Neda Poormolaie, Mousa Bohlooli, Monireh Movahedi, Saman Sargazi
Doxorubicin (DOX) is a cornerstone anthracycline chemotherapeutic agent with a narrow therapeutic window, where minor deviations in systemic concentration can cause severe and often irreversible cardiotoxicity. This drives the need for analytical platforms capable of rapid, decentralized therapeutic drug monitoring (TDM). While chromatographic methods such as HPLC and LC–MS remain the gold standard, their reliance on centralized laboratories and complex sample preparation limits point-of-care applicability. This review critically examines advances in nanomaterial-modified electrochemical platforms for DOX detection, emphasizing analytical parameters governing clinical relevance over detection limit alone. Beyond sensitivity-driven comparisons, we discuss how nanomaterial composition, hybrid architecture, and interfacial chemistry influence dynamic range, antifouling behavior, signal stability, and validation in complex biological matrices. Carbon allotropes, metallic nanostructures, metal oxides, polymers, and porous frameworks such as MOFs and COFs are evaluated from a structure–performance perspective. Current trends indicate a shift toward hybrid architectures that balance high sensitivity with operational robustness. Despite progress, many reported ultralow detection limits remain clinically marginal due to narrow working ranges, limited long-term stability, and insufficient validation in real samples. This review highlights key analytical trade-offs and design priorities for developing electrochemical DOX sensors with genuine translational potential.