TDM of anticancer drugs: We can work it out! | 04

For this episode we will take a slightly different trip - one that takes us into the rapidly changing world of new psychoactive drugs. From synthetic cannabinoids and novel stimulants, to designer benzodiazepines and emerging psychedelics, the landscape is constantly evolving. New molecules appear faster than we can sometimes characterise them, creating major challenges for clinicians, toxicologists, laboratories and regulators. So, how can we detect these entities when we may not even know what we are looking for? And what can pharmacology and toxicology tell us about their clinical effects and their risks? In this episode, we are joined by Souleiman El Balkhi and Richard Kevin, who walk us through what it takes to make sense of the vast NPS terrain.

Fungal infections remain a stubborn clinical problem: treatment options are limited, and the margin between an ineffective dose and a toxic one is often narrow. Getting antifungal exposure right for each patient is not a formality; it can be the difference between clearing an infection and losing ground to it. Therapeutic drug monitoring (TDM) offers clinicians a way to walk that line with more confidence, protecting efficacy on one side and guarding against adverse effects on the other. In this episode, Isabel Spriet and João Telles, both deeply immersed in antifungal TDM in their respective hospitals, walk us through what it takes to guide a patient safely through azole therapy: choosing the first dose without perfect information, watching for the factors that push exposure up or down, negotiating for hospital resources to make TDM possible, and untangling drug interactions that still defy easy explanation.

What do Arthurian legend, a medieval convent, and the future of precision medicine have in common? They all converge in Rennes, France this September - and if this episode is anything to go by, the IATDMCT-SFPT Joint Congress 2026 is shaping up to be one of the most ambitious meetings our community has ever produced. In a first for France, the IATDMCT and the French Society of Pharmacology and Therapeutics (SFPT) are joining forces under one roof, bringing together TDM specialists, clinical toxicologists, pharmacovigilance experts, and clinical pharmacologists to ask a deceptively simple question: are we finally ready to turn the promise of precision medicine into everyday clinical reality? In a special role reversal, our usual host Florian Lemaitre steps out from behind the microphone and into the hot seat, joined by his congress co-chair Marie-Clémence Verdier. Together, they take us on a tour of the scientific programme, the spirit behind the congress theme, and a few tantalising hints about what awaits delegates - including several secret surprises.

Adherence to medication is the very basic level we wish to reach in patient care. Yet for many patients taking drugs every day (sometimes several times a day, over long periods of time, this is far from straightforward. Treatment failure and adverse drug reactions can result not from the wrong medicine, but simply from inconsistent intake. Non-adherence is rarely intentional; it is a complex, multifaceted problem shaped by practical barriers, patient perceptions, and the realities of daily life. Therapeutic drug monitoring offers a powerful objective tool for fixing this hole — identifying who is and isn't taking their medication, enabling clinicians to have targeted, constructive conversations and intervene in ways that can make an effective difference.

Tuberculosis remains one of the world's most persistent infectious diseases, and despite decades of available treatments, achieving cure remains a long and winding road. The challenge isn't just the disease itself – there is also a notable difference in how patients respond to TB drugs. Where pharmacokinetic variability can range 20-50 fold and the complex multidrug regimens, therapeutic drug monitoring represents a crucial but underutilised tool. From the early bactericidal activity in the first two weeks to managing drug-resistant strains, TDM offers a path to optimising treatment while minimising toxicity. Yet significant barriers remain, particularly in the low- and middle-income countries where TB burden is highest.