Cancer therapy has become increasingly successful at controlling disease, but some treatments can place the cardiovascular system under substantial stress. Anthracyclines such as doxorubicin remain an important example, while HER2-directed medicines, fluoropyrimidines, tyrosine kinase inhibitors and several other anticancer therapies can produce different forms of cardiovascular toxicity.
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The European Society of Cardiology describes cancer therapy-related cardiovascular toxicity as encompassing conditions including cardiac dysfunction, heart failure, vascular disease, hypertension and arrhythmias.
This is changing the treatment conversation. Instead of waiting for cardiac symptoms to appear, oncology teams increasingly assess cardiovascular risk before treatment and monitor patients during therapy.
The Cardio-Oncology Pathway Starts before the First Infusion
The modern approach increasingly begins with a baseline cardiovascular assessment. Depending on the patient's risk and planned cancer treatment, evaluation can include an ECG, echocardiogram, cardiac troponin, natriuretic peptides and, when appropriate, cardiac MRI or CT.
The ESC patient guidance distinguishes surveillance according to cardiovascular risk. Low-risk patients may require relatively limited monitoring, whereas patients at higher risk can require cardiology assessment and preventive heart treatment before or during cancer therapy.
This risk-based model is important because two patients receiving the same chemotherapy regimen may not have the same probability of developing cardiac complications.
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Anthracyclines Remain a Central Treatment Focus
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Anthracycline-associated cardiac injury continues to receive particular attention because cumulative exposure can influence risk.
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ESC material reports an anthracycline cardiotoxicity incidence of approximately 9% in one large study, with about 98% of identified cases diagnosed at a median of 3.5 months.
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That timing helps explain the growing emphasis on early surveillance. Detecting declining ventricular function or biomarker abnormalities while treatment is still underway can create an opportunity to intervene before clinically significant heart failure develops.
Troponin Is Moving the Detection Window Earlier
Cardiac troponin is becoming an important part of cardio-oncology monitoring because myocardial injury may occur before measurable symptoms. ESC guidance identifies troponin as a useful marker of early myocardial injury, particularly in patients exposed to anthracyclines and trastuzumab. Natriuretic peptides such as BNP and NT-proBNP can provide additional information about cardiac stress.
This creates a practical clinical sequence:
Cancer treatment → biomarker surveillance → imaging assessment → early cardiac intervention → reassessment of cancer therapy
The objective is not simply to identify heart damage, but to identify it early enough to preserve both cardiovascular health and cancer-treatment continuity.
Imaging Is Becoming More Detailed Than a Single Ejection Fraction
Echocardiography remains central to monitoring, but contemporary cardio-oncology increasingly incorporates global longitudinal strain alongside conventional left ventricular ejection fraction. Three-dimensional echocardiography, cardiac MRI and other imaging approaches can provide additional information when conventional assessment is insufficient.
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A 2026 ESC/EACVI consensus statement specifically addressed multimodality imaging for cardiovascular disease in patients receiving cardiotoxic anticancer treatments, reflecting the increasing role of advanced imaging in this field. ESC 365
The Treatment Objective Is Shifting From Stopping to Continuing Cancer Therapy Safely
One of the most important developments is the effort to manage cardiac dysfunction without automatically abandoning an effective anticancer medicine. This is particularly relevant for HER2-directed treatment.
ESC guidance notes that HER2-related cardiac dysfunction can occur during treatment and that, after appropriate heart-failure therapy, selected patients may be able to resume trastuzumab without developing recurrent dysfunction.
That makes treatment decisions increasingly multidisciplinary, involving oncologists, cardiologists, imaging specialists, pharmacists and specialist nurses.
Dexrazoxane Remains an Established Cardiac Protection Option
Dexrazoxane represents one of the clearest examples of a therapy specifically associated with prevention of anthracycline-related cardiac injury. The U.S. FDA lists Zinecard (dexrazoxane hydrochloride) under supportive-care cancer approvals for prevention of cardiomyopathy associated with doxorubicin administration. Its prescribing information nevertheless states that cardiac toxicity is not completely eliminated and recommends cardiac-function monitoring.
The significance is broader than one medicine: prevention, monitoring and treatment increasingly operate as a connected pathway.
2026 Evidence Is Strengthening the Heart-Failure Treatment Conversation
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At ESC Cardio-Oncology 2026, analysis of available studies found the greatest improvement in cardiac function among evaluated approaches with renin-angiotensin-aldosterone-system inhibition and beta-blockers.
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The ESC simultaneously emphasized that evidence for several newer heart-failure medicines remains limited and that additional randomized trials are needed.
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This is an important distinction for the treatment landscape: established cardiovascular medicines are already being integrated into cancer care, while newer cardioprotective approaches continue to be investigated.
Survivorship Is Extending the Treatment Window
Cardiotoxicity does not necessarily end when chemotherapy ends. ESC guidance recommends cardiovascular reassessment after cancer therapy, with the intensity determined by treatment exposure and baseline risk. High- and very-high-risk survivors may require ECG, natriuretic peptide testing and echocardiography at defined intervals, while longer-term monitoring can continue for years. European Society of Cardiology
As more people live longer after cancer treatment, the clinical pathway is consequently expanding from pre-treatment assessment → active-therapy surveillance → early cardiac intervention → survivorship monitoring.
The Market Is Following the Clinical Pathway
The chemotherapy-induced cardiotoxicity treatment landscape is therefore becoming broader than medicines used after cardiac dysfunction appears. It increasingly encompasses risk assessment, biomarkers, echocardiography, strain imaging, heart-failure treatment, cardioprotective strategies and long-term survivorship programs.
The central shift in 2026 is clear: cardio-oncology is moving the emphasis from reacting to cardiac injury toward identifying vulnerability earlier and protecting the heart while effective cancer treatment continues.