ASCO23 Day 3 :Parp Inhibitors & Late Breaking Abstract session

While there were fewer gynecologic cancer sessions on Day 3, Sunday June 4th there were two important sessions regarding the use of PARP inhibitors and trial results for a drug to teat  platinum resistant ovarian cancer drug which may be change practice.

Parp Inhibitor Optimal Selection and Toxicity Management 

Dr Tew - Status updates on Parp use

Dr Friedlander- Real World Experience in Managing PARP Toxicities 

 

 

 Susan Feinberg  (FORCE) - Living on a PARPi 

 

Late Breaking Abstract Session  

Mirvetixumab in Folate Receptor Alpha positive platinum resistant ovarian cancer

I wish I had been able to be in the room when this session took place. I could feel the excitement from the Tweets being posted.  This is the first trial to show overall survival benefit in platinum resistant ovarian cancer! This is practice changing. 

Wow! Amazing to see an #OverallSurvival benefit for Mirvetuximab for patients with platinum resistant #OvarianCancer
🚨 new standard of care alert 🚨 #GynCSM #ASCO23
Congrats to the investigators and patients who made this #research possible! @ASCO pic.twitter.com/ojYBIDKYS0

— Megan Hutchcraft MD (@MeganLeigh127) June 4, 2023

🚨Amazing to see ⬆️ in overall survival for mirvetixumab in FOLR1 positive platinum resistant #ovariancancer. Absolutely new standard of care!! 👏 #gyncsm #ASCO23 pic.twitter.com/yweWSh5qES

— Eleonora Teplinsky, MD (@drteplinsky) June 4, 2023

I shared tweets others wrote about the MIRASOL trial (mirvetixumab in FOLR1 positive platinum resistant #ovariancancer ) but... this slide says it all . #ASCO23 #gyncsm pic.twitter.com/Sif0gn76a8

— Dee Sparacio (@womenofteal) June 4, 2023

 Here is a slide of the overall survival  MIRV 16.46 months vs investigator choice of treatment 12.75 months.

 Stop by tomorrow for highlights from my last day of ASCO - Day 4 . 

Dee

Every Day is a Blessing

New FDA Approved Drug for Ovarian Cancer Recurrence - Impact on Patients

On November 14, 2022 the FDA granted accelerated approval of mirvetuximab soravtansine-gynx (Elahere, ImmunoGen, Inc.) and antibody drug conjugate. (https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-mirvetuximab-soravtansine-gynx-fra-positive-platinum-resistant) . Women who have received one to three prior treatments and have folate receptor alpha (FRα) positive, platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer can receive the drug. The FDA also approved the companion assay device (VENTANA FOLR1 (FOLR-2.1) RxDx Assay ) for determining folate receptor alpha (FRα). The device is made by Ventana Medical Systems, Inc.

The approval was based on the results of the SORAYA Study NCT04296890), a single-arm trial of 106 women who had up to three other treatments and also received bevacizumab. Patients who had ocular, corneal, grade 1 neuropathy or lung infection issues were excluded. The Overall Response Rate (ORR) was 31.7% and median Duration of  Response (DOR) was 6.9 months. 

Women who are given the drug will receive a dose of 6 mg/kg adjusted ideal body weight every 3 weeks by IV. I wondered what adjusted ideal body weight was, so  I found this formula for calculating it. Adjusted body weight(ABW) = Ideal Body Weight(IBW)  + 0.25 * (ABW - IBW)                         Source: (https://pubmed.ncbi.nlm.nih.gov/22836946/)

Some side effects women in the study experienced included vision impairment, fatigue, nausea, abdominal pain, peripheral neuropathy, diarrhea, decreased albumin, constipation, dry eye, decreased magnesium, etc. There is a warning for ocular toxicity. You may learn more at https://ascopost.com/issues/december-10-2022/fda-grants-accelerated-approval-to-mirvetuximab-soravtansine-gynx-for-fr-positive-platinum-resistant-epithelial-ovarian-fallopian-tube-or-peritoneal-cancer/ .

 I often wondered how fast drug approval translates into actual use in the clinic. It has been one month since the approval took place. The following is anecdotal information but I thought it was interesting enough to share. In that one month's time,  I have offered peer support to three women dealing with recurrent ovarian cancer. Two of those women brought up to me that their oncologists told them about the new drug "with the very long name". It seems like no one called it , Elahere. One has been already tested to see if she was folate receptor alpha (FRα) positive. One was told about it but will continue with her current treatment which is going well for her. But she was happy to have another option  for the future. One did not mention the new drug during our conversation. 

In the ASCO Post Article noted above Ursula A. Matulonis, MD, Chief of the Division of Gynecologic Oncology and the Brock-Wilson Family Chair at Dana-Farber Cancer Institute and co-leader of the SORAYA study stated “There have been no approved therapies for platinum resistant ovarian cancer since 2014, so [this] action by the FDA is a very significant milestone.”  I agree and I am happy to see how quickly oncologists are sharing the information about the drug with the patients. 

 

Dee

Every Day is a Blessing!

 

 

 

Day 18 A Month of Teal : Ovarian Cancer - Recurrence is Common

Recurrence was one thing I tried not to think about when I was initially diagnosed. But more than 80% of women diagnosed with ovarian cancer ( or fallopian tube or primary peritoneal cancer ) have a recurrence after completing initial treatment

Most likely once you finish front line treatment for ovarian cancer your doctor will follow up with you on a regular basis. He/she may ask you to have your CA-125 level checked every 1-3 months . Increases over time in your level of CA-125 may signal a recurrence. A trial by the Medical Research Council (MRC) and the EORTC  showed there was no benefit to women in detecting and treating a rising CA-125. If your CA125 rises you may be asked to have a CT scan.

Patients with confirmed recurrent disease are separated into two groups:

• Platinum resistant or platinum refractory recurrence is when a women 's disease will progress while on initial treatment or when the disease returns within 6 months of completing initial treatment.  A women will usually begin treatment with a drug other than the carboplatin/cisplatin taxol combination that she was given originally.
• Platinum sensitive recurrence  is when the disease recurs more than  6 months from finishing initial treatment. In this case, most women are given a platinum drug and another chemotherapy agent. 

Sources:
NCI
https://www.cancer.gov/types/ovarian/hp/ovarian-epithelial-treatment-pdq#section/_82
OCRFA
https://ocrfa.org/patients/about-ovarian-cancer/recurrence/

Over the next two days  I will share more information on the chemotherapy and targeted therapy treatments a women might receive after a recurrence.

Dee
Every Day is a Blessing!