Clinical Pharmacology in Oncology

Clinical pharmacology deals with the relationship between drugs and individuals and helps in rational prescribing of drugs to treat diseases, alleviate symptoms and prevent adverse effects. Traditionally, rational prescribing was driven primarily by the clinical pharmacokinetic and pharmacodynamic considerations. In addition, therapeutic drug monitoring, drug interactions, and pharmacokinetic studies in special populations such as hepatic and renal impairment play a major role in achieving the rational prescribing. More recently, particularly in oncology, a lot of progress has been made in the areas of biomarkers, pharmacogenomics and pharmacogenetics that underscore the well-established paradigm—‘One size does not fit all’. Genomics has also led to the identification of druggable targets and the development of targeted therapies. It has not only made a positive impact on oncology practice but also changed the way drugs are being developed. Consequently, novel trials strategies that enrich the patient population likely to benefit from a given drug are making their way in. At the same time, developments in quantitative pharmacology have brought PK/PD modelling to the forefront of drug development and personalized medicine through identification of sources of variability of response to drugs. With the advent of targeted therapies, and more recently immunotherapies, which are often exorbitantly priced, economic considerations are becoming more and more important in risk–benefit assessments. Thus, in present day therapeutics, pharmacoeconomic analysis features prominently in the decision algorithms of rational prescribing. This chapter attempts to provide an overview of the clinical pharmacological basis of therapeutics in oncology.