Elahere for Ovarian Cancer: How to Manage Side Effects

August 15, 2023 9:00 am

The following article is provided by The Clearity Foundation to support women with ovarian cancer and their families. Learn more about The Clearity Foundation and the services we provide directly to women as they make treatment decisions and navigate emotional impacts of their diagnosis.

doctor with patient

A new drug approval is providing hope for many people living with ovarian cancer.

Some women have what is known as “platinum-resistant” cancer, that means the disease is no longer responding to platinum-based chemotherapy, the most common chemo drug used for ovarian cancer. Unfortunately, platinum-resistant ovarian cancer patients have limited treatment options and poor outcomes.

However, a new drug called Elahere (generic name mirvetuximab soravtansine) may offer hope to patients with such resistant cancers. To be eligible, the cancer cells must over-express an important marker — the folate receptor-alpha by greater >75%. About 35-40% of women with platinum resistant cancers will over-express this important target.

As with any medication, Elahere is not without side effects. Because Elahere is a type of chemotherapy, it can damage healthy cells along with cancer cells.

“It does come with side effects that include eye toxicities or eye side effects. That’s why seeing your eye doctor and using the steroid eyedrops as well as the lubricating drops are really important,” Dr. Yasmin Lyons, assistant professor in the division of gynecologic oncology at the University of Texas Health Science Center in San Antonio, tells SurvivorNet.

“There are other side effects, such as elevated liver enzymes, anemia, abdominal pain, nausea, and fatigue,” she adds.

Eye problems

Eye problems are common with Elahere and can also be severe.

Symptoms include:

  • Blurred vision
  • Dry eyes
  • Sensitivity to light
  • Eye pain
  • New or worsening vision changes

It’s very important to let your doctor know if you have any eye problems at baseline. And then what you’ll need is an eye exam before you start the treatment. And then, during treatment, especially if you have any symptoms, you’ll also get special eye drops to use during the treatments, as well as after treatment,” Dr. Lyons says.

Patients may need to stop wearing contact lenses throughout treatment, unless otherwise directed by their physician.

An eye doctor may be able to help manage side effects, regardless of severity. Less than 1% of people stop treatment because of eye problems. Still, patients should not be afraid to tell their doctors about any side effects they may be experiencing.

Blurred vision

  • 30-40% of patients might have blurred vision at some point in time during treatment.
  • Most people who had blurred vision noticed it around the second infusion.
  • If you experience blurred vision or vision changes, you should contact your doctor right away.
  • The majority of the vision side effects are considered low grade and reversible.

Other Possible Side Effects

When compared to the standard treatments for patients with platinum resistant ovarian cancer, Elahere had fewer side effects overall. There are several other side effects that may present during treatment with Elahere, including:

  • Lung problems (pneumonitis) also known as inflammation of the lungs: Symptoms include trouble breathing, shortness of breath, cough, or chest pain
  • Nerve problems (peripheral neuropathy): Symptoms include numbness or tingling in your hands or feet or muscle weakness
  • Feeling tired (fatigue)
  • Nausea and vomiting
  • Upset stomach
  • Abdominal pain
  • Constipation or diarrhea
  • Anemia (decreased red blood cell count)

Coping With the Side Effects

Coping with side effects can be challenging, but there are several strategies and supportive measures that can help make the process more manageable. Dr. Lyons notes that there are some steps doctors take to offset side effects before beginning treatment.

“In order to minimize any of the abdominal pain and nausea side effects, you’ll receive IV medications before you get Elahare infusion [to help prevent nausea],” Dr Lyons explains. “And then after you get the drug, you’ll be sent home with prescriptions as needed for nausea and vomiting.”

