Introduction: Anticancer drugs have benefits for treating cancer but they have many adverse effects such as cardiotoxicity. Especially anthracyclines are known for their cardiotoxic effects. So, there is a need for evidence in this regard as to how we can prevent these side effects for better management and care of patients receiving chemotherapy. The previous literature described the effectiveness of exercise and ACE inhibitors in this regard. Our research complements these findings by further investigating the effectiveness of candesartan and carvedilol in reducing early cardiotoxicity. Additionally, our study introduces the novel perspective of using SGLT-2 inhibitors, a facet not previously covered in the European Society of Cardiology Guidelines on Cardio-oncology (2022). These comparisons highlight the evolving landscape of cardiotoxicity prevention strategies and the contribution of our research to this dynamic field.

Objective:This systematic review investigated strategies to mitigate cardiotoxicity induced by anticancer medications with an emphasis on exercise and pharmacological interventions.

Methods:We conducted a systematic review of three randomized controlled trials (RCTs), one ATOPE trial, and one retrospective cohort study following PRISMA guidelines 2020.

Results:Among 448 patients, exercise interventions, particularly in breast cancer patients, demonstrated significant improvements in left ventricular ejection fraction (LVEF) and cardiotoxicity prevention. Pharmacological interventions, including candesartan and carvedilol, have shown potential in reducing early DOX-induced subclinical cardiotoxicity (DISC). Combination therapy with lisinopril and bisoprolol effectively preserved the LVEF. A retrospective cohort study demonstrated the cardioprotective potential of SGLT-2 inhibitors in reducing cardiovascular events.

Conclusion:This systematic review underscores the promise of exercise and pharmacological interventions for preserving cardiac function in cancer patients receiving chemotherapy. These findings have significant implications for enhancing the quality of care for patients with cancer.

Keywords: Cardiotoxicity, Anticancer drugs, Anthracyclines, Antineoplastic agents