Anthracycline Cardiotoxicity in Adult Cancer Patients

• Published in: JACC CardioOncology 2024-10, Vol.6 (5), p.655-677
• Main Authors: Camilli, Massimiliano, Cipolla, Carlo Maria, Dent, Susan, Minotti, Giorgio, Cardinale, Daniela Maria
• Format: Article
• Language: English
• Subjects: anthracycline; biomarkers; cancer survivorship; diagnosis; heart failure
• ISSN: 2666-0873; 2666-0873
• DOI: 10.1016/j.jaccao.2024.07.016

Since their introduction in the 1960s, anthracyclines have been a significant breakthrough in oncology, introducing dramatic changes in the treatment of solid and hematologic malignancies. Although new-generation targeted drugs and cellular therapies are revolutionizing contemporary oncology, anthracyclines remain the cornerstone of treatment for lymphomas, acute leukemias, and soft tissue sarcomas. However, their clinical application is limited by a dose-dependent cardiotoxicity that can reduce cardiac performance and eventually lead to overt heart failure. The field of cardio-oncology has emerged to safeguard the cardiovascular health of cancer patients receiving these therapies. It focuses on controlling risk factors, implementing preventive strategies, ensuring appropriate surveillance, and managing complications. This state-of-the-art review summarizes the current indications for anthracyclines in modern oncology, explores recent evidence on pathophysiology and epidemiology, and discusses advances in cardioprotection measures in the anthracycline-treated patient. Additionally, it highlights key clinical challenges and research gaps in this area. [Display omitted] •Anthracyclines serve as an essential therapy for many solid and hematologic malignancies, but their use is burdened by cardiac complications that negatively affect patient outcomes and may limit optimal cancer treatment.•Appropriate surveillance before, during, and after anthracycline exposure is crucial to prevent the progression of related cardiotoxicity toward overt heart failure.•Despite our knowledge on anthracycline cardiotoxicity, many unanswered questions still need to be addressed through properly designed basic/translational research and randomized clinical trials.•The establishment of a multidisciplinary cardio-oncology team is crucial to optimize oncologic outcomes without compromising cardiovascular health.