If Your Ovarian Cancer Has Returned and Stopped Responding to Treatment – You’ve Got Some New Options

Creator: Liz Neporent
Published: 2024-02-21T12:34:29-05:00

Liz Neporent

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Advanced Cancer Treatment Insights

The new drug Elahere offers hope in hart-to-treat ovarian cancer by increasing survival and slowing disease progression.
Ovarian cancers with high levels of a protein known as FR-alpha may spread faster and be harder to treat.
Elahere can benefit patients who have stopped responding to traditional forms of chemotherapy that contain an element known as “platinum”.
Testing for elevated FRα levels helps your doctor understand what treatments you are likely to respond to best.

Ovarian cancer that has stopped responding to chemotherapy now has new hope thanks to a new drug called Elahere.

Ovarian cancers with high levels of a protein called FR-alpha are known as folate receptor-positive (FRα). These proteins are found on the surface of cancer cells in up to 80% of new and recurrent cases of ovarian cancer.

When FRα levels are high, it can mean the cancer is more aggressive and has stop responding to chemotherapy that uses drugs that include the chemical platinum.

“f the cancer is growing on platinum-based therapy or platinum resistance, if the recurrence is less than six months from the end of the last platinum-based treatment, then we know that if we come back with carboplatinum or other platinum agents, that it’s unlikely that the cancer’s going to respond,” Dr. Marta Crispens, professor, and director, in the division of gynecologic oncology at Vanderbilt University tells SurvivorNet.

But Crispens says that Elahere has changed the treatment game.

It is the first treatment to show a statistically significant overall survival benefit in patients with platinum-resistant ovarian cancer and provides an effective new option for patients with folate receptor alpha positive tumors.

What tests will tell me if my cancer is Folate Receptor Positive?

When doctors suspect ovarian cancer has returned, they take a small tissue sample to check for folate receptor expression, which means they look at how much of the FRα protein is found on the cancer cells’ surface. This can be done during surgery or a biopsy.

“It’s a very specific test, something called immunohistochemistry where they can basically take an antibody, put it on the slide that has the cancer on it or a slice of the cancer on it and see what percentage the cells are folate receptor alpha positive, and that’s how they determine eligibility for speciality treatments,” Dr. Crispens says.

It’s important to talk to your doctor about this test because it’s not routinely ordered for all ovarian cancer patients. However, getting it done as early as possible can help get you the best treatment for you.

In certain places in the US, including Minneapolis, patients can get this testing for free if:

You have ovarian, fallopian tube, or primary peritoneal cancer.
You live and get treatment in the US or a US Territory.
You haven’t had this test before.
Your doctor thinks it’s right for you.

NeoGenomics and Labcorp, are two leading companies in medical testing that offer these free tests to eligible patients through programs like FR-ASSIST™.

NeoGenomics specializes in cancer genetic testing and molecular diagnostics, while Labcorp is a global life sciences company known for its wide range of diagnostic services.

Either way, getting the test can give doctors valuable information about how to best treat you for ovarian cancer.

What is the drug Elahere?

Elahere (molecular name mirvetuximab soravtansine) is a relatively new drug for FRα-positive, platinum-resistant epithelial ovarian cancer. “Platinum-resistant” means that the cancer does not respond well to chemotherapy drugs containing platinum, which are often used as a first-line treatment.

This cancer doesn’t respond well to certain chemotherapy drugs, even after trying three different kinds.

Elahere works by targeting the FRα protein found in high levels on cancer cells but not healthy ones. It stops cancer cells from growing while sparing healthy cells, making treatment more effective with fewer side effects.

The drug was approved on the extremely promising results of a phase 3 study called MIRASOL.

The trial, involving 453 patients, primarily looks at how long patients live without their cancer worsening. It also examines overall survival and response to treatment.

Final results showed:

It reduced the chances of death compared to chemotherapy by 33%. Patients taking Elahere lived for an average of 17 months compared to about 13 months for the patients on chemotherapy.
It reduced the chance of the cancer progressing by 35%. Patients on Elahere went nearly 6 months without their cancer spreading compared to 4 months for the patients on chemotherapy.
More than 40% of patients taking Elahere saw their tumors shrink — and for 5% they disappeared completely.
Elahere was also better tolerated than chemotherapy. Very few patients in the study had to stop taking it because of side effects.

“It’s way to target a drug directly to the cancer cells, hopefully increasing how effective the drug could be while decreasing the side effects the effects on normal cells,” Dr. Crispens says.

Although Elahere does indeed tend to carry fewer side effects than many ovarian cancer drugs, it can cause blurred vision. tiredness, and nausea. Pregnant or breastfeeding women should avoid Elahere due to safety concerns.

If you are considering taking Elahere, Dr, Crispens urges you to discuss what to expect with your doctor to make sure you understand potential benefits and downsides.

Are there other drugs that treat folate receptor-positive cancer?

There are several other drugs under development that may help in folate receptor-positive ovarian cancer. Both are in clinical trials.

A clinical trial is like a special test to see if a new medicine or treatment works and is safe for people. Doctors give the treatment to patients and carefully watch what happens, checking for any side effects or changes. This helps them figure out if the treatment can help others with the same problem.

Farletuzumab, a special protein called an antibody, is designed to target FRα on cancer cells. It stops tumor growth and progression by attaching to FRα. It is currently being tested in clinical trials to make sure it’s safe, effective, and given at the right dose.

Another hopeful treatment, STRO-002, is also being studied in clinical trials. Like Elahere, it combines an antibody with a powerful poison. However, STRO-002 zeroes in on FRα-positive cancer cells. By delivering the poison directly to these cells, it kills them.

Ask your doctor if one of these clinical trials makes sense for you. They can help you identify and apply for the one nearest you.

Questions to ask your doctor

Should I be tested for folate receptor expression?
Am I a good candidate for taking Elahere?
What are the pros and cons of testing and treatment?
Will my treatment be covered by insurance?
Are there any clinical trials that are right for me?

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Liz Neporent is a writer and reporter for SurvivorNet. Read More

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