Anthracyclines and cardiotoxicity

Cancer and cardiovascular disease are both leading causes of death worldwide. Although, cancer therapy has undoubtedly improved overall survival and prognosis, many agents have undesired side effects that result in secondary morbidities either acutely or in the long term. Anthracyclines, the most commonly used antineoplastic agent in breast cancer, are among such agents. The far-most concerning toxicity of anthracyclines is cardiac failure, which results from a variety of molecular mechanisms including oxidative stress and sarcomere structural alterations. However, mitochondrial dysfunction has recently emerged as a key factor in the pathophysiology of cardiotoxicity thus its preservation is considered as a possible approach in preventing cardiac damage. Interestingly, novel and safe strategies have emerged, including the activation of AMPK by metformin, nutraceuticals, exercise and dietary caloric restriction.