Monoclonal-induced cardiotoxicity in patients with non-Hodgkin's lymphoma and breast cancer: A retrospective study in an oncology clinic

Monoclonal antibodies, such as trastuzumab and rituximab, significantly contribute to the oncological therapeutic arsenal. However, they may be associated with the development of cardiotoxicity. This study collected data from clinical records of patients in the use of rituximab and trastuzumab in a private oncology clinic from 2017 to 2019. It also investigated cardiovascular adverse drug reactions and associated risk factors. Cardiotoxicity was defined as symptomatic in the presence of signs and symptoms suggestive of heart failure (HF) such as dyspnea, nocturnal cough, and fatigue, among others. Asymptomatic HF was confirmed by the decline in the left ventricular ejection fraction (LVEF) ≥10% of baseline or LVEF ≤50%. Among the 57 patients undergoing trastuzumab, 12 patients (21%) had cardiotoxicity and 8 patients (67%) had extreme or high-risk scores in the cardiotoxicity risk assessment algorithm. Among the 37 patients treated with rituximab, 3 patients (8%) had cardiotoxicity. The presence of previous diabetes mellitus significantly increased the risk of trastuzumab-induced cardiotoxicity ( p = 0.02). However, none of the other risk factors influenced the incidence of trastuzumab- and rituximab-induced cardiotoxicity, which the sample size may explain. More studies are needed to investigate the association of risk factors with cardiotoxicity induced by trastuzumab and rituximab, aiming to establish strategies to prevent and manage this effect early.