Dr Lynam on the Clinical Implications of Targeted Therapies in Ovarian Cancer

“[Mirvetuximab soravtansine and trastuzumab deruxtecan] are very new agents that we can add to our armamentarium to better classify treatment and make sure that we're making and sequencing therapies appropriately for patients, because we have these really promising findings in phase 2 [and phase 3] clinical trials that are investigating these drugs, and really understanding how we can best leverage patients’ therapy decisions based off of what their individualized expression patterns are.”

Sarah Lynam, MD, an assistant professor in the Division of Gynecologic Oncology in the Department of Reproductive Biology at Case Western Reserve University School of Medicine, and an attending physician in the Division of Gynecologic Oncology at the Seidman Cancer Center at the University Hospitals Cleveland Medical Center, discussed the clinical applicability of mirvetuximab soravtansine-gynx (Elahere) and fam-trastuzumab deruxtecan-nxki (Enhertu; T-DXd) for the treatment of patients with ovarian cancer.

As data have emerged from the phase 2 DESTINY-PanTumor02 trial (NCT04482309) and phase 3 MIRASOL trial (NCT04209855), comprehensive biomarker testing has become increasingly important in treatment planning for patients with recurrent ovarian cancer, Lynam began. Evaluating patients for both HER2 and folate receptor α (FRα) expression helps identify patients who may benefit from targeted therapies such as trastuzumab deruxtecan and mirvetuximab soravtansine, she stated. Having this knowledge also allows for more flexibility regarding toxicities, particularly because each agent has its own list of toxicities, Lynam noted. Specifically, with mirvetuximab soravtansine, myelosuppression is a common adverse effect (AEs) observed, based on earlier data, she explained. Additionally, anemia and blood dyscrasias are also common with therapy, she stated. Secondary AEs seen with these 2 agents also include a multitude of gastrointestinal AEs. Of note, patients receiving mirvetuximab soravtansine should be closely monitored for ophthalmologic toxicities, particularly blurred vision following therapy, she emphasized.

Conversely, trastuzumab deruxtecan is associated with a higher incidence of pulmonary toxicity, including pneumonitis or lung inflammation, Lynam said. These safety considerations may influence treatment selection, particularly for patients with preexisting conditions that predispose them to either ocular or pulmonary complications, she concluded.