Adverse effects associated with cancer treatment, including cancer therapy-related cardiovascular toxicity (CTR-CVT), affect patients’ quality of life and overall survival. Severe and potentially life-threatening cardiotoxicity associated with myocardial dysfunction is most likely to occur after treatment with anthracyclines, which are commonly used in cancer therapy. Cardiotoxicity is a significant complication for the patient and may also necessitate interruption of oncological treatment. The mechanism of anthracycline-induced cardiotoxicity is complex, multifactorial and not fully understood. Studies to date suggest a link between the formation of reactive oxygen species, oxidative damage and the subsequent induction of cardiac cell apoptosis. Knowledge of the mechanisms underlying anthracycline cardiotoxicity allows for safe implementation of the best possible oncological treatment in cancer patients by minimising the risk of CTR-CVT, as well as for planning preventive and monitoring interventions for the early detection and treatment of potential cardiovascular complications. Therefore, the search for effective methods to prevent anthracycline-induced cardiotoxicity and its clinical consequences, which have a negative impact on prognosis and quality of life, remains one of the major challenges faced by oncologists and cardiologists caring for cancer patients. This review discusses the main mechanisms underlying anthracycline cardiotoxicity and emphasises the need to identify an increased risk of anthracycline-induced cardiotoxicity in the context of optimising cardio-oncological management.