Folate receptor alpha (FRα) high expression (≥75% of viable tumor cells with ≥2+ membrane...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-OVARIAN-FRA-HIGH-ACTIONABLE`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-OVARIAN`
Sources	`SRC-ESMO-OVARIAN-2024` `SRC-MIRASOL-MOORE-2024` `SRC-NCCN-OVARIAN-2025`

Red Flag Origin

Definition	Folate receptor alpha (FRα) high expression (≥75% of viable tumor cells with ≥2+ membrane staining by VENTANA FOLR1 RxDx) in platinum-resistant high-grade serous ovarian carcinoma. Mirvetuximab soravtansine (MIRASOL — mPFS 5.6 vs 4.0 mo, OS 16.5 vs 12.7 mo vs investigator-choice chemo) is FDA-approved 2L+ ADC.
Clinical direction	intensify
Category	high-risk-biology
Shifts algorithm	ALGO-OVARIAN-2L

Trigger Logic

{
  "any_of": [
    {
      "finding": "fra_status",
      "value": "high"
    },
    {
      "finding": "folr1_status",
      "value": "high"
    },
    {
      "finding": "fra_expression",
      "value": "high"
    }
  ],
  "type": "biomarker"
}

Notes

Companion diagnostic: VENTANA FOLR1 (FOLR1-2.1) RxDx Assay (Roche). Other FRα assays not validated for mirvetuximab selection. Re-biopsy at platinum-resistant progression preferred (expression can shift from primary). FRα-medium / -low excluded from MIRASOL labeling — receive AURELIA-style chemo + bev. Class toxicity: ocular AEs (~50% — keratopathy, blurred vision; lubricating drop prophylaxis required, ophthalmology baseline + on-treatment exams). ILD ~3% but routinely watched.

Used By

Algorithms

ALGO-OVARIAN-2L - ALGO-OVARIAN-2L