A Historical Perspective of Anthracycline Cardiotoxicity

Anthracyclines remain important agents in the treatment of solid and hematological malignancy. Early experience with these drugs reported cardiac failure as an adverse event. Later, clinical recognition of cell injury at the time of administration was appreciated. This article explores the evolution of our understanding about anthracycline-associated cardiotoxicity, including the various strategies for the pretreatment assessment of patients for whom anthracyclines are contemplated, the frustrations associated with the lack of specific tests that could identify patients at risk of developing problems with their next 1 or 2 cycles, the concept of balancing oncologic benefit with cardiac risk in the treatment of cancer patients, and the newer strategies for reducing the potentially devastating complications of the treatment of malignant disease with anthracyclines.