Chemotherapy-induced cardiotoxicity is a serious consequence of chemotherapy during cancer treatment that can affect any patient. The purpose of this review is to highlight the development of cardiotoxicity associated with the use of anthracyclines or trastuzumab and to examine prevention and treatment methods using polyphenols, biologically active substances that hold significant therapeutic potential. The main mechanisms of this pathology, modern biomarkers for detection, and the classification and biological activity of polyphenols are discussed. Emphasis is placed on polyphenols found in grapes and their antioxidant potential as a protector of the cardiovascular system.

Background/Objectives: Chemotherapy-induced cardiotoxicity is a serious complication in breast cancer treatment, particularly with anthracyclines and HER2-targeted therapy. To evaluate the association between early elevations of cardiac markers (troponin and NT-proBNP) and the development of chemotherapy-induced cardiotoxicity in adult patients with breast cancer. Methods: This systematic review and meta-analysis were conducted according to PRISMA guidelines and registered with PROSPERO (CRD420261301170). A systematic search of PubMed/MEDLINE, Cochrane CENTRAL, and Web of Science databases was conducted. Studies evaluating cardiac markers in breast cancer patients receiving chemotherapy were included in the review. Results: Fourteen studies were included in the qualitative synthesis. Five studies were included in the meta-analysis. Elevated troponin levels were associated with higher odds of subsequent cardiac dysfunction; however, the pooled association was not statistically significant [OR = 3.40, 95% CI 0.69–16.67, p = 0.13] and showed substantial heterogeneity [I² = 86.97%]. A leave-one-out sensitivity analysis was used to identify a study that exerted a substantial influence; its exclusion eliminated between-group heterogeneity and attenuated the pooled effect estimate. Conclusions: Early troponin elevation may provide a biological signal of myocardial injury during cancer therapy. However, the association between elevated troponin level and cancer therapy-related cardiac dysfunction did not reach the threshold of statistical significance and showed substantial heterogeneity. Troponin and NT-proBNP may provide complementary information to cardiac imaging, but their predictive performance and clinical utility require further prospective validation.

Background: Anthracyclines have historically remained a cornerstone of treatment for early HER2-positive breast cancer. However, the emergence of dual HER2 blockade, antibody–drug conjugates, and response-adapted treatment strategies has changed the clinical context in which anthracycline use is considered. Whether anthracyclines continue to provide sufficient oncologic benefit to justify their additional cardiovascular toxicity remains uncertain. Objectives: This study aims to evaluate the contemporary role of anthracyclines in early HER2-positive breast cancer by synthesizing direct comparative evidence and contextual evidence from prospective de-escalation studies. Design: It involves a systematic review with narrative synthesis. Data Sources and Methods: PubMed, the Web of Science, and CENTRAL were searched for prospective studies published from January 2000 to 31 May 2026. A meta-analysis was initially planned, but only three clinically heterogeneous trials directly compared anthracycline-containing and anthracycline-free regimens. Direct comparative and contextual de-escalation evidence was therefore synthesized separately using a narrative approach. Results: Twelve studies were included. BCIRG-006, TRAIN-2, and TRYPHAENA provided direct comparative evidence; nine additional prospective trials provided contextual evidence on anthracycline-sparing or treatment de-escalation strategies. Direct comparisons generally indicated greater cardiac toxicity with anthracycline-containing regimens, although severe events were uncommon and cardiotoxicity definitions varied. Contextual studies supported the feasibility of contemporary anthracycline-sparing approaches in selected populations but did not provide direct estimates of the effect of anthracycline exposure. Conclusions: Anthracycline-containing regimens appear to confer greater cardiac risk than anthracycline-free regimens, but comparative evidence remains limited. The available evidence supports selective rather than routine anthracycline use, with treatment decisions guided by the anticipated oncologic benefit, cardiovascular risk, tumor characteristics, treatment setting, and patient preferences. Registration: PROSPERO CRD420261296599; registered on 29 January 2026.