There is yet another study that's been published showing that Kyprolis affects the heart, even early in the treatment process. The study below looked at blood pressure and measures of heart tissue health in 24 patients, with data collected before the start of Kyprolis treatment and then after four cycles of treatment. The authors summarize their findings this way:
"Our results suggest that therapy with carfilzomib [Kyprolis] when used as first line therapy is responsible for increase in systemic blood pressure, alteration of endothelium-mediated vascular dilatation and early myocardial diastolic dysfunction."
Cheers!
Link to study:
Gavazzone, M, et al., "Irreversible proteasome inhibition with carfilzomib as first line therapy in patients with newly diagnosed multiple myeloma: Early in vivo cardiovascular effects," European Journal of Pharmacology, Nov 5, 2018 (full text of article)
Abstract:
Patients who experienced cardiovascular side effects during cancer therapy with carfilzomib for multiple myeloma had relapsed multiple myeloma, so have be previously treated with other cancer therapies. The present is a single center cohort study to evaluate early cardiovascular effects of administration of irreversible proteasome inhibitor carfilzomib in naïve patients. We included 24 patients and collected cardiovascular side effects, echocardiographic parameters and endothelial function at baseline and after 4 cycles. At early follow up we observed increase in blood arterial pressure values (mean change in systolic pressure of 10 mmHg (P-value < 0.01; diastolic arterial pressure and mean arterial pressure of 3.3 mmHg and 5.4 mmHg, both P-value < 0.01). Reactive hyperemia PAT index was reduced in the whole cohort by a mean of 0.46 points (P-value < 0.01); diastolic function was changed: E-wave-deceleration-time (EDT) was reduced by 49,96 ± 31 ms, P-value < 0.05 and early diastolic tissue Doppler velocity (e′) by a mean value of 1.46 cm/s, P - value 0.04.
At early follow up we did not observe events of grade 3 or 4. We observe correlation between events and endothelial dysfunction at baseline and age (OR 1.9, CI 95% 0.05–5.804, P- value: 0.038 for RHI<1.67; OR 1,4, CI 95%0.99–2.56, P- value: 0.04 for age). Our results suggest that therapy with carfilzomib when used as first line therapy is responsible for increase in systemic blood pressure, alteration of endothelium-mediated vascular dilatation and early myocardial diastolic dysfunction.
Forums
Re: Heart-related side effects from Kyprolis
Thanks for posting about that study, Ian.
It's interesting that, not long after the study came out that you mentioned, a study about Velcade came out that is almost a companion study to the one you cited. The Velcade study found no signs of heart damage occurred in a small sample of multiple myeloma patients who were treated with Velcade, and who had no heart damage prior to starting treatment.
The patients in the Velcade study had heart imaging done prior to starting treatment, and then after every cycle of treatment. Other tests of heart function also were carried out. The imaging and additional tests revealed no signs that Velcade was doing any damage to the patients' hearts. The authors summarized their findings as follows:
"No evidence of cumulative myocardial dysfunction was found using echocardiographic markers, primarily GLS (average change in absolute GLS, -1.17; P = .064). Additionally, no echocardiographic evidence of transient cardiotoxicity was found. The left ventricular ejection fraction (LVEF) also did not show any significant changes (ΔLVEF, -2.17%; P = .15). Magnetic resonance imaging confirmed no changes in structure or function (ΔLVEF, -2.6%; P = .54) and extracellular volume fraction (Δ = 2%; P = .46)."
Here's a link to the study:
https://www.clinical-lymphoma-myeloma-leukemia.com/article/S2152-2650(18)30610-4/fulltext
It's interesting that, not long after the study came out that you mentioned, a study about Velcade came out that is almost a companion study to the one you cited. The Velcade study found no signs of heart damage occurred in a small sample of multiple myeloma patients who were treated with Velcade, and who had no heart damage prior to starting treatment.
