Eirwen M. Miller, MD, discusses the importance of advocating for women in gynecologic oncology on International Women’s Day.

Dr Miller on the Importance of Patient Advocacy in Gynecologic Oncology

Eirwen, Miller, MD, gynecologic oncologist, the Allegheny Health Network (AHN) West Penn Hospital, discusses the importance of advocating for women from a patient perspective and 

highlights the effect that events such as International Women’s Day

 have on women’s advocacy in the oncology space.

Miller begins by stating that patient advocacy in gynecologic oncology constitutes a pivotal part of daily practice, given that all of her patients are women. These patients span across every phase of life, and understanding their current priorities is crucial, she states. For instance, Miller explains that she treats mothers who express their sole desire is to witness their child graduating from college, as well as grandmothers aspiring to attend their grandchildren’s sporting events, provided they feel well enough. Understanding the individual goals of each patient enables treatment plans to align with thoseaspirations, she adds.

Recognizing the unique objectives of each woman and acknowledging their identities as individuals remains vital, even amid the focus on cancer treatment, Miller elucidates. Furthermore, as a patient demographic, women could benefit from enhanced support in advocating for themselves, Miller says, who adds that selflessness often prompts female patients to put the needs of others ahead of their own. Many women dedicate substantial portions of their lives to caring for others as primary caregivers, making it common for women to deprioritize their own needs, Miller explains.

Miller recounts numerous instances where a woman would delay seeking medical attention for herself because she was prioritizing the needs of another family member. Frequently, women sacrifice their own well-being to cater to the needs of those around them, she says. International Women's Day underscores the importance of women addressing their own needs, including health, mental well-being, and overall wellness, amidst the responsibilities they shoulder in daily life, she concludes.

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Dr Miller on Updates With ADCs and Emerging Targets in Ovarian Cancer

Eirwen M. Miller, MD, gynecologic oncologist, Allegheny Health Network West Penn Hospital, discusses updates on antibody-drug conjugates (ADCs) and emerging targets in ovarian cancer, as presented by Sarah Crafton, MD, of Allegheny Health Network, 

At the SOSS, Dr Crafton provided an insightful discussion on ADCs and emerging targets in ovarian cancer, Miller begins. The phase 3 MIRASOL trial (NCT04209855) yielded promising initial results with mirvetuximab soravtansine-gynx (Elahere) in patients with platinum-resistant ovarian cancer, she explains. Findings from MIRASOL were presented at the 

, she explains. Notably, in December 2023, following the ASCO Meeting, 

the FDA granted priority review to mirvetuximab soravtansine

 in patients with folate receptor α (FRα)–positive, platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer.

Mirvetuximab soravtansine led to an overall survival (OS) benefit in the MIRASOL population compared with investigator’s choice of chemotherapy, Miller explains. This treatment option is significant for patients with unmet needs, and has a favorable toxicity profile, she adds.

Given that many patients with platinum-resistant ovarian cancer have undergone extensive prior treatments with notable hematologic toxicities, the hematologic toxicities associated with mirvetuximab soravtansine are relatively well tolerated, Miller expands. Furthermore, the medical community’s growing experience with the medication has increased comfort levels regarding the management of ocular toxicities, she emphasizes. Oncologists are developing robust algorithms for ophthalmology referrals, fostering strong relationships with eye care professionals for regular eye exams, and proactively educating patients about ocular toxicity symptoms, she explains.

Mirvetuximab soravtansine stands out as an exciting medication, considering the challenge of eliciting favorable OS results in patients with platinum-resistant ovarian cancer, Miller continues. The impact of this agent on the treatment paradigm is already evident and will continue to reshape current practices, she notes.

Dr Crafton also highlighted ADCs under investigation in clinical trials for patients with ovarian cancer, many of which target FRα and some of which are directed toward TROP-2, Miller adds. Miller concludes by stating that several trials are open for enrollment or will soon be available, emphasizing the importance of enrolling patients to these trials to propel advancements in this field.

Eirwen M. Miller, MD, discusses updates on antibody-drug conjugates and emerging targets in ovarian cancer.

Dr Miller on the Impact of Mirvetuximab Soravtansine on Clinical Practice in Ovarian Cancer  

Eirwen M. Miller, MD, gynecologic oncologist, Allegheny Health Network West Penn Hospital, discusses how the success of mirvetuximab soravtansine-gynx (Elahere) in ovarian cancer has bolstered the development of novel antibody-drug conjugates (ADC) and other drug targets in ovarian cancer.

the FDA granted accelerated approval to mirvetuximab soravtansine-gynx

 (Elahere) for adult patients with folate receptor α (Frα)–positive, platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer, who have received 1 to 3 prior systemic treatment regimens. Findings from the phase 3 SORAYA trial (NCT04296890) supported the regulatory approval, demonstrating improved progression-free survival, objective response rate, and overall survival with the ADC vs investigator’s choice of single-agent chemotherapy.

Additionally, initial results from the phase 3 MIRASOL trial (NCT04209855) showed that mirvetuximab soravtansine demonstrated overall survival benefit vs investigator's choice chemotherapy in patients with platinum-resistant ovarian cancer, Miller reports. The favorable toxicity profile of this agent is noteworthy, especially for heavily pretreated patients who may have experienced significant hematologic adverse effects from prior cytotoxic chemotherapy, Miller states. The agent's approval therefore marks a significant advancement in addressing an unmet need for patients in this challenging setting, she asserts.

