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Traditionally, all patients receive the same ‘one-size-fits-all’ dose when treated with oral anticancer medicines. Research has shown that this results in highly variable concentrations of these medicines in the blood. Too high concentrations may lead to serious side effects, while too low concentrations may lead to failure of therapy. This means that oral anticancer medicines are good candidates for personalised dosing: some patients may need more, and others less, to reach the right concentration in the blood.

One way to personalise the dose is by measuring the concentration of the drug in the blood, and then adjusting the dose if needed. This is called Therapeutic Drug Monitoring (TDM). The goal is to reach a certain target level of the drug in the blood. These target levels are based on studies showing that patients whose drug levels are above this target live longer than those whose drug levels are below it.

In my thesis, I explored three important questions about TDM. First: “Which medicines are most likely to benefit from TDM?” Second: “What are these target levels that should be aimed for?” To answer these questions, we created an overview of studies on these questions of 77 oral anticancer medicines. Finally, we asked: “Does TDM actually improve survival without causing extra side effects?” This is essential evidence to support its use in everyday care. In this thesis we answered this question for four different oral anticancer medicines, and also explored why TDM does not seem feasible for ten others.