Cardiac Toxicity of Cancer Therapies: Mechanisms, Surveillance, and Clinical Implications

Cardiotoxicity caused by cancer treatments is a growing concern as the survival rate of cancer increases.This review synthesizes the current research on cancer therapy-related cardiac toxicity.A comprehensive literature search was performed in PubMed, Scopus, and Google Scholar (2015-2025).Chemotherapy drugs like anthracyclines cause irreversible myocardial injury via oxidative stress and mitochondrial dysfunction, while trastuzumab causes reversible dysfunction through human epidermal growth factor receptor 2 (HER2) signaling disruption.Radiation can lead to heart disease years later, and immunotherapy sometimes triggers heart inflammation.Surveillance relies on advanced imaging (e.g., global longitudinal strain echocardiography, cardiac magnetic resonance imaging) and biomarkers (troponin, B-type natriuretic peptide), though guidelines from American Society for Clinical Oncology and European Society of Cardiology differ in monitoring frequency and biomarker use.Risk stratification is essential, with high-dose anthracyclines, prior cardiovascular disease, and HER2-targeted therapies posing elevated risks.Primary prevention strategies include dexrazoxane and sodium-glucose cotransporter 2 inhibitors.Secondary prevention uses heart failure therapies.New tools; like artificial intelligence and genetic testing, may soon predict who is at risk and guide personalized care.By balancing cancer treatment success with heart safety, we can improve long-term health for survivors.