How have you incorporated mirvetuximab into the treatment of platinum-resistant ovarian cancer?

This question is going to be increasingly important in the current landscape of ovarian cancer management. 

I have prioritized early ordering of biomarker testing so that I have the test profiles available at recurrence, particularly in the platinum-resistant standpoint.

I find that toxicity, patient preference for targeted therapy, and ph3 data to support benefit over physician choice (MIRASOL) provide a strong case to advocate for mirv in this setting.

Where some challenge might exist is that in MIRASOL, the physician's choice was without bev (although prior bev was required unless contraindicated). With that being said, particularly for moderate expressors of folate, I would consider mirv + bev combination. 

I think that "saving" more effective therapies for later is sometimes a gamble since conditions like bowel obstructions and performance status could limit future lines and I'd hate to miss opportunities to use the most effective therapies.

Related to Q1, this has been on my radar for a couple of years as I was the PI for SORAYA, so I had access to the agent before FDA accelerated approval – now with regular approval. Since the MIRASOL trial demonstrated benefit over standard single agent chemotherapy, it’s preferred if eligible. I am also advocating Mirv/bevacizumab for ≥50% expressors as now listed in the NCCN guidelines.

YES, in general, later line of use is associated with lower probably of not only objective response but also whether the patient can take it at all due to conditions around the disease state (ascites, bowel function, performance status, etc).