Cancer therapy-induced cardiac metabolic reprogramming: A new frontier in cardio-oncology

With the continuous advancement of cancer treatment technology, cardiotoxicity has gradually become a significant concern regarding the quality of life and long-term prognosis of cancer patients. This review systematically explores the mechanisms of cardiac metabolic reprogramming during cancer treatment, highlighting the impact of chemotherapy, targeted therapy, immunotherapy, and other drugs on the metabolic balance of cardiac cells. The primary manifestation of this impact is the shift from efficient fatty acid oxidation to inefficient glycolysis dependence. Simultaneously, abnormalities in lipid metabolism, intensified oxidative stress, and the involvement of inflammatory factors gradually impair heart function. The study also emphasizes the role of the "reverse Warburg effect" in cardiac cells' response to drug stress, unveiling the complex interplay between metabolism and other non-cardiac cells. This paper also raises the necessity of personalized management strategies, particularly considering the differences in cardiac tolerance among various populations, especially children and elderly patients. Furthermore, it elaborates on the potential applications of multi-omics integration, dynamic monitoring, and digital health management in cardiotoxicity early warning systems. In the future, promoting the integration of basic research and clinical practice, and developing a comprehensive "prevention-monitoring-treatment" system, will be key to enhancing the safety of cancer treatment and improving patient outcomes.