What to Expect When Getting Folate Receptor Alpha Testing for Ovarian Cancer

If you have recurrent or platinum-resistant ovarian cancer, your doctor may recommend folate receptor alpha (FRα) testing. If you test positive for elevated levels of FRα (expressed on 75 percent or more tumor cells), you may be a candidate for a treatment called mirvetuximab soravtansine-gynx (Elahere).

“Mirvetuximab soravtansine-gynx is really exciting, because people who take it see improvements in progression-free survival and overall survival,” says Angeles Alvarez Secord, MD, a professor of obstetrics and gynecology at Duke University School of Medicine in Durham, North Carolina.

Your doctor may order an FRα test after you’ve tried one to three platinum-based chemotherapies that haven’t stopped the cancer from progressing or that led to remission but then progressed. If you’ve had a previous surgery or biopsy, the lab can usually use a sample of that tissue for the test.

But if your tissue sample is more than a few years old, it may be worth collecting a new one, says Joseph Lucci, MD, a professor of gynecologic oncology at McGovern Medical School at the University of Texas Health Science Center in Houston. That’s because the FRα expression can change over time. “So if your prior biopsy was negative,” he says, “it may be worth doing another one that’s reflective of your current disease status.”

If a newer sample is necessary, you may undergo a needle biopsy. The biopsy site may vary from person to person — for example, a lymph node or the abdomen, says Dr. Lucci. How long it takes to schedule the biopsy, collect new tissue, and send it to the lab can differ based on the treatment center.

If you’re newly diagnosed with ovarian cancer, your doctor may have already ordered FRα testing. Doctors are increasingly testing FRα expression earlier in the disease course, says Kevin Elias, MD, a gynecologic oncologist and researcher at Cleveland Clinic. “Now, we may test at the beginning of your treatment, so if you [don’t respond to] platinum-based therapies, you don’t have to wait to see if you’re FRα positive.”

Your doctor may order FRα testing on its own or alongside tests for other ovarian cancer biomarkers. If you’ve already had surgery or a biopsy, you can ask your doctor if the tissue has been tested for FRα.

In most cases, FRα testing is done on tissue that has already been collected, so the test itself doesn’t cause any side effects.

• Pain
• Bleeding
• Infection
• Scarring

Call your doctor if you develop a fever, if the biopsy site won’t stop bleeding, or if the site is swollen, oozing, or tender to the touch.

If test results show that you’re FRα positive, your doctor may talk to you about when you might be a good candidate for treatment with mirvetuximab soravtansine-gynx.

If you test negative but still have some FRα expression — for example, 50 percent or more — you may be able to take the medication in combination with bevacizumab. Other treatment options, including clinical trials, may also be available.

Mirvetuximab soravtansine-gynx is a type of medication called an antibody-drug conjugate, which combines a lab-made antibody with a chemotherapy drug. The antibody targets the FRα protein found on the surface of many ovarian cancer cells, allowing the chemotherapy to be delivered directly into the tumor cells.

“It’s a highly selective medication,” says Lucci, and “offers hope to a group of people who have had very few treatment options in the past.”