Pharmacoepigenetics: from epigenetic regulation to personalized therapeutics

Pharmacoepigenetics is an emerging field of precision medicine that examines how epigenetic modifications influence interindividual variability in drug response. This review discusses the clinical utility of epigenetic therapy in personalized medicine. Current FDA-approved epigenetic drugs including DNA methyltransferase inhibitors, histone deacetylase inhibitors, EZH2 inhibitors, mutant IDH inhibitors, and menin inhibitors are reviewed along with emerging therapies such as BET inhibitors, LSD1 inhibitors, precision epigenetic editing, and combination treatment strategies. Despite notable advances, challenges such as target selectivity, dose-limiting toxicity, epigenetic variability and lack of biomarkers for predicting response or selecting patients continue to limit broader clinical implementation of epigenetic drugs. Continued progress is expected to expand the role of pharmacoepigenetics and improve treatment across a growing range of diseases other than oncology.