Cancer therapy-associated Takotsubo cardiomyopathy: A narrative review of mechanisms, drug associations, and clinical implications

Anticancer therapies have been increasingly associated with Takotsubo cardiomyopathy (TTC). As prior reports remain fragmented across case studies and drug-specific reviews, this paper offers one of the most comprehensive reviews to date of cancer therapy-associated TTC. While classically triggered by emotional or physical stress, TTC has been increasingly associated with chemotherapy and other cancer-directed therapies. This literature review explores the pathophysiology, clinical features, and evolving evidence linking anticancer agents to TTC, with a focus on cytotoxic cancer therapy, hormonal therapy, targeted treatments, and immune checkpoint inhibitors. We describe the proposed mechanisms of cancer therapy-associated TTC, the diagnostic challenges, particularly in patients with cancer, and the complex management strategies, especially regarding the decision to resume oncologic treatment after TTC recovery. Given the increasing use of cardiotoxic agents, a multidisciplinary approach to cardio-oncology care among patients with suspected TTC is crucial. More research is needed to understand the role of TTC in cardiac dysfunction among patients with cancer, clarify risk stratification methods, and improve outcomes for patients at risk of TTC during cancer treatment.