Which monoclonal antibody requires left ventricular ejection fraction (LVEF) monitoring due to the risk of cardiomyopathy?

Trastuzumab, known by its brand name Herceptin, is a monoclonal antibody that specifically targets the HER2 protein, which is overexpressed in some breast and gastric cancers. One of the critical considerations when administering trastuzumab is the risk of cardiomyopathy and heart failure, particularly in patients who have pre-existing cardiac conditions or those who are receiving it in combination with certain chemotherapeutic agents like anthracyclines.

Monitoring left ventricular ejection fraction (LVEF) is essential in patients receiving trastuzumab to detect any changes in cardiac function early. This proactive approach helps manage any potential toxicity due to the drug’s impact on the heart, thus providing a balance between effective cancer treatment and cardiotoxicity management.

In contrast, the other monoclonal antibodies listed—cetuximab, bevacizumab, and rituximab—do not have the same strong association with cardiomyopathy, and therefore, routine LVEF monitoring is not a standard practice for those therapies. This distinction is what makes trastuzumab unique and necessitates careful cardiac assessment during treatment.