Mali Barbi, Medical Oncologist at Northwell Health, shared on X:
“Ray – Coquard and Moore on platinum – resistant ovarian cancer (PROC):
Mirasol, Keynote B96 and Rosella each improved OS. What the trials reported: modest PFS gains, under 2 months in median. OS gains were larger, ~ 4 months.
What the trials did not report: survival after progression. The commentary estimates it by subtracting median PFS from median OS. In the control arms that is about 6 to 9 months. In the experimental arms it is about 10 months. By the same arithmetic, the gain after progression is 2 to 3 months in each trial. That is my calculation from their numbers, not a reported result. Still these are medians, from different populations, with uncontrolled treatment after progression. It is a hypothesis. But if it holds, PFS undersells these drugs, and what we give after progression matters.
Conclusion: the limit in PROC is no longer a lack of active drugs. It is knowing how to order them. No trial tells us.
What I do now: I choose by comorbidities and folate receptor status. That is my judgment, not evidence. Where I think the field needs to go: Rosella is the most elegant of the three. Keynote – B96 after 2 lines of therapy is a hard ask in practice. And new ADCs have different payloads from mirvetuximab, but nobody has shown that resistance does not carry over, so we need phase 2 data.
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