Researchers analyzed rates of cardiac and pulmonary adverse events, as well as associated risk factors, following carfilzomib treatment for myeloma. The results of the analysis were published in Cancer.

Greater efforts are needed to define the potential cardiopulmonary complications associated with carfilzomib treatment for newly diagnosed and recurrent or refractory multiple myeloma, as this next-generation proteasome inhibitor is being used to treat a growing number of patients.

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The researchers explained that identifying risk factors for the development of adverse events may allow clinicians to modify patients’ treatment and mitigate toxicity. However, until recently, there have been little available data on the frequency of cardiac and pulmonary adverse events in patients with myeloma treated with carfilzomib.

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Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database from 2000 through 2013, the researchers identified 635 patients with myeloma treated with carfilzomib. Median age was 72 years (range, 36‐94), 55% of patients were male, and 79% of the patients were white. Median duration of carfilzomib treatment was 58 days (range, 1-716), and approximately 66% of the patients had ICD-9 codes for either cardiac or pulmonary adverse events during that time.

The most common cardiac adverse events included hypertension (22%), peripheral edema (15%), and heart failure (14%); the most common pulmonary adverse events included dyspnea (28%), cough (15%), and pneumonia (15%).

Age, sex, chronic obstructive pulmonary disease (COPD), diabetes, and dyslipidemia were examined as potential risk factors, and COPD was found to be the only statistically significant independent risk factor for development of cardiac adverse events. The hazard of developing cardiac or pulmonary adverse events increased by approximately 40% in patients with preexisting COPD (adjusted hazard ratio, 1.40 for both).

“Given the growing enthusiasm in the field to move carfilzomib to earlier lines of therapy and the heterogeneous pattern of dosing in various clinical trials, an in-depth understanding of patient-related and dose-related risk factors is essential to guide future treatment strategies in selecting the right patient population and modifying the dose based on patient characteristics,” the researchers concluded.

Disclosures: Some authors have declared affiliations with the pharmaceutical industry. Please refer to the original study for a full list of disclosures.


  1. Fakhri B, Fiala MA, Shah N, Vij R, Wildes TM. Measuring cardiopulmonary complications of carfilzomib treatment and associated risk factors using the SEER‐Medicare database [published online November 13, 2019]. Cancer. doi:10.1002/cncr.32601