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Cardiotoxicity of Myeloma Targeted Therapies
Cardiotoxicity of myeloma targeted therapies is both a serious and often overlooked side effect. My experience with this devastating side effect is personal. I was diagnosed with chemotherapy-induced cardiomyopathy in late 2010.
Fully 15 years after I underwent cardiotoxic therapies to treat my MM.
Proof that cardiotoxicity of myeloma targeted therapies is overlooked is that the NCI page for targeted therapies, linked below, does not list any type of heart damage in the list of side effects.
Which myeloma targeted therapy regimens cause heart damage?
1. Proteasome Inhibitors
- Drugs: Bortezomib (Velcade), Carfilzomib (Kyprolis), and Ixazomib (Ninlaro).
- Cardiac Risks:
- Carfilzomib, in particular, has been associated with higher rates of heart failure, hypertension, and arrhythmias.
- Bortezomib and Ixazomib are generally considered to have milder effects on the heart, but can still increase the risk of hypertension and arrhythmias.
2. Immunomodulatory Drugs (IMiDs)
- Drugs: Thalidomide, Lenalidomide (Revlimid), and Pomalidomide (Pomalyst).
- Cardiac Risks:
- Thalidomide and Lenalidomide are associated with an increased risk of blood clots (venous thromboembolism), which can indirectly impact heart health.
- Less commonly, these drugs can also increase the risk of arrhythmias and hypertension, contributing to potential cardiac strain.
3. Monoclonal Antibodies
- Drugs: Daratumumab (Darzalex), Elotuzumab (Empliciti), and Isatuximab (Sarclisa).
- Cardiac Risks:
- These agents generally have a lower risk of direct cardiac toxicity but can occasionally cause hypotension during infusion, which may impact patients with pre-existing heart conditions.
4. CAR-T Cell Therapy
- Drug: Idecabtagene vicleucel (Abecma) and Ciltacabtagene autoleucel (Carvykti).
- Cardiac Risks:
- Cytokine release syndrome (CRS) is a common side effect that can cause high fevers and rapid blood pressure changes, leading to cardiac stress. Severe CRS can result in cardiovascular complications, including arrhythmias and heart failure in some cases.
5. Bispecific Antibodies
- Drug: Teclistamab (Tecvayli), a bispecific T-cell engager targeting BCMA.
- Cardiac Risks:
- Cardiovascular side effects are uncommon but possible due to CRS, which can affect cardiac function and lead to complications like hypotension or heart arrhythmias.
6. Histone Deacetylase (HDAC) Inhibitors
- Drug: Panobinostat (Farydak).
- Cardiac Risks:
- Panobinostat has been linked to cardiac arrhythmias and ECG abnormalities, especially QT prolongation, which can lead to a risk of life-threatening arrhythmias.
What is cardiotoxicity?
I was diagnosed with chemotherapy-induced cardiomyopathy as well as atrial fibrillation in late 2010. I had a reaction to metoprolol and decided to try evidence-based non-conventional heart health therapies including:
- Nutrition
- Supplementation and
- Lifestyle Therapies.
An annual echocardiogram tells me that all of my heart metrics are stabile or have improved. If you have any questions about cardiotoxicity email me at David.PeopleBeatingCancer@gmail.com
David Emerson
- Cancer Survivor
- Cancer Coach
- Director PeopleBeatingCancer
What is targeted therapy?
“Targeted therapy is a type of cancer treatment that targets proteins that control how cancer cells grow, divide, and spread. It is the foundation of precision medicine. As researchers learn more about the DNA changes and proteins that drive cancer, they are better able to design treatments that target these proteins…”
A Systematic Review of the Cardiotoxic Effects of Targeted Therapies in Oncology
“Cardiotoxicity, a critical adverse effect of cancer treatments such as doxorubicin, trastuzumab, and radiotherapy, poses substantial challenges. This systematic review synthesizes findings from studies on cardiotoxicity induced by cancer therapies, focusing on detection and management.
Key predictors of chemotherapy-induced myocardial toxicity (CIMT) include:
- advanced age,
- hypertension,
- hyperlipidemia,
- diabetes,
- and elevated N-terminal pro-B-type natriuretic peptide levels.
Regular echocardiographic assessments, particularly of the left ventricular global longitudinal strain (LVGLS) and left ventricular ejection fraction (LVEF), are essential for early detection.
The CardTox-Score, incorporating these risk factors, shows high sensitivity and specificity in predicting CIMT. Advanced imaging techniques and biomarkers play crucial roles in identifying at-risk patients before functional decline.
Early biomarkers and imaging techniques such as LVGLS and LVEF are effective in diagnosing and managing cardiotoxicity, allowing timely interventions. Cardiology involvement in patient care significantly enhances adherence to cardiac monitoring guidelines and reduces cardiotoxicity risks.
Management strategies emphasize regular cardiac monitoring, patient education, and the use of cardioprotective agents. A collaborative approach between cardiologists and oncologists is vital to assess cardiovascular risks, minimize vascular toxicity, and manage long-term adverse effects, ensuring the safety and efficacy of cancer therapies.
This review underscores the importance of early detection and proactive management of cardiotoxicity in cancer patients to optimize treatment outcomes and improve quality of life.
Discussion
Cardiotoxicity from cancer therapy is a significant concern that necessitates careful monitoring and management. In a study involving 486 patients with hematologic malignancies and breast cancer, cardiovascular (CV) adverse events were reported in 16%-38% of patients, with specific occurrences in
- 24.5% of leukemia,
- 15.8% of malignant lymphoma,
- 38.1% of multiple myeloma,
- and 18.0% of breast cancer cases [25]…
Conclusions
Cardiotoxicity resulting from cancer therapy, particularly CRT for NSCLC and treatments involving ACc and TZ for breast cancer, is a significant complication that negatively impacts patient survival and quality of life. Biomarkers such as high-sensitivity cardiac troponin T and N-terminal pro-B-type natriuretic peptide have proven effective in the early detection of cardiotoxicity.
Additionally, advanced imaging techniques such as positron emission tomography/computed tomography and cardiovascular magnetic resonance imaging are crucial for monitoring and managing cardiac dysfunction. Regular monitoring of biomarkers and echocardiographic parameters, such as LVEF and GLS, enables early identification of high-risk patients, allowing timely interventions and therapy modifications to mitigate cardiotoxicity.
A proactive approach involving close collaboration between oncologists and cardiologists is essential for improving patient outcomes by reducing cardiovascular risks and enhancing quality of life.
Therefore, early detection and effective management of cardiotoxicity are vital in cancer therapy. Utilizing biomarkers, advanced imaging techniques, and implementing personalized cardioprotective strategies are crucial measures to minimize adverse cardiac effects and ensure safer and more effective cancer treatment…”
Cardiotoxicity of myeloma targeted therapies