Cardiotoxicity Associated During Neoadjuvant Chemotherapy in Breast Cancer: A Narrative Review

Neoadjuvant chemotherapy is a fundamental strategy in the treatment of breast cancer, enabling tumor reduction, increasing the feasibility of breast-conserving surgery, and treating micrometastatic disease. However, the use of specific chemotherapeutic agents has been associated with significant cardiovascular adverse effects, which may compromise treatment efficacy and patients’ quality of life. To analyze current scientific evidence on cardiotoxicity associated with neoadjuvant chemotherapy in breast cancer, with emphasis on the main agents involved, risk factors, pathophysiological mechanisms, monitoring strategies, and clinical implications. This is a narrative literature review conducted through searches in PubMed, SciELO, and other relevant scientific journals. Studies published between 2013 and 2025 were included, encompassing reviews, meta-analyses, clinical trials, and clinical guidelines addressing cardiotoxicity related to neoadjuvant chemotherapy in breast cancer. The analyzed studies demonstrated that agents such as anthracyclines (doxorubicin, daunorubicin, epirubicin, and idarubicin), taxanes (paclitaxel and docetaxel), and anti-HER2 therapies (trastuzumab and pertuzumab) are strongly associated with cardiotoxicity. The main mechanisms include oxidative stress, topoisomerase IIβ dysfunction, reversible ventricular dysfunction, and cardiomyocyte injury. The incidence and severity of cardiotoxicity are influenced by risk factors such as advanced age, hypertension, diabetes mellitus, and pre-existing cardiovascular disease. Cardiotoxicity associated with neoadjuvant chemotherapy in breast cancer represents a significant clinical challenge, highlighting the importance of early recognition, appropriate cardiovascular monitoring, and individualized patient management. Preventive strategies and structured follow-up protocols are essential to minimize complications and optimize therapeutic outcomes.