A phase I study of mirvetuximab soravtansine (MIRV) and gemcitabine (G) in patients (Pts) with selected frα-positive solid tumors: Results in the ovarian cancer (EC) cohort.

Abstract

5542 Background: Mirvetuximab soravtansine (MIRV) is an ADC comprising a FRα-binding antibody, cleavable linker, and the maytansinoid DM4, a potent tubulin-targeting agent. MIRV has promising single agent activity in FRα-positive medium/high expression epithelial ovarian cancer (EOC), at 6 mg/kg, based on adjusted ideal body weight (AIBW) IV every (q) 21 days. This study evaluated MIRV and G in recurrent EOC, endometrial and triple negative breast cancer. The recommended phase 2 dose (RP2D) was established at MIRV 6 mg/kg AIBW IV, day 1 and G 800 mg/m2 IV, d1, 8 q21 days (J Clin Oncol 37, 2019, Abs. #3009). Here we report the results from the EOC cohort. Methods: Patients (pts) with FRα-positive platinum resistant EOC with ≤4 prior chemotherapy (CT) regimens, were eligible. FRα positivity was initially defined as ≥ 25% of cells with PS2+ staining intensity (low to high FRα expression) and was subsequently revised to require medium/high FRα expression (≥50%/ ≥75% of cells with PS2+ staining intensity). Results: From 10/2017 to 12/2020, 113 EOC pts underwent FRα screening, with 74 FRα-positive results. Thirty total EOC pts (with median 3 prior lines of therapy) were treated; 8 pts during dose escalation and 22 EOC pts at the RP2D (all evaluable for response). Fifteen (50%) pts had high FRα, 10 pts (33%) medium FRα, and 5 pts (17%) low FRα expression. Eleven (36%) of the 30 EOC pts achieved a partial response (PR), 15 pts (50%) had SD and 4 pts (13%) progressed. Among the 11 responders, 5 pts had high FRα, 4 pts medium FRα and 2 pts low FRα expression. Non-heme clinically significant adverse events (AEs) included: G2 sensory neuropathy (4 pts) G3 diarrhea (3 pts), G3 fatigue (2 pts), G3 pneumonitis (2 pts), and 1 pt with G5 respiratory failure (secondary to pneumonia but drug-induced pneumonitis could not be ruled out). Conclusions: MIRV in combination with G has promising clinical activity in late line platinum resistant FRα-positive EOC, with best responses observed in high FRα expression. The regimen is well tolerated with expected AEs based on the known toxicities of each agent. This study was approved and funded by the National Comprehensive Cancer Network (NCCN) Oncology Research Program from general research support provided by ImmunoGen Corp and Cancer Center Support Grant P30CA033572. Clinical trial information: NCT02996825.

Mirvetuximab Soravtansine in Solid Tumors: A Systematic Review and Meta-Analysis

“…To the best of our knowledge, our meta-analysis is the rst article evaluating the e cacy and safety of MIRV in solid tumors. Since the drug itself has been used in clinical settings for a relatively short time and has been approved by the FDA through an accelerated process [30], most of the clinical trials we collected were single-arm trials [21][22][23][24][25][26][27][28][29], which may have slightly lower quality evidence. Nevertheless, our analysis still yielded relatively encouraging results.…”

“…There were a variety of study designs, including 1 randomized controlled trial [21], 7 single-arm studies [22][23][24][25][26][27][28][29] and 1 multiarm study [24], which provided two records for analysis. The patients who participated in these studies primarily had gynecological cancer, and many of them had prior cancer treatment, with some even having con rmed platinum resistance.…”

Overcoming PARP inhibitor resistance in ovarian cancer

“…In the cohort of 30 patients with recurrent FRα-positive platinum-resistant OC (53% had prior PARPi), the ORR was 36.7% with a median PFS of 5.4 months. 91 A second phase I trial enrolled five patients with recurrent endometrial cancer and 13 with OC, of which five had received prior PARPi; the ORR achieved with mirvetuximab and rucaparib was 40% and median PFS of 12.6 months in those with OC. 92 Pivotal information from the SORAYA trial reported an ORR of 32.4% in 105 patients, with a median duration of response (DOR) of 6.9 months and PFS of 4.3 months.…”