Here are some other tips to cope with the side effects:

  • Communicate with your healthcare team: Keep an open line of communication with your doctors and nurses. Let them know about any side effects you are experiencing, as they may be able to offer remedies or adjust your treatment plan to minimize discomfort.
  • Stay hydrated and eat well: Proper nutrition and hydration are essential during your treatment. Eat a balanced diet with plenty of fruits, vegetables, and protein. Drink enough water to stay hydrated, as this can help combat certain side effects.
  • Rest and conserve energy: We know it can be draining, so make sure to get enough rest and listen to your body. Take naps when needed and avoid overexertion.
  • Manage nausea and vomiting: In addition to anti-nausea medications, eating small, frequent meals and avoiding strong smells can also help.
  • Stay active: Gentle exercise, such as walking or yoga, can improve your mood and help with fatigue.
  • Seek emotional support: Treatment can be emotionally challenging. Talk to friends, family, or a counselor about your feelings and fears. Support groups with people going through similar experiences can also be beneficial.
  • Practice relaxation techniques: Activities like meditation, deep breathing exercises, or listening to calming music can help reduce stress and anxiety.

Remember, each person’s experience is unique, and what works for one may not work for another. Be patient with yourself and give yourself the time and space to heal.

If you encounter severe or persistent side effects, notify your healthcare team promptly, as they are there to help you throughout the process.

Ovarian Cancer And The Folate Receptor

With the advent of Elahere, ovarian cancers are being tested for folate receptor positivity more commonly.  FRα protein levels are quantified using a special test called immunohistochemistry (IHC). A given tumor can express variable levels of FR-alpha (>75%- high, >50% – medium, and >25% -low). Knowing these levels can affect whether your doctor will use Elahere in your care.

In ovarian cancer, many cancer cells have a protein called folate receptor alpha (FRα) on their surface. This protein is found in up to 80% of new and recurrent ovarian cancers, especially in the more aggressive types.

What is a Folate Receptor?

Folate receptors act like “doors” on the surface of cells. They allow an important vitamin called folate (also known as vitamin B9) to enter the cells, which is essential for the growth and division of both healthy and cancerous cells.

In ovarian cancer with folate receptors, there are more of these receptors on cancer cells compared to normal cells.

Why is it Important?

The presence of folate receptors on ovarian cancer cells is significant because it enables doctors to use special treatments that specifically target and fight the cancer cells while leaving the healthy cells unharmed.

It’s like attacking the bad guys without hurting the good guys. This kind of treatment, called targeted therapy, can be very effective in treating ovarian cancer.

Is My Cancer Folate Receptor Positive?

Ovarian cancers are not regularly tested for folate receptor positivity.  FRα protein levels are quantified using a special test called immunohistochemistry (IHC). As of now, IHC may not be routinely performed as part of ovarian cancer workup.

So it’s very important that you ask your doctor about Folate Receptor testing.

“We need a sample or a piece of tissue from your tumor, and that can either be from your upfront surgery if that tissue is still available or we can do a biopsy [if your cancer has come back], and then send that tissue off for testing to see whether or not your tumor expresses this folate receptor,” adds Dr. Lyons.

How Does Elahare Work?

Elahare is an antibody drug conjugate. This kind of new anti-cancer drugs, known as “biological missiles,” is leading a new era of targeted cancer therapy.

Dr Lyons explains, “What that means is that the antibody part of the drug conjugate binds to the folate receptor on the tumor cells, and then that gets taken up into the tumor cell. And then the drug that is conjugated with is the part that actually kills the tumor cells, by affecting the tumor cells ability to divide.

To summarize:

  1. Elahare attaches to the outside of the cancer cell.
  2. After binding to FRα, Elahare is taken into the cell
  3. Elahare releases a strong cancer-killing drug inside the cancer cell
  4. The cancer-killing drug can also impact other nearby cells that may be cancerous

Questions to Ask Your Doctor

  • How should I expect to feel during treatment?
  • What are the most common side effects of Elahare?
  • Is there anything I can do to offset these side effects?
  • Should I stop the medication if I get sick because of the treatment?
  • What if we need to adjust my treatment plan?

This article was published by: survivor.net

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