When the U.S. Food and Drug Administration granted accelerated approval for the ovarian cancer drug mirvetuximab soravtansine (Elahere) in 2022, it came with a label warning that it could be toxic to the cornea, the clear surface at the front of the eye. That’s why researchers at Stanford University wanted to learn more about how the new drug affected their patients’ eyes.
This week at AAO 2024, the 128th annual meeting of the American Academy of Ophthalmology, they will present data from the first real-world study on mirvetuximab ocular toxicity, showing more than 55 percent of patients experienced decreased vision due to corneal damage. They also introduce a practical grading scale for mirvetuximab-related corneal toxicity and provide guidance on how to provide optimal care for these patients so they can remain on a potentially life-saving treatment while protecting their vision.
Mirvetuximab is part of an emerging class of anti-cancer drugs called antibody-drug conjugates. This type of drug is gaining in popularity because they can offer a significant improvement over standard chemotherapy for many cancers. Unfortunately, these newer medications can cause a variety of side effects on the eyes, including blurry vision, cornea toxicity, dry eye, and light sensitivity.
The Stanford Ophthalmology team, led by Prithvi Mruthyunjaya,MD, worked with the Stanford Obstetrics and Gynecology department to gather for the first time real-world data on the ocular toxicity of mirvetuximab.
Filippos Vingopoulos, MD, PhD, and colleagues regularly followed 18 women (36 eyes) receiving mirvetuximab treatment for nearly six months. They found that 47 percent of eyes showed evidence of moderate or severe corneal toxicity and 22 percent showed mild toxicity. Only 31 percent of eyes were unaffected by treatment.
The most common side effect was the buildup of material in the cornea, specifically paracentral ring-like subepithelial cystic deposits, followed by corneal haze and filamentous keratitis. These can cause blurry vision, eye pain, light sensitivity, or foreign body sensation. More than half of the patients experienced a decrease in vision.
However, most of the women’s symptoms improved or completely resolved after treatment with a strong topical corticosteroid drop and with a reduced dosage of mirvetuximab infusions or when treatments were spaced further apart. Vision returned to normal in 65 percent of eyes and improved in most of the remaining eyes. Cornea toxicity had fully resolved or significantly improved in almost all patients at the last follow up visit.
“Close ophthalmology follow up is required for oncology patients on mirvetuximab, as high potency topical corticosteroids along with dose reduction or spacing might be needed to preserve or restore vision,” Dr. Vingopoulos said. “As novel promising treatments are incorporated in our anti-cancer treatment algorithms, post-market surveillance with real-world studies and close collaboration between ophthalmology and multiple other disciplines of medicine will allow for optimal care for our patients.”
For patients on mirvetuximab treatment, a baseline eye examination is recommended prior to treatment onset and then every other cycle for the first eight cycles of treatment, or more frequent if clinically indicated.
About the American Academy of Ophthalmology
The American Academy of Ophthalmology is the world’s largest association of eye physicians and surgeons. A global community of 32,000 medical doctors, we protect sight and empower lives by setting the standards for ophthalmic education and advocating for our patients and the public. We innovate and support research to advance our profession and to ensure the delivery of the highest-quality eye care. Our EyeSmart® program provides the public with the most trusted information about eye health. For more information, visit aao.org.
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