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Recent Advances in the Prevention and Treatment of Chemotherapy–induced Cardiotoxicity

Hanieh Kazemnian, Hassan Mehrad-Majd*

Department of Biology, Faculty of Science, MashhadBranch, Islamic Azad University, Mashhad, Iran



The current studyaimed to overview recent advances in preventing and treating chemotherapy-induced cardiotoxicity. Chemotherapy is widely used in cancer treatment, however,it can have adverse effects on the heart, leading tothe development of risk factors,such as hypertension, obesity, dyslipidemia, and metabolic syndrome. Anthracycline compounds are the most commonly used chemotherapy agents and are associated with an increased risk of developing anthracycline-induced cardiotoxicity (AIC). The precise mechanisms underlying AIC remain a subject of debate, but evidence suggests that the primary causes arethe generation of reactive oxygen species (ROS) and subsequent oxidative stress. Several risk factors havebeen linked to the development of AIC, including cumulative dose, pre-existing cardiac disease, age, gender, and cardiac risk factors. Genetic susceptibility may also play a role as a potential risk factor for AIC. In order to protect cardiac function, various strategies have been explored, such asdeveloping less-toxic derivatives of anthracyclines, determining safer cumulative anthracycline doses, and identifying new cardioprotective agents. Prophylactic treatment with cardioprotective agents is the bestapproach for high-risk patients. This article reviewedthe present strategies for protecting cancer patients from AIC based on effective cardioprotective drugs along with the balance between their benefits and potential adverse effects.

1. Introduction:

The considerable advances in detecting and treatingcancer patients haveled to a remarkableincrease in life expectancy during the past two decades. Chemotherapy,with anti-cancereffects in the treatment of both solid and hematologic malignancies, significantly contributes to the potential for cancer cure and subsequent improved survival rates.Nevertheless, these therapies are not without their drawbacks, particularly with regard to their impact on cardiac health. Adverse effects on the heart encompass a spectrum of consequences, includingthe development of multiple riskfactors,such as hypertension, obesity, dyslipidemia, andmetabolic syndrome. Additionally, there is an increased likelihood of subsequent cardiotoxicity,which may acceleratecardiomyopathyin patients treated with antitumor agents1,2.Anthracyclinescompounds,includingdoxorubicin, daunorubicin, epirubicin, mitoxantrone,and idarubicin, are the most commonchemotherapy agents.They are used extensively to treat different kinds of cancer, such assolid tumors, lymphoma, sarcoma,breast cancer,small cell carcinoma of the lung, esophageal carcinoma,and pediatric leukemia3.However, caution is required for the clinical usefulness of anthracyclines due to their various adverse effects, especially thedevelopment of anthracycline-induced cardiotoxicity (AIC) that increases therisk of developing cardiac dysfunction and impacts the quality of life and mortality of cancer patients.

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