Cardiovascular Adverse Events During Proteasome Inhibitor Therapy for Myeloma
Posted: Tuesday, July 16, 2019
According to research published in the Journal of Clinical Oncology, cardiovascular adverse events are common for patients with relapsed multiple myeloma undergoing proteasome inhibitor therapy. Repeated assessments of cardiac biomarkers, electrocardiograms, and echocardiography were used to determine the risk factors and outcomes for patients receiving either carfilzomib or bortezomib treatment.
“Cardiovascular adverse events are common during [proteasome inhibitor] therapy for relapsed multiple myeloma], especially with carfilzomib, particularly within the first 3 months of therapy,” concluded Robert F. Cornell, MD, of the Vanderbilt University Medical Center, and colleagues. “Cardiovascular adverse events were associated with worse overall outcomes, but usually, discontinuation of therapy was not required.”
The study included 95 patients of whom 65 underwent carfilzomib treatment and 30 received bortezomib. At a median follow-up of 25 months, 55% of the 64 cardiovascular adverse events recorded were at least grade 3 in severity. A total of 51% of patients receiving carfilzomib and 17% receiving bortezomib experienced a cardiovascular adverse event (P = .002).
A total of 86% of cardiovascular adverse events occurred during the first 3 months of treatment, with a median time from treatment initiation to first cardiovascular adverse event of 31 days. Though patients who experienced a cardiovascular adverse event had poorer progression-free survival (log-rank P = .01) and overall survival (log-rank P < .001), 89% of those patients were able to safely continue proteasome inhibitor therapy, with 41% needing chemotherapy modifications.
An increased risk for cardiovascular adverse events was identified in patients receiving carfilzomib who also had an elevated baseline brain natriuretic peptide level of greater than 100 pg/mL or N-terminal brain natriuretic peptide level of greater than 125 pg/mL (odds ratio = 10.8; P < .001). In addition, patients whose natriuretic peptide levels increased during the first cycle of carfilzomib treatment were found to have a significantly higher risk of cardiovascular adverse events (odds ratio = 36.9; P < .001).
Disclosure: The study authors’ disclosure information may be found at ascopubs.org.