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Anthracycline-Induced Cardiotoxicity: A Review of Pathophysiology, Diagnosis, and Treatment

  • Cardio-oncology (S Francis, Section Editor)
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Opinion statement

Anthracyclines have been widely used in children and adults to treat hematologic malignancies, soft-tissue sarcomas, and solid tumors. However, anthracyclines come with both short- and long-term cardiotoxic effects, ranging from occult changes in myocardial structure and function to severe cardiomyopathy and heart failure that may result in cardiac transplantation or death. Here, we review the progress made over the past two decades in understanding the molecular and genetic basis of anthracycline-induced cardiotoxicity; detecting and monitoring myocardial dysfunction; using adjunct cardioprotectant therapies, such as dexrazoxane; and improving cardioprotection with agents such as liposomal and pegylated doxorubicin. Despite this increased understanding, preventing drug-induced cardiotoxicity while maintaining oncologic efficacy to achieve the highest quality of life over a lifespan remain cornerstones of successful anthracycline chemotherapy during childhood.

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Conflict of Interest

Dr. Shashi Raj, Dr. Vivian I. Franco, and Dr. Steven E. Lipshultz each declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Pediatric Cardiology, University of Miami Miller School of Medicine, Miami, FL, USA

    Shashi Raj MD & Steven E. Lipshultz MD

  2. Holtz Children’s Hospital of the University of Miami/Jackson Memorial Medical Center, Miami, FL, USA

    Shashi Raj MD & Steven E. Lipshultz MD

  3. Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA

    Vivian I. Franco MPH & Steven E. Lipshultz MD

  4. Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA

    Steven E. Lipshultz MD

  5. Department of Pediatrics, Wayne State University School of Medicine, Children’s Hospital of Michigan, 3901 Beaubien Boulevard, Suite 1K40, Detroit, MI, 48201, USA

    Steven E. Lipshultz MD

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  1. Shashi Raj MD
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Correspondence to Steven E. Lipshultz MD.

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Raj, S., Franco, V.I. & Lipshultz, S.E. Anthracycline-Induced Cardiotoxicity: A Review of Pathophysiology, Diagnosis, and Treatment. Curr Treat Options Cardio Med 16, 315 (2014). https://doi.org/10.1007/s11936-014-0315-4

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