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Oral drugs undergo what is known as first-pass metabolism. First-pass metabolism is when the concentration of a drug, specifically when administered orally, is significantly reduced before it reaches systemic circulation

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Bortezomib exerts its therapeutic effects in MM by binding to the 5 subunit of the 26S proteasome to inhibit the ubiquitinproteasome pathway, blocking activation of the Nuclear factor kappa-light-chain-enhancer (NF-B) of activated B cells signaling pathway, inducing mitochondrial apoptosis, and suppressing angiogenesis and bone destruction within the tumor microenvironment