What is Folate Receptor-Alpha Positive Cancer?

Folate receptors are proteins that act like “doors” on the surface of cells, allowing the entry of a vitamin called folate (also known as vitamin B9) into the cells. Folate is essential for cell growth and division, including both healthy cells and cancer cells. In folate receptor ovarian cancer, these receptors are found in higher amounts on the surface of cancer cells compared to normal cells.

The presence of folate receptors on ovarian cancer cells is significant because it allows doctors to use targeted therapies that specifically attack cancer cells while sparing healthy cells.

How do I Know if my Cancer Is Folate Receptor Positive?

“We need a sample or a piece of tissue from your tumor, and that can either be from your upfront surgery if that tissue is still available or can do a biopsy (if your cancer has come back), and then send that tissue off for testing to see whether or not your tumor expresses this folate receptor,” Dr. Yasmin Lyons, assistant professor in the division of gynecologic oncology at The University of Texas Health Science Center at San Antonio  told SurvivorNet.

Ovarian cancers are not regularly tested for folate receptor positivity. FRα protein levels are quantified using a special test called immunohistochemistry (IHC). As of now, IHC may not be routinely performed as part of ovarian cancer workup.

However, ImmunoGen has partnered with the cancer laboratory testing company, NeoGenomics, to launch a free-of-cost FRα testing program, called FR-ASSIST.

Any patient with a diagnosis of ovarian cancer without prior FRα testing who resides and receives treatment within the USA is eligible to receive a free IHC for the protein through NeoGenomics. However, your oncologist may need to request this test for you by filling out a simple form.

Other laboratory testing companies, such as Labcorp, offers immunohistochemistry (IHC) testing, also free of charge to eligible patients.

To be eligible for the Sponsored Testing Program, patients must meet all of the following criteria to be eligible:

• A patient has epithelial ovarian cancer, fallopian tube or primary peritoneal cancer
• A patient lives and receives treatment in the United States or a US Territory
• A patient does not have a known FRα expression from a previous test
• A patient has not previously been tested under this program
• A patient’s physician has determined that the test is clinically appropriate for the individual patient

FRα Positivity: Why Does It Matter?

Folate receptors found on ovarian cancer cells are important because they enable doctors to use targeted therapies that focus on attacking only the cancer cells, leaving the healthy cells unharmed.

One such targeted therapy is using drugs called folate receptor inhibitors, such as Elahare (drug name mirvetuximab soravtansine). As of today, Elahare is the first and only FDA-approved FRα-targeted treatment for platinum-resistant ovarian cancer though there is a substantial pipeline of agents being developed that target the folate receptor.

These drugs are designed to block the folate receptors on cancer cells, preventing the entry of folate and depriving the cancer cells of a crucial nutrient for their growth and division. By targeting folate receptors, these treatments aim to slow down or stop the growth of the ovarian cancer.

Targeted therapies like folate receptor inhibitors are an important area of research and treatment for ovarian cancer, as they can potentially offer more effective and less harmful treatment options for patients with folate receptor-positive ovarian cancer.

What Is Ovarian Cancer?

Ovarian cancer is known as the cancer that whispers because symptoms are vague and can be similar to regular menstrual cycle fluctuations.

It is one of the deadliest cancers. Of all the women who will be diagnosed with ovarian cancer, only 47% will be alive 5 years after their diagnosis.

The reasons for these poor outcomes are many. Firstly, there is no screening test for ovarian cancer.

Secondly, and perhaps more importantly, the early stages of this cancer may produces no symptoms or only vague symptoms that are often misdiagnosed. These symptoms can include pain in the abdomen, nausea, bloating, feeling full after eating small amounts of food, tiredness, and a change in bowel habits, among other things.

These symptoms can also occur in many other conditions, most of which are benign. Thus, it is not uncommon for these cancers to go undiagnosed well into the later stages, such as stage 3 or 4.

Unfortunately, the later the stage, the more challenging its treatment. Even if the cancer is caught and treated at early stages, the chance of it returning in the future at almost 80%.

An essential component of ovarian cancer treatment is platinum-based chemotherapy, such as carboplatin and cisplatin. 25% of women, however, have ovarian cancers that are resistant to these therapies at the time of their initial diagnosis.

Even if the cancer is initially responsive to such therapies, it tends to become resistant to them over time. Such platinum-resistant ovarian cancers carry a grim prognosis.

There is a very limited number of treatment options for these, and such patients live fewer than 12 months on average. All of this speaks to a great need for efficacious treatment options for these patients.

Questions to Ask Your Doctor

• Should my cancer be tested for the FRα protein?
• Should you order an immunohistochemistry (IHC) test?
• What additional tests might I need?
• Am I eligible for Elahere?

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