Cardioprotection in oncology: Mechanisms, risks and therapeutic strategies

Objectives of this review is to conduct an analysis of current data of cardiotoxicity of anticancer drugs and radiation therapy, methods of cardiovascular risk stratification, strategies for primary and secondary cardioprotection, approaches to monitoring and treating.Data SourcesA comprehensive search was conducted in PubMed/MEDLINE, Web of Science, Scopus. The search strategy combined medical subject headings related to сardio-oncology, antineoplastic agents, cardioprotective strategies. Reference lists of included studies were manually searched for relevant publications.Data SummaryThe review identifies distinct molecular pathways of cardiotoxicity, ranging from oxidative stress and Top2β inhibition in anthracyclines to immune-mediated myocarditis with checkpoint inhibitors and direct fibrotic damage from radiation. Results for standard heart failure medications remain controversial, often demonstrating no protective benefit in large-scale trials. While baseline risk stratification using biomarkers and advanced imaging methods is essential, current pharmacological interventions show significant heterogeneity in efficacy. Emerging non-pharmacological strategies, particularly structured aerobic exercise and lifestyle modification, show promise in mitigating systemic inflammation and preserving cardiac reserve.ConclusionThe existing arsenal of methods for the prevention and treatment of CTRCD/CTR-CVT remains very limited and does not meet the scale of the problem. Future progress in cardio-oncology depends on the implementation of multidisciplinary support for oncological patients and the development of personalized, dynamic cardio-risk assessment tools integrated with artificial intelligence with innovative cardioprotectors. There is an urgent need to intensify fundamental and clinical research aimed at developing innovative cardioprotective agents and personalized approaches to the management of cancer patients.