Cardiac damage in anthracyclines therapy: focus on oxidative stress and inflammation

Despite their serious side effects, anthracyclines (ANTs) are the most prescribed chemotherapeutic drugs because of their strong efficacy in both solid and hematological tumors. A major limitation to ANTs clinical application is the severe cardiotoxicity observed both acutely and chronically. The mechanism underlying cardiac dysfunction under chemotherapy is mainly dependent on the generation of oxidative stress and systemic inflammation, both leading to progressive cardiomyopathy and heart failure. Recent advances: Over the years, the iatrogenic ANTs-induced cardiotoxicity was thought to be simply given by iron metabolism and ROS production: however, several experimental data indicate that ANTs may use alternative damaging mechanisms, such as topoisomerase 2β inhibition, inflammation, pyroptosis, immunometabolism, autophagy.