Pharmacokinetic DDIs arise upon modulation of the absorption, distribution, and metabolism or excretion (ADME) properties of one drug by co-administration of another drug and can lead to massive changes of drug plasma concentrations with potentially life-threatening consequences. [6] Most commonly, a perpetrator drug modulates the metabolism of a victim drug by chemical inhibition or transcriptional induction of drug-metabolizing enzymes. In both cases, such an interaction leads to an altered metabolic fate of the victim drug. [7] The clinical implications of such interactions can result in a lack of efficacy, especially in the context of so-called prodrugs. Prodrugs are drug variants with enhanced solubility or lifetime, which rely on in vivo bioconversion to exert their pharmacological activity. [8] Positive treatment outcomes in prodrug therapies strongly depend on the ability of the patient to endogenously bioactivate the prodrug compound to its pharmacologically active metabolite(s). [9] Drug metabolism predominantly occurs in the liver and is mainly catalyzed by enzymes of the cytochrome P450 (CYP) family. These enzymes oxidize, reduce, and hydrolyze a wide range of drugs or chemical entities. Therefore, it does not come as a surprise that inhibition or induction of CYP enzymes is largely involved in clinical DDIs and has led to severe ADRs and the withdrawal of multiple drugs from the market. [10] In many cases, DDIs manifest themselves in secondary organs, to which liver-generated metabolites are transported through systemic circulation. Such tissues include kidney, heart, brain, gut, and lungs, and drug target tissues, such as tumors. [11] Oncology patients are considered especially prone to toxic DDI events owing to i) the wide use of anticancer prodrugs, [12,13] ii) the inherent toxicity of anticancer agents and their very narrow therapeutic index, iii) the likelihood of cancer patients to receive many different medications for the management of other illnesses, [14] and iv) the increasing use of combination therapies with more than one anticancer medication. [15] Hence, clinicians are confronted with the growing risk of prescribing drug combinations that can inadvertently lead to severe clinical implications. [16] Additionally, genetic polymorphisms in the liver can lead to individual patterns of CYP-enzyme-mediated metabolism for different patients. [17] Management of DDIs is, therefore, crucial in oncology therapy, where the altered Drug-drug interactions (DDIs) occur when the pharmacological activity of one drug is altered by a second drug. As multimorbidity and polypharmacotherapy are becoming more common due to the increasing age of the population, the risk of DDIs is massively increasing. Therefore, in vitro testing methods are needed to capture such multiorgan events. Here, a scalable, gravity-driven microfluidic system featuring 3D microtissues (MTs) that represent different organs for the prediction of drug-drug interactions is used. Human liver microtissues (hLiMTs) are combined with tumor m...