Chemotherapy-induced cardiotoxicity in breast cancer: mechanisms, diagnostic advances, and emerging protective strategies

Cardiotoxicity is a significant adverse effect of chemotherapy, particularly in breast cancer survivors, especially those undergoing aggressive treatment regimens or with pre-existing cardiovascular conditions. This presents a major challenge for cardio-oncologists, who must balance the effective treatment of cancer with minimizing the risk of cardiovascular damage. Addressing this challenge requires a comprehensive understanding of the mechanisms by which chemotherapy agents induce cardiotoxicity, and the development of reliable methods for early detection and the identification of effective cardioprotective strategies. Preclinical animal models have served as indispensable tools for elucidating underlying mechanisms and assessing the efficacy of potential cardioprotective strategies. This review aims to explore the key signaling pathways implicated in this process, focusing on mechanisms such as oxidative stress, reactive oxygen species generation, inflammatory pathways, cellular damage, and mitochondrial dysfunction. It also discusses advancements in detection techniques and cardioprotective strategies that have shown great promise in preserving cardiac function during cancer treatment without diminishing the effectiveness of chemotherapy. Ultimately, this review emphasizes the need to integrate cardiotoxicity management into breast cancer treatment protocols to enhance patient survival and quality of life.