and apoptotic cell death, particularly in malignant cells. It is primarily used in the treatment of multiple myeloma and mantle cell lymphoma. - **Ketoconazole** is a small molecule triazole antifungal that acts as a strong inhibitor of cytochrome P450 3A4 (CYP3A4), used to treat fungal infections and known to alter the metabolism of many drugs. When administered together, ketoconazole acts as a pharmacokinetic enhancer by inhibiting the metabolism of bortezomib (through CYP3A4 inhibition), thereby increasing systemic exposure to bortezomib. This combination has been investigated in a clinical setting to characterize the impact of ketoconazole on bortezomib pharmacokinetics, showing a mean increase of about 35% in bortezomib exposure[1][2][3][4]. This combination does not represent a marketed product but rather a co-administration used in clinical context for drug-drug interaction assessment.