Mirvetuximab soravtansine: current and future applications

Ovarian epithelial cancer (OEC), particularly high-grade serous carcinoma (HGSC), remains a clinical challenge due to its late-stage diagnosis, high recurrence rates, and poor survival outcomes. Mirvetuximab soravtansine (MIRV), an antibody-drug conjugate targeting folate receptor alpha (FR alpha), has demonstrated promising efficacy in platinum-resistant OEC, particularly in high FR alpha-expressing populations, as evidenced by key clinical trials such as FORWARD I, FORWARD II, SORAYA, and MIRASOL. These trials highlight MIRV's ability to improve progression-free survival, response rates, and quality of life in advanced disease settings. Emerging data suggest that FR alpha is also highly expressed in serous tubal intraepithelial carcinoma (STIC), a non-invasive precursor lesion to HGSC. Although MIRV has not yet been studied for STIC management, we propose its potential application in this context to prevent progression to invasive carcinoma, particularly in high-risk populations undergoing risk-reducing bilateral salpingo-oophorectomy. This novel use could bridge the gap between prevention and treatment, offering a proactive strategy for hereditary cancer management. Furthermore, MIRV's therapeutic versatility extends to other FR alpha-positive tumors, such as endometrial and breast cancers, broadening its clinical relevance. Despite challenges such as accessibility and cost, MIRV represents a significant advancement in precision medicine, with potential to redefine prevention and treatment strategies for hereditary and sporadic cancers.