Dr Williams on Eye Toxicities Associated With ADCs in Ovarian Cancer

Heather R. Williams, MD, assistant professor, Department of Obstetrics and Gynecology – Division of Gynecologic Oncology, University of Arkansas for Medical Sciences, discusses ocular toxicities associated with antibody-drug conjugates (ADCs) and strategies for managing these toxicities in patients with ovarian cancer.

In 2022, the ADC mirvetuximab soravtansine-gynx (Elahere) received accelerated FDA approval for patients with folate receptor alpha–positive, platinum-resistant epithelial ovarian, primary peritoneal, or fallopian tube cancer who have received between 1 and 3 prior therapies. This regulatory decision was supported by findings from the single-arm, phase 3 SORAYA trial (NCT04296890). In SORAYA, 41% and 6% of patients experienced any-grade and grade 3/4 treatment-related blurred vision, respectively. Additionally, the prescribing information for mirvetuximab soravtansine includes a boxed warning for ocular toxicities, including keratopathy, visual impairment, photophobia, dry eye, uveitis, and dry eye.

Among patients with ovarian cancer who experience eye toxicities from mirvetuximab soravtansine, most experience blurred vision, Williams says. Patients receiving this ADC are required to use steroid or lubricating eye drops daily and keep a daily log detailing when they use eye drops to mitigate some ocular toxicities, Williams notes.

More severe eye toxicities, such as keratopathy, need to be monitored for by patients’ ophthalmologists, Williams explains. Patients are required to visit their eye doctor prior to initiating treatment with mirvetuximab soravtansine, as well as after the first few treatment cycles, to maintain eye health Williams emphasizes. Although collaboration between gynecologic oncologists and ophthalmologists is not typical, this multidisciplinary approach to patient care is important when using ADCs, according to Williams.

Patient and caregiver education about the risk of developing these adverse effects associated with ADCs is also crucial, Williams notes. As evidenced by the successful use of ADCs in patients with other tumor types, patients are usually able to manage eye drops and other preventive measures, Williams concludes.