Dr Matulonis on the Management of Mirvetuximab Soravtansine-Related Toxicities in FRα+ Ovarian Cancer

Ursula A. Matulonis, MD, chief, Division of Gynecologic Oncology, Brock-Wilson Family Chair, Dana-Farber Cancer Institute; professor, medicine, Harvard Medical School, discusses common toxicities associated with mirvetuximab soravtansine-gynx (Elahere), and how to properly manage these treatment-related adverse effects (TRAEs) for patients with folate receptor alpha (FRα)-high ovarian cancer.

In November 2022, mirvetuximab soravtansine became the first antibody-drug conjugate (ADC) to gain FDA approval for FRα-positive, platinum-resistant ovarian cancer based on results from the phase 3, single-arm SORAYA trial (NCT04296890).

In the trial, mirvetuximab soravtansine elicited an overall response rate of 32.4% in the overall patient population, Matulonis says. Five complete responses and 29 partial responses were achieved, which is difficult to achieve with other standard agents in the platinum-resistant setting, Matulonis notes. The median duration of response seen with this agent was 6.9 months.

As the first approved ADC in this space, it is important for both physicians and patients to understand the management of treatment-related toxicities, Matulonis explains. In terms of severity, these TRAEs are predominantly grade 1 and grade 2 AEs, she adds. Gastrointestinal toxicities like nausea, and ocular toxicities such as blurred vision and keratopathy, are the most observed toxicities, Matulonis details. Keratopathy was a grouped term that encompasses several other TRAEs, including corneal cyst, corneal disorder, corneal epithelial microcysts, keratitis, keratopathy, limbal stem-cell deficiency, corneal opacity, corneal erosion, corneal pigmentation, corneal deposits, keratitis interstitial, punctate keratitis, and corneal epithelial defect. Keratopathy is typically discovered through routine eye examinations, and may not translate into changes in visual acuity, Matulonis states.

According to FDA guidelines, patients receiving mirvetuximab soravtansine should undergo a routine eye examination before treatment initiation, followed by every 2 cycles, Matulonis continues. After cycle 8 of treatment, patients are then concurrently treated with both prophylactic steroid eyedrops and preservative-free lubricating eyedrops, she says. Steroid eyedrops should be administered 6 times daily starting the day prior to each infusion until day 4. Beginning day 5, the steroid eyedrops should be administered 4 times daily during each cycle of mirvetuximab until day 8. Meanwhile, preservative-free lubricating eye drops should be utilized atleast 4 times daily or as needed during treatment.

Editor’s Note: Dr Matulonis reports consulting fees from Agenus, AstraZeneca, Blueprint Medicines, Boehringer Ingelheim, GSK, Merck, NextCure, Novartis, and Trillium; and data and safety monitoring board participation for Advaxis, Alkermes, and Symphogen. This study was sponsored by GSK.