Real-world treatment patterns and safety of mirvetuximab soravtansine in patients with platinum-resistant ovarian cancer: a multi-center analysis using the TriNetX Global Collaborative Network

To characterize real-world treatment sequencing and compare the safety profile of mirvetuximab soravtansine versus conventional chemotherapy in patients with platinum-resistant ovarian cancer (PROC) using a large federated electronic health record database. This retrospective observational study utilized the TriNetX Global Collaborative Network. Female patients with recurrent ovarian, fallopian tube, or peritoneal cancer who initiated mirvetuximab or conventional salvage chemotherapy between November 2022 and March 2026, with documented prior platinum exposure within 180 days, were included. Propensity score matching (PSM; 1:1 nearest-neighbor) was performed on age, prior taxane, bevacizumab, and PARPi exposure, hypertension, and diabetes. The primary safety outcomes were corneal disorders (ICD-10 H18) and peripheral neuropathy (ICD-10 G62); thrombocytopenia and pneumonitis were additionally evaluated. A 90-day landmark analysis assessed the onset dynamics of adverse events. Overall survival (OS) was analyzed using the Kaplan-Meier method. Among 320 mirvetuximab-treated and 1,848 control patients, 311 patients per group remained after matching. Mirvetuximab was initiated at the third line or later in 53.8% of patients and beyond the sixth line in 7.2%. Corneal disorders occurred in 17 of 303 evaluable patients in the mirvetuximab cohort (5.6%) versus none in controls ( p < 0.0001). New-onset peripheral neuropathy was more frequent with mirvetuximab (28.8% vs. 8.9%; OR 4.13, 95% CI 2.27–7.50; p < 0.0001). Thrombocytopenia did not differ (18.5% vs. 17.9%; p = 0.87); pneumonitis was not evaluable. A 90-day landmark analysis demonstrated distinct time courses: corneal toxicity was more frequently diagnosed in the early period (early vs. late, OR 5.94, p = 0.001), whereas the incidence of peripheral neuropathy continued to increase through day 365 (early vs. late, OR 1.78, p = 0.130). Median OS was 552 versus 532 days (HR 0.967, 95% CI 0.759–1.233; p = 0.7889). In this real-world cohort, mirvetuximab was associated with higher rates of corneal toxicity and peripheral neuropathy compared with conventional chemotherapy. These distinct temporal patterns support intensified early ophthalmologic surveillance and continued monitoring for peripheral neuropathy. No significant survival difference was observed in this cohort, in which individual FRα status was unavailable. Real-world comparative effectiveness remains to be evaluated in cohorts with documented FRα expression.