Case series discussion of cardiac and vascular events following carfilzomib treatment: possible mechanism, screening, and monitoring

Table 3 Recommended monitoring and management of possible carfilzomib-associated cardiac and vascular-related events

(A) Prevention of cardiac and vascular- related events	• Monitor cardiopulmonary symptoms
	• Monitor cardiopulmonary signs (vitals, weight, physical exam)
	• Administer carfilzomib over 30 min
	• Check baseline transthoracic echocardiogram, and repeat echocardiogram every two to three cycles^a Note, if baseline ejection fraction is below normal, consider utilizing prophylactically strategies listed in (B) Monitor BNP^a
	• Close follow-up by cardiologist or cardio-oncologist^a
(B) Management of treatment-emergent possibly cardiac and vascular- related complications	• Rule out alternative causes (e.g., pulmonary embolus, pneumonia, anemia)\
	• Hold carfilzomib until toxicity resolves to grade <2.
	• If the decision is made to rechallenge:
	− Implement all preventative/monitoring strategies listed in (A)
	− Consider dose reduction
	− Decrease or eliminate hydration, especially if the patient has completed ≥1 cycle of 27 mg/m² carfilzomib while retaining stable renal function and without experiencing tumor lysis
	− Minimize corticosteroids and concomitant fluid retention
	− Cautious use of diuretics
	− Use of anti-hypertensives as indicated

^aRecommended for patients who are at increased cardiac risk (e.g., anthracyline exposure, age >60 years, amyloid, coronary artery disease).
BNP, brain natriuretic peptide.

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