The patients in the Velcade study had heart imaging done prior to starting treatment, and then after every cycle of treatment. Other tests of heart function also were carried out. The imaging and additional tests revealed no signs that Velcade was doing any damage to the patients' hearts. The authors summarized their findings as follows:
"No evidence of cumulative myocardial dysfunction was found using echocardiographic markers, primarily GLS (average change in absolute GLS, -1.17; P = .064). Additionally, no echocardiographic evidence of transient cardiotoxicity was found. The left ventricular ejection fraction (LVEF) also did not show any significant changes (ΔLVEF, -2.17%; P = .15). Magnetic resonance imaging confirmed no changes in structure or function (ΔLVEF, -2.6%; P = .54) and extracellular volume fraction (Δ = 2%; P = .46)."
Here's a link to the study:
https://www.clinical-lymphoma-myeloma-leukemia.com/article/S2152-2650(18)30610-4/fulltext
Re: Heart-related side effects from Kyprolis
I'm in my third cycle of carfilzomib (Kyprolis) after Velcade-induced neuropathy and then Revlimid stopped working. Started once weekly and it kicked my you-know-what big time, so now I'm on the two-consecutive-day regimen, with dexamethasone also the first day. The first week I had body discomfort side effects and breathlessness, but not nearly as bad as when doing once-weekly, and of shorter duration. This week, the second of the cycle, my discomforts were a bit higher, much more breathlessness, and on day two my blood pressure, usually remarked on as perfect, was up to 172/70. Staff was concerned, said I should monitor it. Last night it was 146/72, but this morning it is 157/81. I'm sending the European Journal of Pharmacology abstract to my oncologist. They seem to recall several other cases where blood pressure increased with Kyprolis. Should note that I have a heart stent, take metoprolol (Toprol, Lopressor) to block arrythmia, and am 80 years old.
Really glad for this forum and the information you-all provide,
Really glad for this forum and the information you-all provide,
-
albertlannon - Name: Albert Lannon
- Who do you know with myeloma?: self
- When were you/they diagnosed?: June, 2017
- Age at diagnosis: 79
Re: Heart-related side effects from Kyprolis
Well, my doctor and I decided to give the Kyprolis (carfilzomib) another try after my off week got me through Christmas nicely. Even the two-day, lower-dose infusion had elevated my blood pressure and had me breathless. He put me on a blood pressure medication, chlorthalidone, 3 weeks ago. About 4 hours after the last infusion, Monday, my usually perfect blood pressure (pre-Kyprolis) set a personal record, 200 / 86. And the breathlessness. I've cancelled the second dose and the oncologist has some alternatives for me to look at. Frankly, I fear a stroke more than I do death.
-
albertlannon - Name: Albert Lannon
- Who do you know with myeloma?: self
- When were you/they diagnosed?: June, 2017
- Age at diagnosis: 79
Re: Heart-related side effects from Kyprolis
Here's yet another study related to Kyprolis and its heart-related side effects:
Dasanu, CA, et al, "Severe left atrial enlargement due to carfilzomib use in multiple myeloma," Journal of Oncology Pharmacy Practice, January 12, 2019 (abstract)
Abstract:
Several cardiovascular effects have been attributed to carfilzomib in the recent literature. These side effects must be recognized promptly by treating physicians and pharmacists. Special attention is required in patients with pre-existing cardiac conditions, liver function abnormalities and/or advanced age. This is the first report of a severe left atrial enlargement due to carfilzomib use in the setting of multiple myeloma. This condition improved dramatically seven months after cessation of carfilzomib. The authors discuss further various cardiac and vascular abnormalities linked with carfilzomib in the medical literature. Prompt withdrawal of this agent is essential in these cases as it may prevent dismal outcomes.
Dasanu, CA, et al, "Severe left atrial enlargement due to carfilzomib use in multiple myeloma," Journal of Oncology Pharmacy Practice, January 12, 2019 (abstract)
Abstract:
Several cardiovascular effects have been attributed to carfilzomib in the recent literature. These side effects must be recognized promptly by treating physicians and pharmacists. Special attention is required in patients with pre-existing cardiac conditions, liver function abnormalities and/or advanced age. This is the first report of a severe left atrial enlargement due to carfilzomib use in the setting of multiple myeloma. This condition improved dramatically seven months after cessation of carfilzomib. The authors discuss further various cardiac and vascular abnormalities linked with carfilzomib in the medical literature. Prompt withdrawal of this agent is essential in these cases as it may prevent dismal outcomes.
15 posts
• Page 2 of 2 • 1, 2
Return to Treatments & Side Effects