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September 2, 2026Journal of the American College of Cardiology682 citationsOpen Access

Prevention of Anthracycline-Induced Cardiotoxicity

PVPimprapa VejpongsaEYEdward T.H. Yeh

Key Result

Topoisomerase 2β has been identified as the primary molecular target for cardioprotection against anthracycline-induced cardiotoxicity, informing current primary and secondary prevention strategies.

Key Points

  • To review clinical mechanisms and evaluate evidence-based interventions for preventing anthracycline-induced cardiotoxicity in cancer patients.
  • Synthesized clinical trial evidence and consensus guidelines on cardioprotection during anthracycline chemotherapy.
  • Evaluated primary pharmacological interventions, dosing modifications, and cardiac monitoring protocols.
  • Dexrazoxane and continuous infusion regimens reduce the risk of left ventricular dysfunction and clinical heart failure.
  • Neurohormonal therapies, including beta-blockers and angiotensin pathway inhibitors, provide cardioprotective benefits in high-risk patients.
  • Baseline cardiovascular risk stratification and serial strain imaging enable early detection and timely therapeutic mitigation.

Structured PICO

What are the current strategies for primary and secondary prevention of anthracycline-induced cardiotoxicity?

P
Population
Cancer patients receiving anthracycline chemotherapy
I
Intervention
Strategies for primary and secondary prevention of anthracycline-induced cardiotoxicity
O
Outcome
Prevention of anthracycline-induced cardiotoxicity

This review highlights topoisomerase 2β as a primary molecular target for cardioprotection and summarizes current strategies to prevent anthracycline-induced cardiotoxicity.

Limitations

  • Knowledge gaps requiring further investigation

Abstract

Anthracycline compounds are major culprits in chemotherapy-induced cardiotoxicity, which is the chief limiting factor in delivering optimal chemotherapy to cancer patients. Although extensive efforts have been devoted to identifying strategies to prevent anthracycline-induced cardiotoxicity, there is little consensus regarding the best approach. Recent advances in basic mechanisms of anthracycline-induced cardiotoxicity provided a unified theory to explain the old reactive-oxygen species hypothesis and identified topoisomerase 2β as the primary molecular target for cardioprotection. This review outlines current strategies for primary and secondary prevention of anthracycline-induced cardiotoxicity resulting from newly recognized molecular mechanisms and identifies knowledge gaps requiring further investigation.

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Cite This Study

Vejpongsa et al. (2014) conducted a review in Anthracycline-induced cardiotoxicity. Primary and secondary prevention strategies was evaluated. Topoisomerase 2β has been identified as the primary molecular target for cardioprotection against anthracycline-induced cardiotoxicity, informing current primary and secondary prevention strategies.

synapsesocial.com/papers/6a97959de9e4ae5ab972f4b4https://doi.org/10.1016/j.jacc.2014.06.1167
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