Sex diff erences in anthracycline cardiotoxicity

Anthracyclines are still among the most effi cient drugs of cancer chemotherapy used. However, a signifi cant risk of cardiotoxicity limits their use. Cardiotoxicity can be acute during the treatment or may be delayed for a number of years after cessation of the treatment. Chronic cardiotoxicity includes cardiomyopathy and congestive heart failure and may develop in 5-10% of the patients. The molecular mechanisms of the anticancer activity and of the cardiotoxic eff ects are not completely elucidated yet. Nonetheless, the development of doxorubicin-induced adverse eff ects is linked to the total cumulative dose, the additional combined treatment, the age and appeared to involve at least mitochondrial dysfunction. Even if there is a clear gender-based discrepancy in the incidence of cardiovascular disease, sparse information is available concerning the diff erence of doxorubicin-induced cardiotoxicity between male and female. Females live longer than males in many species including humans and develop less cardiovascular diseases, at least until menopause. Moreover, several mitochondria features are prone to sexual dimorphism. Here, we summarize the literature on sex diff erences in anthracyclines-induced cardiotoxicity in humans and in animal models. Developing sex-based medicine is needed as well as the cooperation between oncologist and cardiologist to improve the understanding of the anticancer drug-related cardiotoxicity.