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Review
. 2019 Jul;11(1):15-23.
doi: 10.3892/mco.2019.1854. Epub 2019 May 8.

Anthracycline-induced cardiotoxicity in the chemotherapy treatment of breast cancer: Preventive strategies and treatment

Fengfeng Cai  1 , Manuel Antonio Falar Luis  1 , Xiaoyan Lin  1 , Minghong Wang  2   3 , Lu Cai  1 , Chunmei Cen  1 , Ewelina Biskup  4
Affiliations
Review

Anthracycline-induced cardiotoxicity in the chemotherapy treatment of breast cancer: Preventive strategies and treatment

Fengfeng Cai et al. Mol Clin Oncol. 2019 Jul.

Abstract

Anthracyclines are highly effective chemotherapeutic agents, used for a wide variety of malignancies. Cardiotoxicity is a well-recognized side effect of anthracycline therapy that limits the total amount of drug administered and can cause heart failure in some patients. Most experimental data support oxidative stress as the etiology of anthracycline-induced cardiotoxicity. The objective of this paper was to provide a review of the clinical classification, risk factors, monitoring and prevention of anthracycline-induced cardiotoxicity in patients with breast cancer.

Keywords: anthracyclines; breast cancer; cardiotoxicity; doxorubicin; prevention; risk factors; treatment.

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Figures

Figure 1.
Figure 1.
Structures of the anthracyclines currently used.
Figure 2.
Figure 2.
Unified mechanism for anthracycline-induced cardiotoxicity. ROS, reactive oxygen species; TOP2B, DNA topoisomerase II β; PGC, PPARG coactivator 1.
Figure 3.
Figure 3.
Comparative electrocardiogram data of a 55-year-old female who had reversible cardiotoxicity due to chemotherapy with trastuzumab. In V1-3, the R-wave disappeared, and the V4-6 T wave was low and flat. B, before; A, after; 1 CT, first round of chemotherapy; 2 CT, second round of chemotherapy; 3 CT, third round of chemotherapy; 4 CT, fourth round of chemotherapy; 5 CT, fifth round of chemotherapy.
Figure 4.
Figure 4.
Simplified depiction of the detection and treatment of cardiotoxicity in breast cancer. Schematic of the continuum of breast cancer treatment in relation to subsequent cardiotoxicity and heart failure. Modified from Khouri et al (60). BNP, B-type natriuretic peptide; ECG, electrocardiogram; CV, cardiovascular; MUGA, multigated acquisition; MRI, magnetic resonance imaging.
See this image and copyright information in PMC

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