Case Report: Use of mirvetuximab soravtansine in a patient with platinum-resistant ovarian cancer and concomitant PARP-inhibitor-related myelodysplastic syndrome

Response rates in platinum-resistant ovarian cancer remain low (16-30%) and decline with subsequent lines of therapy. Mirvetuximab soravtansine (MIRV), an antibody-drug conjugate targeting folate receptor alpha (FRα), has demonstrated clinically meaningful activity in FRα-positive disease. We report a 65-year-old patient with heavily pretreated, FRα-positive ovarian cancer who developed therapy-related myelodysplastic syndrome with increased blasts (MDS-IB2, DNMT3A-mutated) during therapy with MIRV in combination with carboplatin having received prior PARPi maintenance therapy. Azacitidine treatment induced complete hematologic remission. Following progression of the ovarian cancer disease, MIRV was reintroduced concurrently with ongoing azacitidine. This strategy resulted in seven months of sustained disease control of the ovarian cancer without evidence of MDS worsening. In fact, after three cycles of azacitidine, a follow-up bone marrow biopsy showed no residual MDS. This case demonstrates that MIRV can be safely and effectively administered alongside azacitidine, providing clinically meaningful tumor control without compromising hematologic outcomes. These findings support the concurrent management of ovarian cancer and therapy-related MDS as a viable and underutilized treatment approach in a highly challenging clinical setting.