Clinical Pharmacology and Therapeutic Optimization in Cardio Oncology: Dosing, Interactions, and Safety Management

Cardio-oncology has emerged as a critical subspecialty at the intersection of cancer treatment and cardiovascular medicine, driven by the growing recognition that many effective anticancer therapies carry significant cardiotoxic risk. As survival rates improve across multiple cancer types, the long-term cardiovascular consequences of treatment — including cardiomyopathy, arrhythmia, hypertension, and thromboembolic events — have become major determinants of patient outcomes and quality of life. Anthracyclines, HER2-targeted agents, tyrosine kinase inhibitors (TKIs), immune checkpoint inhibitors (ICIs), and radiotherapy adjunct medications each carry distinct cardiovascular liability profiles, yet their clinical use is rarely guided by a unified pharmacological framework. The complexity is compounded by the fact that oncology patients frequently present with pre-existing cardiovascular comorbidities, polypharmacy burdens, and altered drug metabolism — all of which directly affect the pharmacokinetics (PK) and pharmacodynamics (PD) of anticancer agents.This Research Topic aims to consolidate and advance the clinical pharmacology evidence base underpinning safe and effective anticancer therapy use in cardio-oncology practice. Rather than exploring biological targets or disease mechanisms, this collection focuses on the translational and practical dimensions of drug therapy: how anticancer agents are absorbed, distributed, metabolised, and eliminated; how their cardiovascular effects are dose-dependent or exposure-driven; and how clinicians can proactively identify, prevent, and manage cardiotoxicity through evidence-based therapeutic optimization strategies. By bringing together pharmacologists, clinical cardiologists, oncologists, and clinical pharmacists, this Topic seeks to bridge the gap between pharmacological science and bedside decision-making.This Research Topic welcomes original research articles, systematic reviews, meta-analyses, and clinically focused perspectives addressing, but not limited to, the following themes:• PK/PD profiling of cardiotoxic anticancer agents, including population pharmacokinetic modelling and exposure–response relationships• Dose optimization strategies, including dose individualization, therapeutic drug monitoring, and dose modification in special populations (renal/hepatic impairment, elderly, paediatric)• Drug–drug interactions (DDIs) involving anticancer agents and cardiovascular comedications (e.g., anticoagulants, antihypertensives, antiarrhythmics)• Cardiotoxicity risk stratification and pharmacological prevention, including the role of cardioprotective agents such as dexrazoxane and beta-blockers• Safety management protocols for anthracyclines, HER2-targeted therapies, TKIs, ICIs, and radiotherapy adjunct medications• Real-world pharmacovigilance data and adverse event reporting related to cardiovascular outcomes in oncology patients• Regulatory and clinical trial considerations for cardiovascular safety assessment in anticancer drug development Topic editors: Alfredo Mauriello, Antonello D’Andrea, Vincenzo Russo Source: https://www.frontiersin.org/research-topics/78940/clinical-pharmacology-and-therapeutic-optimization-in-cardio-oncology-dosing-interactions-and-safety-management