Sequencing Combination Use and Resistance in Ovarian Cancer

Sequencing multiple antibody drug conjugates is becoming a central question in ovarian cancer as more patients present with overlapping biomarkers and several possible treatment options. The faculty discuss how high folate receptor alpha expression may favor earlier use of mirvetuximab soravtansine because the evidence base is more mature and its clinical role is more clearly defined. More difficult decisions arise when tumors show additional potentially actionable features such as HER2 expression, because the best order of therapy remains uncertain and must often be individualized. Toxicity differences matter substantially in that process, especially when prior neuropathy, marrow reserve, gastrointestinal tolerance, or other patient specific factors may make one drug easier to use than another. The panel also considers combination strategies, noting that topoisomerase based agents may be more difficult to combine with standard chemotherapy because of overlapping hematologic toxicity. Resistance is another concern, as classic chemotherapy resistance mechanisms may still influence outcomes even when drug delivery becomes more targeted.