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Cardiovascular safety in MM
antihypertensive medications may need drug adjustments to reduce their blood pressure while receiving carfilzomib. Regular clinical surveillance with blood pressure control is recommended before and during treatment. In a sub-study of the ENDEAVOR trial, the rate of hypertension was 25% in the entire cohort and 26.4% in an Asian cohort. These rates are higher than in other studies and suggest that particular attention is needed in patients treated with carfilzomib 56 mg/m2 and in subjects of Asian ethnicity. Serial monitoring of cardiac function via echocardiogra- phy39 or cardiac biomarkers such as NT-proBNP are con- sidered of limited value in mitigating the risk of carfil-
zomib-associated cardiac failure.58 In the event of grade 3 or 4 cardiac events, carfilzomib should be withheld until recovery.59 Carfilzomib may be resumed at the physician’s discretion based on a benefit/risk assessment, although preferably at a reduced dose.
In general, the risk-benefit ratio for a drug must be con- sidered in the context of the nature and severity of the disease for which it is used. Dynamic, interdisciplinary cooperation between hematologists and cardiologists is the key to the future studies that are needed to assess and manage cardiovascular safety in patients treated with carfilzomib.
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