Anthracycline-induced cardiotoxicity: course, pathophysiology, prevention and management

Expert Opin Pharmacother. 2007 Jun;8(8):1039-58. doi: 10.1517/14656566.8.8.1039.


Although effective anti-neoplastic agents, anthracyclines are limited by their well recognized and pervasive cardiotoxic effects. The incidence of late progressive cardiovascular disease in long-term survivors of cancer is established and may contribute to heart failure and death. To maximize the benefits of these drugs, a high-risk population has been identified and new strategies have been investigated to minimize toxic effects, including limiting the cumulative dose, controlling the rate of administration and using liposomal preparations and novel anthracycline analogues. Dexrazoxane also shows promise as a cardioprotectant during treatment. This paper reviews these strategies, as well as medications used to manage anthracycline-induced cardiotoxicity, and functional and biochemical means of monitoring cardiotoxicity, including echocardiography, radionuclide scans and biomarker analysis. The treatment of adult cancer survivors who have had anthracycline-related cardiotoxicity has not been systematically studied. Empirically, anthracycline-associated cardiac dysfunction is treated very similarly to other forms of heart failure. These treatments include avoiding additional cardiotoxic regimens, controlling hypertension, lifestyle changes, medications and heart transplantation.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anthracyclines / administration & dosage
  • Anthracyclines / adverse effects*
  • Antibiotics, Antineoplastic / administration & dosage
  • Antibiotics, Antineoplastic / adverse effects*
  • Cardiovascular Agents / therapeutic use
  • Drug Interactions
  • Drug Monitoring / methods
  • Heart / drug effects*
  • Heart Diseases / chemically induced*
  • Heart Diseases / drug therapy
  • Heart Diseases / physiopathology
  • Heart Diseases / prevention & control
  • Humans
  • Neoplasms / drug therapy
  • Razoxane / therapeutic use
  • Risk Factors


  • Anthracyclines
  • Antibiotics, Antineoplastic
  • Cardiovascular Agents
  • Razoxane