Proactive measures are commonly used to address ocular toxicities associated with the agent, including frequent eye exam screening, strong referral algorithms to ophthalmology, and patient education about ocular toxicity symptoms, Miller continues. The increasing comfort and familiarity with managing ocular toxicities has contributed to the successful integration of mirvetuximab soravtansine into clinical practice, she says.

In light of prior difficulty demonstrating OS benefit with therapies in platinum-resistant ovarian cancer, mirvetuximab soravtansine is positioned as a transformative option in this space, Miller states, adding that the agent is already influencing clinical practice,

Furthermore, several clinical trials investigating ADCs targeting FRα and TROP-2 are open or will soon be available for enrollment. The evolving landscape of ADCs and the positive outcomes observed with mirvetuximab soravtansine underscore the potential for further advancements in the management of ovarian cancer, Miller concludes.

Eirwen M. Miller, MD, discusses how mirvetuximab soravtansine-gynx in ovarian cancer has bolstered the development of novel ADCs in ovarian cancer.

Eirwen M. Miller, MD, a gynecologic oncologist at Allegheny Health Network, West Penn Hospital, discusses the current treatment landscape of ovarian cancer.

The treatment landscape of ovarian cancer has evolved rapidly in recent years, specifically with ongoing clinical trials examining the role of immunotherapy with or without a PARP inhibitor in the up-front maintenance setting, Miller explains. Results from these trials are highly anticipated, as they could help refine up-front maintenance therapy in the platinum-resistant setting before potentially moving treatments to the frontline setting, Miller says. 

Trials are also examining antibody-drug conjugates and monoclonal antibodies, Miller notes. Overall, ovarian cancer has new data that continues to provide more options and is pushing the treatment landscape forward, Miller concludes.

Eirwen M. Miller, MD, discusses the current treatment landscape of ovarian cancer.


Dr. Miller on the Current Treatment Landscape of Ovarian Cancer

Eirwen M. Miller, MD, a gynecologic oncologist at Allegheny Health Network, West Penn Hospital, discusses the safety and efficacy of veliparib (ABT-888) vs other PARP inhibitors usedin the treatment of patients with ovarian cancer.

There are other indications for PARP inhibitors other than veliparib in a treatment setting, according to Miller. Olaparib (Lynparza) is approved in a treatment setting, as well as niraparib (Zejula) in conjunction with immunotherapy, Miller explains. As such, PARP inhibitors are not only best served in the maintenance setting, Miller explains.

Although the addition of veliparib to chemotherapy was tolerated, there is not substantial evidence to suggest that the agent is as active as other PARP inhibitors that have received regulatory approval, Miller notes. However, other PARP inhibitors were not found to be as well tolerated as veliparib when combined with cytotoxic chemotherapy, Miller concludes.

Eirwen M. Miller, MD, discusses the safety and efficacy of veliparib vs other PARP inhibitors used in the treatment of patients with ovarian cancer.

Dr. Miller on the Safety, Efficacy of Veliparib Vs Other PARP Inhibitors in Ovarian Cancer

Eirwen M. Miller, MD, gynecologic oncologist, Allegheny Health Network, West Penn Hospital, discusses the potential utility of sequential PARP inhibition in ovarian cancer.

Retreatment with a PARP inhibitor after a patient has progressed on a prior PARP inhibitor has been done anecdotally in ovarian cancer, says Miller. However, it is not yet understood whether sequential PARP inhibition is effective for patients in this setting, Miller explains. Moreover, whether PARP inhibitor selection effects efficacy is unknown, Miller adds. Additionally, safety remains a concern with this treatment approach, Miller says. 

However, retreatment with PARP inhibitors may be considered for patients with ovarian cancer who harbor germline or somatic 

 mutations and have progressed on frontline maintenance therapy, Miller concludes. 

Eirwen M. Miller, MD, discusses the potential utility of sequential PARP inhibition in ovarian cancer.  



Dr. Miller on the Potential Utility of Sequential PARP Inhibition in Ovarian Cancer 

Eirwen M. Miller, MD, gynecologic oncologist, Allegheny Health Network, West Penn Hospital, discusses her approach to frontline maintenance therapy in ovarian cancer.

Prior to implementing frontline maintenance therapy, patient factors, such as whether patients have ascites and plural effusions despite paracentesis or thoracentesis, whether they are candidates for primary debulking surgery, and whether debulking surgery would be optimal or suboptimal, need to be considered, says Miller. These factors can inform whether a patient should receive bevacizumab (Avastin), whereas the results of germline and somatic molecular testing can inform if a patient should receive a PARP inhibitor, Miller says. 

Patients who are homologous recombination deficient (HRD) who are started on bevacizumab should have olaparib (Lynparza) added to their maintenance plan based on the results of the phase 3 PAOLA-1 trial, Miller says. Patients who are homologous recombination proficient (HRP) should continue on bevacizumab alone if it was already started, Miller says. 

Patients who are not started on bevacizumab and are HRD should receive a PARP inhibitor, whereas patients who have not started on bevacizumab and are HRP could be considered for niraparib (Zejula) based on the results of the phase 3 PRIMA trial, concludes Miller. 

Eirwen M. Miller, MD, discusses her approach to frontline maintenance therapy in ovarian cancer.  



Eirwen M. Miller, MD

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