Cardiovascular events during carfilzomib therapy for relapsed myeloma: practical management aspects from two case studies

Abstract

Carfilzomib has a favorable benefit-risk profile in MM; adopting proactive practices can assist in the prevention, early detection, and management of carfilzomib-associated cardiovascular events, which may allow for continuation of therapy with this effective agent.

Analysis of carfilzomib cardiovascular safety profile across relapsed and/or refractory multiple myeloma clinical trials

“…38 Elderly patients and patients with preexisting cardiac conditions, such as cardiac failure and hypertension, could have an increased risk for developing CV events while receiving carfilzomib. 40,41 A single-institution study to identify potential biomarkers in MM patients at high risk for cardiac AEs when treated with carfilzomib indicated a trend toward differential baseline expression of 8 proteins (tumor necrosis factor-related apoptosis-inducing ligand, myoglobin, matrix metalloproteinase-1, heparin-binding EGF-like growth factor, CD40 ligand, platelet-derived growth factor, heat shock protein 27, and epidermal growth factor). 42 Multivariate analysis did not reveal any association between these proteins and cardiac AEs.…”

Proteasome Inhibitors: Harnessing Proteostasis to Combat Disease

“…Across several clinical trials, 18.1% of phase 1-3 MM patients treated with carfilzomib experienced adverse cardiovascular events of all grades [120]. These complications can be managed by a combination of basic risk assessments, hydration, cardiovascular monitoring, intervention (such as reducing the carfilzomib dose), and patient education to notice cardiovascular symptoms and regularly monitor blood pressure [121]. Clinical guidelines were developed in collaboration with cardiologists to minimize the risk of cardiovascular events in patients treated with carfilzomib [122].…”

Carfilzomib and dexamethasone versus eight cycles of bortezomib and dexamethasone in patients with relapsed or refractory multiple myeloma: an indirect comparison using data from the phase 3 ENDEAVOR and CASTOR trials

“…In contrast, the number of patients with peripheral neuropathy was significantly lower in the Kd56 group than in the Vd group [13,14]. It has been demonstrated that Kd56 is generally well tolerated and has a favorable benefit-risk profile [16].…”