PATIENTS WITH VERY HIGH RISK OF CARDIOVASCULAR ADVERSE EVENTS DURING CARFILZOMIB THERAPY: PREVENTION AND MANAGEMENT OF EVENTS IN A SINGLE CENTER EXPERIENCE

Abstract

Objective: Carfilzomib (CFZ) improves the prognosis of multiple myeloma (MM) patients, but has shown cardiovascular toxicity. The cardiovascular adverse events (CVAEs) risk stratification now seems well established, while little is known about the course and management of patients with high risk or CVAEs during therapy. So, we aimed to describe our specialistic experience in decision-making to support health professionals in selecting the best management strategies to prevent and treat CVAEs. Design and method: From January 2015 to September 2022, 194 patients with indication to CFZ underwent baseline evaluation of CVAEs risk and were prospectively followed. We proposed a novel approach with inducible ischemia imaging tests for patients at high baseline CV risk to rule out clinical conditions that could contraindicate the starting of CFZ. Results: After baseline evaluation, 16 (8.2%) patients resulted at high risk of CVAEs: 13 (6.7%) patients performed inducible myocardial ischemia imaging test and 3 (1.5%) could not receive CFZ for CV contraindications. 178 (91.7%) patients started CFZ: 82 (46%) experienced arterial hyperten-sion-related events and 37 (20.8%) major CVAEs (Fig. 1); 19 (10.7%) patients had to suspend or remodulate CFZ. Conclusions: Together with baseline risk stratification also subsequent cardiovascular clinical and diagnostic follow-up appeared critical to identify clinical conditions that could contraindicate the anti-cancer therapy.