Cancer development involves both genetic and epigenetic alterations. Aberrant epigenetic modifications are reversible, allowing excellent opportunities for therapeutic intervention. Nowadays, several epigenetic drugs are used worldwide to treat, e.g., myelodysplastic syndromes and leukemias. However, overcoming resistance and widening the therapeutic profiles are the most important challenges faced by traditional epigenetic drugs. Recently, novel approaches to epigenetic therapies have been proposed. Next-generation epigenetic drugs, with longer half-life and better bioavailability, are being developed and tested. Since epigenetic phenomena are interdependent, treatment modalities include co-administration of two different epigenetic drugs. In order to sensitize cancer cells to chemotherapy, epigenetic drugs are administered prior to chemotherapy, or both epigenetic drug and chemotherapy are used together to achieve synergistic effects and maximize treatment efficacy. The combinations of epigenetic drug with immunotherapy are being tested, because they have proved to enhance antitumor immune responses. The next approach involves targeting the metabolic causes of epigenetic changes, i.e., enzymes which, when mutated, produce oncometabolites. Finally, epigenome editing makes it possible to modify individual chromatin marks at a defined region with unprecedented specificity and efficiency. This review summarizes the above attempts in fulfilling the promise of epigenetic drugs in the effective cancer treatment.

Background: Multimorbidity, polypharmacy, and inappropriate prescribing are significant challenges in the geriatric population. Tools such as the Beers List, FORTA, and STOPP/START criteria have been developed to identify potentially inappropriate prescribing (PIP). STOPP/START criteria detect both potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). The latest, third version of STOPP/START criteria expands the tool, based on the growing literature. The study aimed to evaluate the prevalence of PIP and the number of PIP per person identified by STOPP/START version 3 and to compare it to the previous version. Methods: This retrospective, cross-sectional study enrolled one hundred geriatric patients with polypharmacy from two day-care centers for partially dependent people in Poland. Collected data included demographic and medical data. STOPP/START version 3 was used to identify potentially inappropriate prescribing, whereas the previous version served as a reference. Results: STOPP version 3 detected at least one PIM in 73% of the study group, a significantly higher result than that for version 2 (56%). STOPP version 3 identified more PIMs per person than the previous version. Similarly, START version 3 had a significantly higher prevalence of PPOs (74% vs. 57%) and a higher number of PPOs per person than the previous version. The newly formed STOPP criteria with high prevalence were those regarding NSAIDs, including aspirin in cardiovascular indications. Frequent PPOs regarding newly formed START criteria were the lack of osmotic laxatives for chronic constipation, the lack of mineralocorticoid receptor antagonists, and SGLT-2 inhibitors in heart failure. Conclusions: This study showed the high effectiveness of the STOPP/START version 3 criteria in identifying potentially inappropriate prescribing, with a higher detection rate than version 2.

Introduction: Potentially inappropriate medications (PIMs), are common among residents of long-term care institutions (LTCIs) and may contribute to cognitive impairment (CIm). STOPPCog criteria, developed in 2025, support the identification of PIMs relevant to cognition and accuracy of dementia treatment. Objectives: The study aimed to identify PIMs according to the STOPPCog criteria among residents of long-term care institutions in Poland, and to assess the association between CIm and exposure to specific drug classes. Patients and Methods: This is a multicenter cross-sectional study in four LTCIs. Medication lists were reviewed using STOPPCog criteria and anticholinergic burden scales. Cognitive status was assessed with the Mini-Mental State Examination (MMSE), and CIm was defined using a conventional cut-off. We compared exposure frequencies between residents with and without CIm and explored factors associated with MMSE using regression models adjusted for key demographic and clinical variables and facility effects. Results: Of 204 residents, 133 (65.2%) had at least one STOPPCog-listed medication on their medication list. Drugs with anticholinergic burden (ACB) (54.9%), especially one subgroup - antipsychotics (39.2%), were most frequently used within the study sample. Antipsychotics were the only drug class significantly associated with CIm independently of sex, age, comorbidity burden, and facility (p < 0.001). The majority of residents with a previous diagnosis of dementia in their medical records and consequently dementia-specific pharmacotherapy had severe CIm. Conclusion: There is a high prevalence of PIMs among LTCIs residents. Antipsychotic deprescribing and early diagnosis of CIm should be further evaluated in future prospective studies and clinical practice.