Carfilzomib-induced sinus bradycardia: A case report and literature review

Carfilzomib is a second-generation irreversible proteasome inhibitors commonly used in the treatment of relapsed or refractory multiple myeloma. However, cardiac toxicity (heart failure, hypertension, coronary heart disease, etc.) has become the main factor leading to its reduction or withdrawal. We report a case of a 55-year-old female patient with multiple myeloma who developed sinus bradycardia following the administration of carfilzomib, along with a review of the relevant literature. The correlation between carfilzomib and cardiotoxicity was assessed by reviewing the medical history, applying the adverse drug reaction correlation evaluation, and using the Naranjo assessment scale. The clinical manifestations included chest tightness, shortness of breath, and abnormal electrocardiogram monitoring. The condition was effectively managed following treatment with a combination of trimetazidine and salbutamol. We conducted a literature review of 27 published cases of proteasome inhibitor-induced cardiac toxicity. In the 27 published cases, 12 cases were caused by carfilzomib (44.4%). To our knowledge, this is the first reported case of carfilzomib-associated sinus bradycardia, expanding the spectrum of proteasome inhibitors-related cardiotoxicity. This provides inspiration for suspected patients to stop using carfilzomib early and symptomatic treatment can effectively reduce mortality and improve prognosis.