Strategies for prevention and management of ocular events occurring with mirvetuximab soravtansine

Andrew Hendershot; Mark Slabaugh; Kamran M Riaz; Kathleen N Moore; David M O'Malley; Ursula Matulonis; Gottfried E Konecny

doi:10.1016/j.gore.2023.101155

Strategies for prevention and management of ocular events occurring with mirvetuximab soravtansine

Gynecol Oncol Rep. 2023 Feb 28:47:101155. doi: 10.1016/j.gore.2023.101155. eCollection 2023 Jun.

Authors

Andrew Hendershot¹, Mark Slabaugh¹, Kamran M Riaz², Kathleen N Moore³, David M O'Malley⁴, Ursula Matulonis⁵, Gottfried E Konecny⁶

Affiliations

¹ The Ohio State University Wexner Medical Center, Columbus, OH, USA.
² Dean McGee Eye Institute, The University of Oklahoma College of Medicine, Oklahoma City, OK, USA.
³ Stephenson Cancer Center, The University of Oklahoma, Oklahoma City, OK, USA.
⁴ The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
⁵ Dana-Farber Cancer Institute, Boston, MA, USA.
⁶ UCLA Health, Los Angeles, CA, USA.

Abstract

Mirvetuximab soravtansine (MIRV) is a first-in-class antibody-drug conjugate (ADC) targeting folate receptor alpha (FRα) and is indicated for the treatment of adult patients with FRα-positive, platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer who have received 1 to 3 prior systemic treatment regimens. MIRV has demonstrated single-agent anticancer activity in clinical trials, with a differentiated safety profile comprising primarily low-grade, resolvable gastrointestinal and ocular adverse events (AEs). Pooled safety analysis of 464 MIRV-treated patients across 3 trials, including the phase 2 SORAYA study, found that 50% of patients had ≥1 ocular AEs of interest (AEIs) of blurred vision or keratopathy, the majority being grade ≤2. Grade 3 ocular AEIs occurred in 5% of patients, and 1 patient (0.2%) had a grade 4 event of keratopathy. All grade ≥2 AEIs of blurred vision and keratopathy resolved to grade 1 or 0 in patients with complete follow-up data. MIRV-associated ocular AEs were primarily characterized by resolvable changes to the corneal epithelium, with no cases of corneal ulcers or perforations. This reflects the distinctive, milder ocular safety profile for MIRV compared with that of other ADCs with ocular toxicities in clinical use. To maintain a generally low incidence of severe ocular AEs, patients should follow recommendations for maintaining ocular surface health, including daily use of lubricating eye drops and periodic use of corticosteroid eye drops, and should undergo an eye examination at baseline, at every other cycle for the first 8 cycles of treatment, and as clinically indicated. Dose modification guidelines should be followed to maximize patients' ability to remain on therapy. Close collaboration between all care team members, including oncologists and eye care professionals, will help patients benefit from this novel and promising anticancer agent. This review focuses on the etiology, rates, prevention, and management of MIRV-associated ocular events.

Keywords: Antibody-drug conjugates; Eye care; Folate receptor alpha; Mirvetuximab soravtansine; Ocular adverse events; Ovarian cancer.

Publication types

Review