A Review on the Effect of Traditional Chinese Medicine Against Anthracycline-Induced Cardiac Toxicity

Abstract

Anthracyclines are effective agents generally used to treat solid-tumor and hematologic malignancies. The use of anthracyclines for over 40 years has improved cancer survival statistics. Nevertheless, the clinical utility of anthracyclines is limited by its dose-dependent cardiotoxicity that adversely affects 10-30% of patients. Anthracycline-induced cardiotoxicity may be classified as acute/subacute or chronic/late toxicity and leads to devastating adverse effects resulting in poor quality of life, morbidity, and premature mortality. Traditional Chinese medicine has a history of over 2,000 years, involving both unique theories and substantial experience. Several studies have investigated the potential of natural products to decrease the cardiotoxic effects of chemotherapeutic agents on healthy cells, without negatively affecting their antineoplastic activity. This article discusses the mechanism of anthracycline-induced cardiotoxicity, and summarizes traditional Chinese medicine treatment for anthracycline-induced heart failure (HF), cardiac arrhythmia, cardiomyopathy, and myocardial ischemia in recent years, in order to provide a reference for the clinical prevention and treatment of cardiac toxicity.

Keywords: adverse effects; anthracyclines; antineoplastic; cardiac toxicity; traditional Chinese medicine.

Figure 1

Mechanism involved in traditional Chinese medicine treated on cardiotoxicity induced by anthracycline. ROS, reactive oxygen species; EF, ejection fraction; FS, fractional shortening; LV flow, left ventricular outflow; LVDF, left ventricular diastolic function; LVEF, left ventricle ejection fraction; LVFS, left ventricular fractional shortening; LV mass, left ventricular mass; CK, creatine kinase; Tnl, troponin I; BNP, brain natriuretic peptide; CK-MB, creatine kinase isoenzymes; cTnT, cardiac Troponin T, Rg3, GinsenosideRg3; SA, Salvianolic acids; TSNIIA-SS, Tanshinone IIA sodium sulfonate; P. grandiflorum, Platycodon grandiflorum; GB, Ginkgolide B; ZGCT, Zhi Gan Cao Tang; XG, Xinfuli Granule; WXKL, Wenxin Granule; SYKT, Sanyang Xuedai; SMY, Sheng-Mai Yin; NOS, nitric oxide synthase; SND, Sini decoction; GU, Glycyrrhiza Uralensis; MDA, malondialdehyde; SC, Schisandra chinensis; SOD, superoxide dismutase.