Mirvetuximab soravtansine in platinum-resistant ovarian cancer: from biological rationale to clinical impact and future directions

Abstract Platinum-resistant ovarian cancer (PROC) remains a major clinical challenge due to limited therapeutic options and poor prognosis. Conventional treatments provide only modest benefits, and immune checkpoint inhibitors have shown limited efficacy in unselected populations, underscoring the need for biomarker-driven strategies. Mirvetuximab soravtansine (MIRV) is a first-in-class antibody–drug conjugate targeting folate receptor alpha (FRα), which is highly expressed in a substantial proportion of epithelial ovarian cancers. By combining selective tumor targeting with intracellular delivery of the cytotoxic payload DM4, MIRV achieves potent antitumor activity with a manageable safety profile and evidence of a clinically relevant bystander effect. Clinical trials including SORAYA and MIRASOL demonstrated that MIRV significantly improved response rates, progression-free survival, and overall survival in patients with FRα-high PROC, thereby establishing MIRV as a clinically meaningful treatment option. Ongoing research is evaluating MIRV by using combination regimens, earlier treatment lines, and maintenance strategies. Despite these advances, challenges remain, including resistance mechanisms, optimization of biomarker assessments, and cost considerations. Future efforts should focus on refined patient selection, rational combination strategies, and next-generation antibody–drug conjugates, which are expected to further expand the clinical utility of FRα-targeted therapy.