Letter to the editor: Comment on "possible protective effect of rosuvastatin in chemotherapy-induced cardiotoxicity in HER2 positive breast cancer patients: a randomized controlled trial".

We have read with keen interest the original article by Kettana et al., which investigates the potential cardioprotective effects of rosuvastatin in HER2-positive breast cancer patients undergoing chemotherapy. We appreciate the study's meticulous methodology and its contribution to medicine oncology. However, we suggest a cautious interpretation of the results due to unmeasured confounding variables that could influence cardiotoxicity development and treatment efficacy. The study's fixed dosing approach to rosuvastatin precludes the assessment of dose-dependent effects, prompting a recommendation for future dose-response analyses. We also highlight the need to incorporate patient-reported outcomes for a more holistic treatment efficacy evaluation. Furthermore, we propose metabolomic analysis to uncover the drug's mechanisms of action and computational methods like molecular docking to predict its potential targets, which could refine drug design and inform personalized treatment strategies. Our commentary aims to refine the study's conclusions and encourage research that maximizes the understanding and clinical management of chemotherapy-induced cardiotoxicity.