Review on cardioprotective strategies in the setting of chemotherapy-induced cardiotoxicity

Chemotherapy-induced cardiotoxicity represents a major challenge in the care of cancer patients, particularly with anthracyclines, HER2-directed therapies, and other cytotoxic agents. As cancer survival improves, preserving cardiovascular health has become increasingly important. This review summarizes current evidence on pharmacologic, non-pharmacologic, and novel drug-delivery strategies for preventing and managing CIC, with a focus on optimizing left ventricular function. A comprehensive literature search of PubMed identified randomized controlled trials, observational studies, systematic reviews, and meta-analyses evaluating cardioprotective strategies in adults receiving cardiotoxic chemotherapy. Outcomes included left ventricular ejection fraction (LVEF), heart failure incidence, troponin levels, and global longitudinal strain (GLS). Pharmacologic strategies with the strongest evidence include dexrazoxane and liposomal encapsulation of anthracyclines. Beta-blockers, ACE inhibitors, ARBs, MRAs, and statins to non-pharmacologic interventions like structured exercise programs and echocardiographic surveillance with GLS provide varying degrees of support. Still, the current literature is marked by heterogeneity in study design, endpoints, and patient populations. Other potential pharmacologic interventions include SGLT2 inhibitors and GLP-1 RA. While meta-analyses often show favorable trends, large-scale randomized controlled trials remain essential to validate these approaches, optimize patient selection, and standardize implementation. Until such data are available, clinicians should consider individualized risk assessment and adopt a multifaceted approach, incorporating both preventative and early detection strategies, to preserve cardiac function and maximize the safety of cancer therapy. A multifaceted approach incorporating pharmacologic therapy, exercise, imaging surveillance, and drug formulation strategies can potentially mitigate chemotherapy-induced cardiotoxicity. Large-scale, well-designed randomized trials are needed to optimize timing, patient selection, and combinations of cardioprotective interventions. Until such data are available, individualized risk assessment and early intervention remain key to preserving cardiac function in patients undergoing potentially cardiotoxic chemotherapy.