Clinical Scorecard: Exploring the Role of Glucagon-like Peptide 1 Agonists in Cardio-Oncology: Should We Shift Our Focus?

At a Glance

Key Highlights

• Proteasome inhibitors in MM increase cardiovascular risks including heart failure and ischemic heart disease.
• GLP1a use in MM patients with T2DM is associated with reduced major adverse cardiovascular events, heart failure, and all-cause mortality.
• GLP1a may have dual benefits by improving cardiometabolic status and potentially modulating MM tumour progression.

Guideline-Based Recommendations

Diagnosis

• Assess cardiovascular risk factors and comorbidities including T2DM in patients with multiple myeloma prior to proteasome inhibitor therapy.

Management

• Consider GLP1a therapy for glycaemic control in MM patients with T2DM to potentially reduce cardiovascular events and mortality.
• Combine GLP1a therapy with structured lifestyle interventions to optimize cardiometabolic and oncologic outcomes.

Monitoring & Follow-up

• Monitor cardiovascular status and glycaemic control regularly in MM patients receiving proteasome inhibitors and GLP1a.
• Observe for gastrointestinal complications, although GLP1a use was not associated with increased risk in the studied cohort.

Risks

• Be aware of potential cardiovascular risks associated with proteasome inhibitors in MM patients.
• Recognize that current evidence on GLP1a benefits in MM is observational; further randomized trials are needed.

Patient & Prescribing Data

Adults with multiple myeloma and Type 2 diabetes mellitus receiving proteasome inhibitors

GLP1a use was associated with a 33% lower risk of major adverse cardiovascular events, 43% reduced heart failure risk, and 44% lower all-cause mortality without increased gastrointestinal complications.

Clinical Best Practices

• Incorporate cardiovascular risk assessment in MM patients before initiating proteasome inhibitors.
• Use GLP1a as part of a personalized treatment plan for MM patients with T2DM to improve cardiovascular outcomes.
• Support GLP1a therapy with lifestyle modifications to enhance overall patient health and quality of life.
• Advocate for randomized controlled trials to validate observational findings and clarify GLP1a’s role in MM management.
• Consider health economic evaluations to assess long-term cost-effectiveness of GLP1a in this population.

References

• Chang et al., Cardiovascular outcomes and mortality in diabetic multiple myeloma patients initiated on proteasome inhibitors according to prior use of glucagon-like peptide 1 agonists