Cardiotoxicity of doxorubicin-based therapy: What is the protective cognition that phytochemicals provide us?

Doxorubicin (DOX) continues to attract the interest of preclinical and clinical investigations despite its longer-than-50-year record of longevity. The clinical application of DOX can be regarded as a sort of double-edged sword. On one hand, anthracyclines play an indisputable key role in the treatment of tumors; on the other hand, their chronic administration leads to cardiomyopathy and congestive heart failure, which is usually refractory to common medications. Finding the ideal cardioprotective agents has always been the focus of oncologists and cardiologists. Researchers put a lot of energy into phytochemicals because they are often in line with the expected standards, that is, to improve DOX-induced cardiotoxicity without compromising the clinical efficacy or to even produce synergy. We summarized the previous efforts, briefly outlined the mechanism of DOX cardiotoxicity, and focused on exploring the protective effects and potential mechanisms of all phytochemical types that have been investigated under DOX-induced cardiotoxicity. Phytochemicals have been found to be potential cardioprotective agents with universal safety and effectiveness. As a resource repository of pharmacophores, phytochemicals deserve to be utilized as drug templates for further development and research in combating DOX-induced cardiotoxicity.