Cardiac Events More Common After Specific Therapy for Relapsed Multiple Myeloma

11/27/17

In patients receiving therapy for relapsed multiple myeloma, heart failure, angina, and other cardiovascular adverse events occurred more frequently with carfilzomib compared with bortezomib, according to a study scheduled for presentation at the upcoming American Society of Hematology annual meeting (December 9-12, 2017; Atlanta, GA).

“Cardiovascular adverse events were more common with carfilzomib than with bortezomib but usually did not require discontinuation of therapy with careful management,” wrote Robert Frank Cornell, MD, Vanderbilt University Medical Center, and colleagues.

The observational, multi-institutional study followed 97 patients starting proteasome inhibitor therapy for relapsed multiple myeloma over a median 14 months: 65 patients received a chemotherapy regimen that included carfilzomib, and 32 patients received a regimen that included bortezomib.

In all, 61 cardiovascular adverse events occurred. Among evaluable patients, 50% receiving carfilzomib and 15% receiving bortezomib experienced at least one cardiovascular adverse event. The median time from treatment start to cardiovascular adverse event was 33 days, and 86% of all such events occurred within the first 3 months of treatment.

Among patients receiving carfilzomib, baseline brain natriuretic peptide (BNP) greater than 100 pg/ml or N-terminal proBNP (NTproBNP) greater than 125 pg/ml was associated with an increased risk of a cardiovascular event. In patients with normal baseline natriuretic peptide levels, an increase during cycle 1 was associated with increased risk, according to the study.

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Multivariate analysis showed that carfilzomib was linked with a higher risk of cardiovascular events compared with bortezomib therapy, elevated baseline natriuretic peptide levels were associated with higher risk, and patients with one or fewer traditional cardiovascular risk factors at baseline had a lower risk of cardiac events.

“The majority (68%) of patients with cardiovascular adverse events resumed proteasome inhibitor-based therapy after cardiovascular adverse events without chemotherapy modification; another 30% who experienced a cardiovascular adverse event were able to resume proteasome inhibitor therapy with chemotherapy modifications,” researchers wrote. “Only 2% required discontinuation of therapy due to a cardiovascular adverse event.” —Jolynn Tumolo