Table 1. Types of chemotherapy, immunotherapy and radiotherapy and their molecular mechanisms of action; adapted from16 with permission.
| Therapy | Anticancerous mechanism | Cardiotoxicity mechanism |
|---|---|---|
| Anthracyclines | Inhibit DNA synthesis | Oxidative stress (cardiomyocyte apoptosis) Inhibition of topoisomerase activity (DNA damage) |
| Alkylating agents | Inhibit DNA synthesis (by DNA alkylation) | Inhibit long-chain fatty acid oxidation |
| Antimicrotubule agents | Inhibit cell division (repression of polymerization/depolymerization of microtubules) | Activate Neuronal Calcium Sensor 1 (NCS1) causing Ca²⁺ overload |
| Monoclonal antibodies | Bevacizumab: inhibits angiogenesis (anti VEGF); Trastuzumab: inhibits cell proliferation (anti EGF/HER2/neu receptor) | Oxidative stress (cardiomyocyte apoptosis) |
| TKIs | Inhibit cell proliferation Determine apoptosis | Mitochondrial impairment Cardiomyocyte apoptosis |
| Radiation therapy | Damages cell DNA Inhibits cell division Determines apoptosis Inhibits angiogenesis | Causes endothelial dysfunction Induces fibrogenesis and atherosclerosis Oxidative stress |