- © 2008 by American Society of Clinical Oncology
Interaction Between Statins and Rituximab in Non-Hodgkin's Lymphoma
To the Editor:
I read with interest the editorial by Carver et al1 in Journal of Clinical Oncology on the approach to doxorubicin cardiotoxicity in the elderly patients treated for non-Hodgkin's lymphoma. The authors stated they have a “low threshold to add statins in light of the possible protective effect of this drug class on anthracylcine cardiotoxicity.” However, I would caution the authors (and readers) to consider recent data before adopting this practice.2 In a laboratory study, statins were found to significantly decrease rituximab-mediated complement-dependent cytotoxicity and antibody-dependent cellular cytotoxicity of B-cell lymphomas. These studies suggested that statins, through cholesterol depletion, induced conformational changes in CD20 that result in impaired binding of the anti-CD20 monoclonal antibody. It is firmly established that rituximab has a major beneficial impact in the outcome of patients with non-Hodgkin's lymphoma.3 Impairing the binding of rituximab to the tumor cells by adding a statin may negate some of the benefit of this drug, and needs to be weighed against any potential cardiac benefit derived from this approach as outlined by the authors. Furthermore, although there are no clinical data to support holding statins during rituximab administration, it may be prudent to consider doing so, even in patients already on this class of drug. Patients could be restarted on their statin one or two half-lives after the last dose of rituximab has been administered. At the very least, physicians should discuss this potentially negative interaction with their patients.
AUTHOR'S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST
The author(s) indicated no potential conflicts of interest.
Footnotes
-
published online ahead of print at www.jco.org on October 20, 2008
