From:  Cardiotoxicity in breast cancer patients treated with chemoradiotherapy

 Cardiotoxicity of systemic therapies and radiotherapy in breast cancer treatment.

CategoryPathophysiologyClinical ManifestationsCardiotoxicity rates
AnthracyclinesTopoisomerase II inhibition
Increased ROS
Mitochondrial dysfunction
Heart failure
Arrhythmias
29% [35]
TaxanesMassive histamine releaseConduction system disease
Heart failure
5–20% [40]
Alkylating agentsMetabolite-induced increased ROSHeart failure
Arrhythmias
Hemorrhagic myocarditis (severe)
Pericarditis
Up to 28% [40]
HER2 inhibitorsHER2 inhibition reduces cardiomyocyte repair & survivalHeart failure14% [41]
Immune checkpoint inhibitorsT-cell mediated inflammationMyocarditis
Pericarditis
Takotsubo cardiomyopathy
Coronary artery disease
3% [42]
Aromatase inhibitorsEstrogen-inhibition
Reduced vasodilation and lipid metabolism
Heart failure
Coronary artery disease
Arrhythmias
13% [43]
Radiation therapyOxidative stress
Endothelial injury
Fibrosis
Coronary artery disease
Constrictive pericarditis
Heart failure
Valvular dysfunction
Arrhythmias
4%/Gy [44]

ROS: reactive oxygen species.