Meghan Berkenstock on Managing Ocular Toxicities With ADCs in Cervical and Ovarian Cancers

With the approval of tisotumab vedotin-tftv (Tivdak) for patients with metastatic cervical cancer and mirvetuximab soravtansine-gynx (Elahere) for patients with platinum-resistant ovarian cancer, gynecologic oncology care teams have needed to strengthen their relationship with ophthalmology departments, according to Meghan K. Berkenstock, MD.

Berkenstock is an associate professor of ophthalmology at the Johns Hopkins Wilmer Eye Institute, who presented on ocular toxicity management with antibody-drug conjugates (ADCs) in gynecologic cancers during the Society of Gynecologic Oncology (SGO) 2023 Annual Meeting on Women’s Cancer. In an interview with Oncology Nursing News®, she underscored the main takeaways for oncology professionals.

For both medications, patients should undergo an ophthalmic exam, including visual acuity and slit lamp exam at baseline, prior to each dose, and as clinically indicated, she noted.

However, as she explained in the interview, certain remediation strategies are useful with the different drugs. With tisotumab vedotin, topical corticosteroids should be administered immediately before infusion and for 72 hours post infusion.¹ In addition, topical ocular vasoconstrictor drops should be administered in each eye immediately before infusion and cooling eye pads should be used during the infusion. Moreover, patients should be taught to use lubricating eye drops for the duration therapy, and for 30 days past their last dose. Patients should be advised to not wear contact lenses throughout their treatment.

“By doing all these things, you really remediate any problems that may come to the surface, which again, allows for more of the administration of the [tisotumab vedotin] Tivdak,” Berkenstock said.

Mirvetuximab soravtansine, on the other hand, is associated with more corneal toxicities and therefore warrants a different remediation strategy, she said.² With this agent, ophthalmic topical steroids are recommended. One drop should be administered in each eye 6 times daily starting the day prior to each infusion, until day 4, and then administered 4 times daily for days 5 to 8 of each cycle. Moreover, lubricating eye drops should be used at last 4 times daily. Patients should wait at least 10 minutes after ophthalmic topical steroid administration before using lubricating eye drops.

She noted that, in explaining the possible ocular toxicities to patients, clinicians should stress that although these adverse events are common, they are easily treated, and very rarely do they result in dose interruptions or discontinuations—so long as the patient is upfront with their ophthalmologist about these symptoms when they do occur.

References

1. Tivdak. Prescribing information. Seagen Inc and Genmab US Inc; 2021. Accessed April 7, 2023. https://seagendocs.com/Tivdak_Full_Ltr_Master.pdf
2. Elahere. Prescribing information. ImmunoGen Inc; 2022. Accessed April 7, 2023.https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/761310s000lbl.pdf