Dr Berkenstock on the Mitigation of ADC-related Ocular Toxicities in Gynecologic Cancers

Meghan K. Berkenstock, MD, associate professor, ophthalmology, Johns Hopkins Wilmer Eye Institute, discusses the management of antibody-drug conjugate (ADC)–related ocular toxicities in gynecologic cancers.

As the use of ADCs in ovarian, cervical, and other gynecologic cancers increases, there is growing need for effective mitigation strategies for treatment-related adverse effects (TRAEs), specifically high-grade ocular toxicities, Berkenstock says. Common ocular TRAEs include conjunctivitis, ulcerative keratitis, dry eye, and keratopathy/keratitis. Many of these ocular toxicities occur because of off-target delivery of the agent’s payload, which can lead to a loss of epithelial cells on the cornea, Berkenstock explains. Reduction in the number of epithelial cells can lead to infection or thinning of the cornea, she adds.

The management of these toxicities in clinical practice involves substantial coordination of patient care and communication between ophthalmologists and oncologists, Berkenstock emphasizes. Many patients take time to adjust to the use of prophylactic steroid eye drops, which should be given prior to and 72 hours after infusion with tisotumab vedotin-tftv (Tivdak) or through day 10 of treatment with mirvetuximab soravtansine-gynx (Elahere), Berkenstock states. Clinicians not only issue the original prescription for these steroids, but remind the patient to regularly administer them, Berkenstock says. Morevoer, they can monitor the patient for signs of ocular toxicities, such as reduced visual acuity, blurred vision, light senstivity, redness, dryness and irritation. The performance of a regular baseline eye exam prior to each ADC infusion is also vital to toxicity management, Berkenstock notes.

The early referral of patients to ophthalmologists in the event of conjuctival or corneal inflammation can also help prevent the development of severe ocular AEs, Berkenstock says. This also supports ongoing efforts to educate ophthalmologists about ADCs, and familiarize them with the AE grading scale for ocular examinations, Berkenstock concludes.

Editor’s Note: Dr Berkenstock reports serving as a consultant for Eyepoint Pharmaceuticals.