Purpose of reviewDoxorubicin has long been known to cause cardiotoxicity, yet our understanding of its pathophysiologic mechanisms remains incomplete. This review aims to update readers on the most recent evidence supporting candidate mechanisms and proposed treatments for doxorubicin cardiotoxicity.Recent findingsDoxorubicin causes cardiotoxicity via traditional mechanisms, such as oxidative stress, DNA and mitochondrial damage, and iron overload, as well as through novel pathways such as autophagy and CYP1 induction. The relative importance of each pathway and how these pathways interact with each other is not well-understood. Novel approaches to cardioprotection are needed.SummaryNovel mechanisms of doxorubicin cardiotoxicity represent exciting opportunities for prevention and treatment of this entity. Further studies are needed to translate recent findings into clinical use.