Challenges and opportunities to address the emerging burden of targeted therapies in ovarian cancer.

Ovarian cancer (OC) poses a significant socio-economic burden globally with the greatest impact observed in low-and-middle income countries (LMIC). Despite the survival benefit from targeted therapies such as bevacizumab and poly (ADP- ribose) polymerase (PARP) inhibitors, they are associated with high costs to patients and payers which widens the disparities between high and low-income countries. OC treatments may also cause significant morbidity from cytoreductive surgery through to the use of targeted therapies reducing quality of life (QoL). Innovative approaches are necessary to address the increasing burden from the cost and morbidity of OC treatment especially in LMIC. De-escalation of treatment without compromising oncological outcomes could be a strategy to reduce financial cost and morbidity. Moreover, de-escalation techniques integrating the knowledge of pharmacokinetics and pharmacodynamics for dose reduction should be incorporated into clinical trials to identify the minimum effective dose rather than the maximum tolerated with the goal of reducing clinical and financial toxicity. This review summarises the health and economic burden of ovarian cancer with particular reference to LMIC and proposes de-escalation of targeted therapy as a clinical and economic strategy in increasing accessibility and affordability with consideration of patient preferences.