Carfilzomib induced cardiotoxicity in a multiple myeloma patient

Abstract

Proteasome inhibitors such as carfilzomib are indicated in multiple myeloma patients showing relapse and/or refractoriness of clonal activity. However, this therapy has been associated with a significant incidence of cardiotoxicity, especially in patients with known cardiovascular risk factors. Here we report a case of a 60-year-old woman with multiple myeloma, who developed severe congestive heart failure with positive myocardial injury biomarkers together with impaired LVEF and GLS, after treatment with carfilzomib. Therefore, chemotherapeutic drug was discontinued and neurohormonal blocking and diuretic therapy was started resulting in amelioration of symptoms, without changes in LVEF but with significant GLS improvement. Although high-grade cardiotoxicity is relatively rare in patients with non previous cardiac risk factors, it was a predictable side effect of carfilzomib use. Recognition of this syndrome is critical to instauration of appropriate therapy and prevention of morbimortality.

Oxyphenbutazone ameliorates carfilzomib induced cardiotoxicity in rats via inhibition of oxidative free radical burst and NF-κB/IκB-α pathway

“…Carfilzomib indicated for multiple myeloma and mechanistically act by inhibiting proteasomes ( Méndez-Toro et al, 2020 ). Although the drug is well documented for its risk factor fin the establishment of cardiotoxicity especially those who have concurrent cardiovascular disorders ( Méndez-Toro et al, 2020 ).…”

“…Carfilzomib indicated for multiple myeloma and mechanistically act by inhibiting proteasomes ( Méndez-Toro et al, 2020 ). Although the drug is well documented for its risk factor fin the establishment of cardiotoxicity especially those who have concurrent cardiovascular disorders ( Méndez-Toro et al, 2020 ). For CFZ use in cancer chemotherapy cardiotoxicity considered as major limiting factor and chances of cardiotoxicity increases with already existing heart disease ( Singal and Iliskovic, 1998 , Yeh et al, 2004 ).…”

Increased Prevalence of Fragmented QRS in Randomly Selected Group of Multiple Myeloma Patients: A Pilot Study to Assess Prevalence

“…Cardiotoxicity was documented as midwall hyperenhancement consistent with midwall fibrosis using gadolinium enhanced cardiovascular magnetic resonance scan imaging [ 27 ]. In addition, the cardiotoxic effects of carfilzomib were documented using global longitudinal strain imaging in a 60-year-old MM female patient after she developed severe congestive heart failure with elevated cardiac biomarkers and reduction in left ventricular systolic function [ 28 ].…”

Coronary Revascularization in Patients With Cancer

“…Multiple cases of ACS secondary to rituximab, cisplatin, and taxols have been reported [ 31 , 32 ]. Carfilzomib, a newly approved proteasome inhibitor used in the treatment of multiple myeloma, has been associated with an increased risk of heart failure, ischemic heart disease, and hypertension [ 33 ]. Hormonal therapies for breast cancer have been shown to increase the risk of cardiovascular events [ 34 ].…”