Emerging insights into traditional Chinese medicine interventions for chemotherapy-induced cardiotoxicity

Chemotherapy-induced cardiotoxicity (CIC) is a serious and potentially life-threatening adverse effect associated with various chemotherapeutic agents, which has become the second leading cause of mortality among cancer survivors, following only the malignancy itself. However, effective preventive and therapeutic strategies for CIC remain limited. Accumulating evidence suggests that traditional Chinese medicine (TCM) holds considerable promise in mitigating CIC through multiple pathways. However, research findings in this field are currently fragmented and lack systematic integration.

To provide a comprehensive understanding of the current research status, emerging hotspots, developmental trends, and key challenges in the field of TCM interventions for CIC.

A systematic literature search was conducted using the China National Knowledge Infrastructure and Web of Science databases from January 1, 2000, to December 30, 2024. CiteSpace software was employed for visualization and knowledge mapping, enabling an in-depth analysis of research hotspots and trends in TCM interventions for CIC.

A total of 532 relevant articles were retrieved, with the number of publications showing an increasing trend over the past two decades. Core authors such as Xie Ming, Ji Xuming, and Fu Chaomei, along with institutions like Beijing University of Chinese Medicine and the Shanghai University of Traditional Chinese Medicine, have played leading roles in this field. Co-occurrence and clustering of keywords revealed several core research domains, including tumor types associated with CIC, chemotherapeutic agents inducing CIC, and pharmacological mechanisms of TCM interventions. Burst keywords and timeline analyses highlighted emerging research hotspots and developmental trends, such as enhancing efficacy, reducing toxicity, and elucidating underlying mechanism, reflecting a shift toward mechanistic exploration and clinical translation. The article further discusses various TCM therapies-including classical TCM formulas, modern TCM formulas, single herbs, active compounds and injections-in alleviating CIC, as well as modern pharmacological insights and the current challenges in this field.

Over the past two decades, interest in TCM interventions for CIC has grown significantly. Current research hotspots focus on the pathophysiological mechanisms of CIC and emerging evidence supports the potential of multi-target TCM interventions as a strategy to mitigate CIC. However, key challenges remain, future research should prioritize the discovery of novel TCM candidates, in-depth mechanistic investigations, and the implementation of high-quality clinical trials to support evidence-based application of TCM in CIC prevention and treatment.