Chemotherapy-induced cardiotoxicity (CIC) is a well-recognized and potentially severe complication of cancer treatment, particularly with anthracyclines and HER2-targeted therapies. As cancer survival improves, long-term cardiovascular outcomes have become increasingly important, yet current preventive strategies—such as dose reduction, dexrazoxane, neurohormonal blockers, and statins—offer only limited protection and are underutilized in routine clinical practice. There is a growing need for novel interventions that are safe, effective, and mechanistically targeted. Dapagliflozin, a SGLT2 inhibitor initially developed for type 2 diabetes, has demonstrated substantial cardioprotective effects in patients with heart failure, regardless of glycemic status. Its mechanisms—including improved cardiac metabolism, mitochondrial preservation, anti-inflammatory and antioxidant effects, and inhibition of fibrosis—align closely with the known pathways of chemotherapy-induced myocardial injury. Preclinical models have shown that dapagliflozin can preserve left ventricular function, reduce biomarker elevation, and prevent structural remodeling in hearts exposed to doxorubicin. Building on this evidence, a randomized, double-blind, placebo-controlled clinical trial (NCT06888505) is currently underway to evaluate dapagliflozin in cancer patients receiving anthracycline-based chemotherapy, with or without trastuzumab. The study incorporates serial biomarker assessments and cardiac function monitoring to assess its preventive potential. Dapagliflozin represents a promising therapeutic candidate in cardio-oncology. Its pleiotropic cardioprotective effects, oral route of administration, and established safety profile make it a strong contender for integration into future preventive strategies aimed at reducing the cardiovascular burden of cancer therapy.

Background and objectives: Breast cancer is the most common cancer among women. A key factor in tumor development is evasion of immune detection therefore, the search for alternative medicines with reduced toxicity towards normal tissues as well as ability to improve function of immune system and targets tumors cells has received growing interest.Ganoderma lucidum have been demonstrated to possess anti-tumor and immunomodulatory activities. Although numerous studies on the immunomodulatory effects of Ganoderma lucidum have been reported, little is known regarding its immunomodulatory effects in breast cancer patients when given with chemotherapeutic agents. This study aim to investigate the immunomodulating effects of Ganoderma lucidum on breast cancer patients when administered with different chemotherapy through measuring the serum levels of the biomarkers; interferon-γ (IFN-γ), tumor necrotic factor-α (TNF-α), inteleukin-8 (IL-8), and adiponectin (ADN). Patients and Methods: This study was accomplished between September 2015 and August 2016, in Oncology department of Azadi teaching hospital at Duhok and Nanakaly hospital at Hawler. Forty patients with breast cancer were included and divided equally to two groups, group 1 received chemotherapy alone and group 2 received chemotherapy and Ganoderma lucidum capsules. Blood samples were withdrawn from all patients before and after chemotherapy and analysed for estimating the levels of (IFN- γ, TNF-α, IL-8, and ADN). Results: A statistically significant increase of IFN-γ and significant decrease in the mean serum levels of TNF-α and IL-8 after receiving chemotherapy and Ganoderma lucidum compared to pre-treatment levels was found. A non-significant difference was found between pre and post treatment in the mean serum levels of TNF-α, IFN-γ, and IL-8 in patients received chemotherapy only.The mean serum levels of ADN after receiving chemotherapy only or with Ganoderma lucidum did not show any significant difference when compared to pre-treatment levels. Conclusions: The results suggest the possibility of considering utility of Ganoderma lucidum as an immunomodulating, anti-inflammatory and antiangiogenic agent along with chemotherapy in breast cancer patients.