Doxorubicin is a clinically used broad-spectrum antitumor chemotherapeutic agent that plays a key role in the treatment of various malignancies, including leukemia, breast cancer, and lymphoma. However, its clinical application is largely limited by dose-dependent cardiomyopathy , which can lead to heart failure in severe cases and significantly compromise the prognosis and quality of life of cancer patients. This article systematically reviews the core pathological mechanisms underlying doxorubicin-induced cardiomyopathy, including oxidative stress and lipid peroxidation, mitochondrial dysfunction,apoptosis and necrosis,autophagic dysregulation,energy metabolism reprogramming,inflammatory response network,ferroptosis and cuproptosis. It also summarizes targeted preventive and therapeutic strategies (such as targeted antioxidant therapy, mitochondrial protection, apoptosis inhibition, autophagic regulation). The purpose is to provide a systematic theoretical basis and research directions for the basic research and clinical prevention and treatment of doxorubicin-induced cardiomyopathy.