Ovarian cancer treatment: towards novel targets and the rational use of current drugs

Despite the availability of new, targeted treatments, the prospects for patients with ovarian cancer are still poor. Most women will die from their disease. It is therefore important that new treatment options become available. The first part of this thesis examined the specific targeting of the activated metabolism in ovarian cancer, and the role of scans that can visualize this metabolism in developing better treatments. The second part discusses how we can effectively use the currently available treatments. There are only a few treatments that have been shown to improve quality of life or prolong life. New, targeted treatments with a mechanism of action based on specific processes in cancer cells, such as PARP inhibitors, do not always live up to the high expectations. Studying the effects of these drugs not only in the tumor cells but also in the surrounding tissue, and adding molecular imaging early on drugin drug development, could help move from a promising new strategy in the laboratory to a therapy with clinical value. Finally, the thesis contains an analysis of care in the last months of life of patients with ovarian cancer. The use of intensive medical care shortly before the end of life for patients in the Netherlands was compared with analyses from other countries. Admission to hospital, chemotherapy or surgery in the final phase of life occurred less often in the Netherlands than in other parts of the world.