Current strategies for prevention of cancer therapy-related cardiotoxicity: pharmacological, non-pharmacological and emerging approaches

Background: Cardiotoxicity is a major concern in cancer survivors, potentially compromising treatment efficacy, quality of life and long-term survival. With increasing survival rates, the need for effective cardioprotective strategies has become paramount. Objective: This narrative review evaluates current pharmacological, non-pharmacological, and emerging strategies for preventing cancer therapy-related cardiac dysfunction (CTR-CD), emphasizing recent advances, their clinical applicability and research gaps. Methods: We conducted a narrative review based on a non-systematic search of PubMed/MEDLINE, Scopus, and Web of Science up to June 2025, focusing on clinical trials, meta-analyses, guideline recommendations, and key observational studies relevant to CTR-CD prevention. Results: Among pharmacological approaches, renin-angiotensin-aldosterone system inhibitors (RAASi) and beta-blockers modestly preserve left ventricular ejection fraction (LVEF), though benefits on hard outcomes remain unproven. Dexrazoxane is the only FDA-approved agent and shows robust protection in anthracycline-treated patients. Statins and metformin demonstrate promising but still investigational cardioprotective effects, while sodium-glucose cotransporter-2 inhibitors (SGLT2i) show encouraging pilot data. Non-pharmacological strategies-including structured exercise, mediterranean diet, nutritional support and aggressive control of risk factors-are guideline-endorsed, although most evidence relies on surrogate endpoints. Emerging tools such as telemedicine, artificial intelligence and omics sciences offer innovative opportunities for personalized prevention but require multicenter validation. Conclusion: An integrated, multidisciplinary approach combining both pharmacological and non-pharmacological strategies is essential to effectively prevent cardiotoxicity in cancer patients. Current evidence supports dexrazoxane, risk factor control and selective use of RAASi or beta-blocker in high-risk patients. Exercise and nutrition provide functional and quality of life benefits, while several novel strategies remain exploratory. Future large-scale, multicenter, randomized trial are needed to harmonize international guidelines and define the most effective, sustainable prevention models across diverse patient populations.