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. 2023 Feb 10;15(4):1149.
doi: 10.3390/cancers15041149.

Patients with Very High Risk of Cardiovascular Adverse Events during Carfilzomib Therapy: Prevention and Management of Events in a Single Center Experience

Giulia Mingrone  1 , Anna Astarita  1 , Anna Colomba  1 , Cinzia Catarinella  1 , Marco Cesareo  1 , Lorenzo Airale  1 , Arianna Paladino  1 , Dario Leone  1 , Fabrizio Vallelonga  1 , Sara Bringhen  2 , Francesca Gay  2   3 , Franco Veglio  1 , Alberto Milan  1
Affiliations

Patients with Very High Risk of Cardiovascular Adverse Events during Carfilzomib Therapy: Prevention and Management of Events in a Single Center Experience

Giulia Mingrone et al. Cancers (Basel). .

Abstract

Carfilzomib (CFZ) improves the prognosis of multiple myeloma (MM) patients but has shown cardiovascular toxicity. The risk stratification of cardiovascular adverse events (CVAEs) now seems well established, while little is known about the course and management of patients with a high-cardiovascular-risk profile or experiencing CVAEs during therapy. Therefore, we aimed to describe our experience in decision making to support health professionals in selecting the best management strategies to prevent and treat CVAEs. A total of 194 patients with indication to CFZ underwent baseline evaluation of CVAEs risk and were prospectively followed. We propose a novel approach, which includes advanced cardiac imaging testing for patients at high baseline CV risk to rule out clinical conditions that could contraindicate starting CFZ. After baseline evaluation, 19 (9.8%) patients were found at high risk of CVAEs: 13 (6.7%) patients underwent advanced cardiac testing and 3 (1.5%) could not receive CFZ due to CV contraindications. A total of 178 (91.7%) patients started CFZ: 82 (46%) experienced arterial-hypertension-related events and 37 (20.8%) major CVAEs; 19 (10.7%) patients had to discontinue or modify the CFZ dosing regimen. Along with baseline risk stratification, subsequent cardiovascular clinical events and diagnostic follow-up both provided critical data to help identify conditions that could contraindicate the anticancer therapy.

Keywords: arterial hypertension; cardiotoxicity management; cardiovascular adverse event; cardiovascular toxicity; carfilzomib; echocardiography; multiple myeloma.

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Conflict of interest statement

A.M. received honoraria for the advisory board from Amgen and Janssen. S.B.; has received honoraria from Celgene, Amgen, Janssen and Bristol Myers Squibb; has served on the board of directors or advisory committees for Celgene, Amgen, Janssen, GlaxoSmithKline, Sanofi and Pfizer; and has received consultancy fees from Janssen, Takeda, Celgene and Bristol Myers Squibb. F.G. has received honoraria from Amgen, Celgene, Janssen, Takeda, Bristol Myers Squibb, AbbVie and GlaxoSmithKline; and has served on the advisory boards for Amgen, Celgene, Janssen, Takeda, Bristol Myers Squibb, AbbVie, GlaxoSmithKline, Roche, Adaptive Biotechnologies, Oncopeptides, bluebird bio and Pfizer. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curve of incidence of hypertension-related and major CVAEs. Arterial hypertension-related cardiovascular adverse events (CVAEs) are indicated in blue and major CVAEs in yellow. Patients with both hypertensive and major CVAEs are represented (with the proper onset time) in both curves.
Figure 2
Figure 2
Management protocol of cardiovascular adverse events during CFZ therapy. CT: computed tomography, PE: pulmonary embolism.
See this image and copyright information in PMC

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