Pathogenesis and prevention & treatment strategies for cardiotoxicity induced by antitumor drugs based on the "host-guest interaction" theory

Cardiotoxicity induced by antitumor drugs is a significant clinical issue that affects the long-term survival and quality of life of patients with tumor. The traditional Chinese medicine (TCM) theory of "host-guest interaction" (Zhu Ke Jiao) elucidates the pathogenesis of persistent and recalcitrant diseases resulting from the interlocking of pathogenic factors and healthy qi, offering a unique perspective for interpreting such complex conditions. This paper systematically reviews the origin and development of this theory and applies it to cardio-oncology. The core pathogenesis of cardiotoxicity induced by antitumor drugs is "deficiency of healthy qi, weakness of the collaterals, and interlocking of toxicity and stasis." Disease progression follows a three-stage dynamic evolution: invasion of guest toxins into the collaterals, interlocking of toxicity and stasis, and malnourishment of the heart substance. Accordingly, a prevention and treatment system centered on "separating the host from the guest" is established. In the early stage (invasion of guest toxins into the collaterals), treatment focuses on expelling toxins and protecting the heart using modified Shengjiang San combined with Danshen Yin. In the middle stage (interlocking of toxicity and stasis), the approach emphasizes resolving toxins and removing stasis using modified Xuefu Zhuyu Tang supplemented with insect drugs to search out and eliminate pathogens. In the late stage (malnourishment of the heart substance), the strategy aims to strengthen and consolidate body resistance using modified Zhigancao Tang combined with Shengmai San, while also considering promoting blood circulation and dispelling water retention. By extending the "host-guest interaction" theory, this study provides a theoretical basis and clinical insights for elucidating the complex pathogenesis of cardiotoxicity induced by antitumor drugs and its prevention and treatment with TCM.