Clinical spectrum and mechanistic insights into cardiotoxicity from cancer therapies

Cardiotoxicity is a major concern in oncology, influencing both patient safety and therapeutic decision-making. Part 1 of a dedicated 3-part series provides a comprehensive overview of the fundamentals of cardiotoxicity associated with cancer therapeutics, beginning with a definition of cardiotoxicity and classifying its mechanisms into direct myocardial injury, indirect cardiovascular effects, and a combination of both. Clinical manifestations are examined across the spectrum of presentations, from asymptomatic cardiac biomarker elevations to overt heart failure, alongside current detection strategies including imaging and patient-reported outcomes. Timing and incidence patterns are analyzed to highlight early versus delayed toxicity and their implications for surveillance strategies used in clinical practice. Guideline-directed therapies are summarized and suggestions for drug development that concomitantly begins to frame cardiotoxic effects are introduced. Lastly, the impact of cardiotoxicity on cancer treatment decisions, including dose modifications, therapy discontinuation, multidisciplinary management, is considered to establish a clear context for optimal patient care.