What chemotherapy would you consider to treat platinum resistant high grade serous ovarian cancer in patients with a low grade MDS from prior platinum/PARPi?

Before making a recommendation to this patient, a basic understanding of treatment related MDS/AML is needed, along with a clarification of the meaning of “low risk of progression to acute myeloid leukemia (AML)”. My main goal would be to avoid therapy with a demonstrated risk of treatment related MDS/AML. I would also prescribe a low dose of any anti-neoplastic agent and avoid the use of G-CSF or other growth factors.

t-MN: Basics for the Gynecologic Oncologist:

Therapy-related myeloid neoplasm (t-MN) is the term used to describe the spectrum of malignant disorders to include both treatment related MDS (t-MDS) and treatment related AML (t-AML). There appears to be a background elevated risk of t-MN in ovarian cancer patients associated with...

In January 2022, I answered this question on Mednet. I was recently asked to update that response, considering current treatment options for platinum-resistant ovarian cancer patients (with a low-grade MDS). Since January 2022, there have been three treatment regimens with FDA approvals for this group of patients. Two have a biomarker requirement, and one does not; two of these approvals occurred in 2026.

1. Mirvatuximab:
   • 11/2022: FDA accelerated approval 3/2024: FDA full approval
   • FR-alpha + (>75%)
   • 1-3 prior systemic treatment regimens
   • May be combined with chemotherapy or bevacizumab
2. Pembrolizumab plus weekly paclitaxel + bevacizumab:
   • 2/2026: FDA approval
   • PDL1 CPS> 1
   • 1-2 prior systemic treatment regimens
3. Relacorilant + Nab-Paclitaxel: ...