Intracranial activity of mirvetuximab soravtansine in platinum-resistant high-grade serous ovarian cancer: Insights from a patient with central nervous system metastasis

Background: Ovarian cancer is the most lethal gynaecologic malignancy, often diagnosed at advanced stages due to nonspecific early symptoms. Although most patients initially respond to platinum-based chemotherapy, recurrence and resistance occur in the majority, leading to poor prognosis and limited treatment options. Recently, a novel antibody-drug conjugate has demonstrated significant clinical benefit in platinum-resistant high-grade serous ovarian cancer, offering a promising new therapeutic strategy in this historically challenging disease setting. Methods: We report a case of a 66-year-old woman with platinum-resistant high-grade serous ovarian cancer and a central nervous system metastasis who was started on fourth-line palliative treatment with mirvetuximab soravtansine, an antibody-drug conjugate targeting folate receptor-alpha. Following the second cycle, a significant reduction of the left parasagittal subcortical lesion was observed, from 19 × 15 mm to 11 × 6 mm, with complete resolution of vasogenic edema and mass effect, demonstrating intracranial activity of mirvetuximab soravtansine. Conclusion: To our knowledge, no published studies or case reports have yet documented central nervous system activity of mirvetuximab soravtansine in ovarian cancer. This case highlights a potential new therapeutic role for this agent in patients with ovarian cancer and central nervous system involvement and underscores the need for prospective clinical trials to rigorously assess its central nervous system penetration and efficacy in larger patient cohorts.