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

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

(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 cyclesa Note, if baseline ejection fraction is below normal, consider utilizing prophylactically strategies listed in (B) Monitor BNPa
  • Close follow-up by cardiologist or cardio-oncologista
(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
  1. aRecommended for patients who are at increased cardiac risk (e.g., anthracyline exposure, age >60 years, amyloid, coronary artery disease).
  2. BNP, brain natriuretic peptide.