Our Experiences With Mirvetuximab Soravtansine in Advanced Ovarian Cancer

Our Experiences With Mirvetuximab Soravtansine in Advanced Ovarian Cancer Posted By:
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In this Exchange post, Sarah Hayward, PharmD, BCOP, and Amy Ly Indorf, PharmD, BCOP, discuss their practical experience with mirvetuximab soravtansine for patients with platinum-resistant ovarian cancer.

Sarah Hayward, PharmD, BCOP:
Recently, the FDA revised the approval status of the antibody‒drug conjugate mirvetuximab soravtansine from an accelerated approval to a full approval for adult patients with FRα-positive, platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer previously treated with 1-3 previous systemic therapy regimens. This decision was based on the confirmatory phase III MIRASOL trial that compared mirvetuximab soravtansine with an investigator’s choice of single-agent chemotherapy (paclitaxel, pegylated liposomal doxorubicin, or topotecan). This study showed significant improvements in response rate, progression-free survival, and overall survival with mirvetuximab soravtansine in this patient population with difficult-to-treat disease. We had been using mirvetuximab soravtansine where I practice in a phase I clinical trial program. Our providers view it as an exciting option in the platinum-resistant setting that may not be quite as cytotoxic as chemotherapy.

Amy Ly Indorf, PharmD, BCOP:
One issue we have run into with building treatment plans is how to address patients with a lower body weight. Mirvetuximab soravtansine is administered intravenously at 6 mg/kg adjusted ideal body weight once every 3 weeks. It seems logical that if a patient weighs less than the recommended adjusted ideal body weight, then we calculate the dose of mirvetuximab soravtansine based on actual body weight.

Sarah Hayward, PharmD, BCOP:
We are using the exact same process. Our current electronic medical record does not calculate adjusted weights for us, which means we have to be very specific in our documentation about which weight we are using to calculate the dose. We provide the math used in a patient’s treatment plan to make sure everyone on the team is aware of what the dose needs to be so that we are following guidelines on that medication.

Amy Ly Indorf, PharmD, BCOP:
Often patients want to talk about the potential ocular toxicity with mirvetuximab soravtansine. In the MIRASOL trial, 56% of patients experienced an ocular adverse event including grade 3 blurred vision (7.8%), keratopathy (9.2%), and dry eye (3.2%) with a median onset of 5.4 weeks. There were no reported cases of corneal ulcers or perforations. We build prescriptions for eye care medicines into our patient treatment plans so that everyone gets the same instructions. We also have a supportive care calendar built out for patients that outlines the treatment plan.

Sarah Hayward, PharmD, BCOP:
As more antibody‒drug conjugates become available, it is important to educate patients that they do not all have ocular toxicities. This is specific to the agent. Of more importance, we make sure our patients have access to some sort of eye care specialist or professional and tell them that the professional does not have to be an ophthalmologist. An optometrist can provide the same level of supportive care to ensure that the appropriate medication monitoring and eye care support is exactly what is needed for a patient.

Amy Ly Indorf, PharmD, BCOP:
Conversation with patients should be about demystifying the concerns they have around ocular toxicity. Patients inevitably ask: “Will this be permanent? If something happens, will this be permanent?” The clinical trial data with mirvetuximab soravtansine demonstrated that most of the ocular toxicities are reversible and that there is less risk for these AEs with the recommended monitoring and accompanying mitigation strategies including corticosteroid eye drop regimen. As an entire field, we are learning more about ocular toxicities with antibody‒drug conjugates and feeling a little bit more comfortable in discussing them with our patients in a less scary way. 


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Filed under: Women's Health , Oncology/Hematology , NPs & PAs

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