Study of Carboplatin and Mirvetuximab Soravtansine in First-Line Treatment of Patients Receiving Neoadjuvant Chemotherapy With Advanced-Stage Ovarian, Fallopian Tube or Primary Peritoneal Cancer

• Status: Recruiting
• Trial end date: 2025-05-31
• Target enrollment: 0
• Participant gender: Female

Summary

The proposed study design is a single arm Phase II trial to document the feasibility of carboplatin-mirvetuximab - in patients with advanced-stage EOC. Patients with biopsy confirmed, newly diagnosed, advanced-stage serous EOC deemed appropriate for NACT will have their tumors evaluated for FRα receptor over-expression via a centralized immunohistochemical assay (IHC) and identified as appropriate for study participation if IHC staining is PS2+ in >75% of cells (40% of all serous patients). Eligible patients will receive NACT with one cycle of carboplatin, followed by mirvetuximab + carboplatin (if FRα +) every 21 days for three cycles prior to interval cytoreductive surgery (iCRS). A total of 70 will be included in the study. Following completion of 4 cycles total of NACT and after allowing for appropriate recovery of cycle # 4, patients eligible for surgery, will undergo an iCRS. Patients will then complete 3 more cycles of mirvetuximab + carboplatin for a total of 7 intended cycles of treatment. It is up to the treating physician if they want to add bevacizumab to the last 2 cycles or use any type of maintenance therapy. The decision to add bevacizumab or use maintenance therapy does not need to be made upfront. Patients will sign a screening consent form prior to tissue biopsy. If a patient is found to be FRα negative, their treating physician can select the treatment they deem appropriate and the patient will be declared a screen failure. Patients with BRCA mutations are not excluded from this trial and are allowed to receive standard of care maintenance therapy including bevacizumab and/or PARP inhibitors.

• Phase: Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: University of Alabama at Birmingham
• Treatments: Maytansine

Criteria

Inclusion Criteria:

• Patients must have biopsy-confirmed high grade serous epithelial ovarian cancer.

• Patients must present with stage III or IV disease and be appropriate to receive neoadjuvant chemotherapy

• Patients must be willing to provide an archival tumor tissue block or slides, or undergo procedure to obtain a new biopsy using a low-risk, medically routine procedure for immunohistochemistry (IHC) confirmation of FRα positivity

• Patients must have a performance status of 0 or 1.

• Patient's tumor must be positive for FRα expression as defined by a score of PS2+ intensity in >75% of cells

• Patients must have adequate hematologic, liver and kidney functions defined as:

• Absolute neutrophil count (ANC) ≥ 1.5 x 109/L (1,500/μL)

• Platelet count ≥ 100 x 109/L (100,000/μL) without platelet transfusion in the prior 10 days

• Hemoglobin ≥ 9.0 g/dL

• Serum creatinine ≤ 1.5 x upper limit of normal (ULN)

• Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 3.0 x ULN

• Serum bilirubin ≤ 1.5 x ULN (patients with documented diagnosis of Gilbert syndrome are eligible if total bilirubin < 3.0 x ULN)

• Serum albumin ≥ 2 g/dL

• Patients must be willing and able to sign the informed consent form (ICF) and to adhere to the protocol requirements

• Women of childbearing potential (WCBP) must agree to use highly effective contraceptive method(s) (as defined in Section 5.8.6 while on MIRV and for at least 4 months after the last dose

• WCBP must have a negative pregnancy test within the 4 days prior to the first dose of MIRV

Exclusion Criteria:

• Patients who have previously been treated with a systemic anti-cancer therapy

• Patients with low-grade serous, endometrioid, clear cell, or mucinous histology

• Patients with active or chronic corneal disorders, history of corneal transplantation, or active ocular conditions requiring ongoing treatment/monitoring, such as uncontrolled glaucoma, wet age-related macular degeneration requiring intravitreal injections, active diabetic retinopathy with macular edema, macular degeneration, presence of papilledema, and /or monocular vision

• Patients with serious concurrent illness or clinically relevant active infection, including, but not limited to the following:

• History of hepatitis B or C infection (whether or not on active antiviral therapy)

• History of human immunodeficiency virus (HIV) infection

• Any other concurrent infectious disease requiring IV antibiotics within 2 weeks prior to the first dose of MIRV

• Patients with a history of multiple sclerosis (MS) or other demyelinating disease and/or Lambert-Eaton syndrome (paraneoplastic syndrome)

• Patients with clinically significant cardiac disease including, but not limited to, any of the following:

• Myocardial infarction ≤ 6 months prior to first dose

• Unstable angina pectoris

• Uncontrolled congestive heart failure (New York Heart Association > class II)

• Uncontrolled ≥ Grade 3 hypertension (per CTCAE)

• Uncontrolled cardiac arrhythmias

• Patients with a history of hemorrhagic or ischemic stroke within 6 months prior to enrollment

• Patients with a history of cirrhotic liver disease (Child-Pugh Class B or C)

• Patients with a previous clinical diagnosis of noninfectious interstitial lung disease (ILD), including noninfectious pneumonitis

• Patients requiring use of folate-containing supplements (eg, folate deficiency)

• Patients with prior hypersensitivity to monoclonal antibodies (mAb)

• Women who are pregnant or breastfeeding

• Patients who received prior treatment with MIRV or other FRα-targeting agents

• Patients with untreated or symptomatic central nervous system (CNS) metastases

• Patients with a history of other malignancy within 3 years prior to enrollment Note:

patients with tumors with a negligible risk for metastasis or death (eg, adequately controlled basal-cell carcinoma or squamous-cell carcinoma of the skin, or carcinoma in situ of the cervix or breast) are eligible