I am receiving standard 3 week treatment cycles of Carfilzomib combined with 12 mgs of dexamethasone with infusions 2x/wk. No notable side effects after 4 cycles. However, on Heart MRI it is noted that the ejection fraction is lower than when started treatments(60% vs. 46% now). no noticeable symptoms though. Visited with cardiologists at the myeloma clinic and they indicate nothing to worry about-----they believe it is most likely just some transient reduction in heart pump functionality due to the dex that will reverse itself once treatments are concluded in 4 more months.
Local oncologist indicates they are aware of some instances with Carfilzomib where same thing can occur but has also reversed itself.
Question: given Carfolizomib is a relatively new drug, it doesn't seem like the docs have much in the way of answers to the following---anyone with similar experience---I'd welcome your thoughts:
1) how many patients may experience such a side effect from either Carfilzomib or the combo with dex;
2) what % of patients that have such a side effect do actually see a reversal and return to normal ejection fraction after some period of time when treatments end; and
3) what type of monitoring did docs do for you to track heart functionality when you were on Carfilzomib, esp once a change was noted.
I was part of a clinical trial in the Netherlands, treated with Carfilzomib, dex (20mg) on the days of infusions, and thalidomide (200mg) daily. Here they did no monitoring of heart functionality, except for tests before starting chemo and after 4 cycles of induction chemo was finished to make sure I was fit for stem cell transplant. If I had any change, they didn't tell me.
I had a further 4 cycles of the same chemo after stem cell transplant and no monitoring of heart function, and no noticeable bad effects either. In fact, 2 months after completing treatment I was fit enough to walk the last 113 km of the Camino de Santiago in Spain, averaging 23 km per day.
I wonder if there could be an age factor in this? I was 57 when I started treatment, active and in good physical condition.
Good morning, what a fantastic conversation, I was just taken off carfizomid after 4 cycles because of my heart ejection factor being at 20%. I have other issues with my heart, however the heart doctor and the oncologist were not aware of any side effects from carfizomid or dex that could be causing this. I go to the specialist tomorrow, believe me this discussion will come up. Which cancer center are you being treated at?
Cardiologists here indicated that Dexamethasone can cause temporary reduction in ejection fraction which tends to resolve itself a few months after go off of it. Local oncologist here in TN also indicated Carfilzomib can cause similar activity and also it resolves itself---based upon some reports form usage in patients---I am unclear if that is firsthand experience or second hand reports from other docs.
very interesting. I was on Kyprolis and dex for 2 cycles and went into CR. But after the 4th cycle I had facial edema from the Kyprolis not the Dex. I looked like a blow fish. My eyes were swollen shut. I feel much better off the meds. Now I went and see how long I stay in CR.
Hi Looper, I was on Velcade and dex twice a week for 6 months and three weeks of Cytoxin. Then had a stem cell transplant on September 26, 2014. I had a cardiac ultrasound before the transplant and my ejection fraction was 70. I had another cardiac ultrasound February 2015 because my heart rate since the SCT had been 120's to 150's. I have always been in normal sinus rhythm, no abnormal rhythms. My ejection fraction now is 50. The doctor put me on a beta blocker and it has brought my heart rate down to the 90's. I have not had any Chemo Since October 2014 when they gave me 3 Velcade injections after the transplant. My internal medicine MD said he will follow my heart function every 6 months. He didn't seem concerned with the 20 point drop in my ejection fraction. I am 54 years old. Your friend Juli
Hi Looper, I was on Velcade and dex twice a week for 6 months and three weeks of Cytoxin. Then had a stem cell transplant on September 26, 2014. I had a cardiac ultrasound before the transplant and my ejection fraction was 70. I had another cardiac ultrasound February 2015 because my heart rate since the SCT had been 120's to 150's. I have always been in normal sinus rhythm, no abnormal rhythms. My ejection fraction now is 50. The doctor put me on a beta blocker and it has brought my heart rate down to the 90's. I have not had any Chemo Since October 2014 when they gave me 3 Velcade injections after the transplant. My internal medicine MD said he will follow my heart function every 6 months. He didn't seem concerned with the 20 point drop in my ejection fraction. I am 54 years old. Your friend Juli