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Experiences in Ovarian Cancer
Our Experiences With PARP Inhibitors and Mirvetuximab Soravtansine in Advanced Ovarian Cancer

Released: July 07, 2023

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Key Takeaways
  • Being mindful of more unique or lesser-known adverse events may be important for individualizing and managing treatment plans for ovarian cancer that include a PARP inhibitor.
  • Patients with concerns about receiving mirvetuximab soravtansine should be educated that a treatment plan in tandem with appropriate eye care and monitoring may help mitigate risks of ocular toxicity.

In this commentary, Sarah Hayward, PharmD, BCOP, and Amy Ly Indorf, PharmD, BCOP, discuss their experiences with PARP inhibitors and mirvetuximab soravtansine for patients with advanced ovarian cancer and how they manage the discussion of adverse events (AEs) from the program titled, “Expert Discussion on the Evolving Treatment Landscape in Ovarian Cancer: Pharmacist Considerations for Optimizing Care.” 

What common AEs do you see in your patients with ovarian cancer receiving PARP inhibitors? 

Sarah Hayward, PharmD, BCOP:
Class AEs associated with PARP inhibitors are hematologic toxicities and nausea. Across the board, probably the most common AE we see, regardless of the PARP inhibitor, is fatigue. From a hematologic standpoint, we see more cases of anemia in patients receiving olaparib and more cases of thrombocytopenia with niraparib. We also have observed cardiac issues such as elevated blood pressure and palpitations with niraparib. Fortunately, we have not encountered any cases of pneumonitis in our patients.

Amy Ly Indorf, PharmD, BCOP:
We struggle a little bit more with the more unique AEs when managing patients, although the conversation often has focused on hematologic toxicities and fatigue and nausea quite extensively. Other AEs with PARP inhibitors include dysgeusia, dyspepsia, photosensitivity, and increased creatinine. Some of these AEs are harder to characterize; for instance, we have seen dyschezia occur months into therapy. These types of AEs are hard for patients because they potentially affect their quality of life for years while they are receiving this medicine. Just being aware of these unique AEs and knowing that they are a possibility with these medications really helps patients feel confidence in our management and our team.

Sarah Hayward, PharmD, BCOP:
That is a counseling point for patients to help set reasonable expectations for AEs. We need patients to let us know what will be tolerable for them. It is a key point for us to let patients know that an AE like fatigue can improve over time and that they may adjust to it. 

Amy Ly Indorf, PharmD, BCOP:
Managing AEs leads back to how we approach adherence for our patients. It is important for patients to let us know how they are managing their treatment because many factors can contribute to an AE like fatigue, such as anemia in the first 5-6 cycles. Addressing these kinds of issues can help ensure that patients continue receiving therapy without any adherence issues.

What has been your experience so far with using mirvetuximab soravtansine? 

Sarah Hayward, PharmD, BCOP:
We had been using mirvetuximab soravtansine here in a phase I clinical trial program, so it was interesting for us when it came to market.  Our providers view it as an exciting option in the platinum-resistant setting that may not be quite as cytotoxic.

Amy Ly Indorf, PharmD, BCOP:
One issue we have run into with building treatment plans is how to address patients with a lower body weight. It seems logical that if a patient weighs less than the recommended adjusted ideal body weight, then we calculate the dose of mirvetuximab soravtansine based on actual body weight.

Sarah Hayward, PharmD, BCOP:
We are using the exact same process. Our current electronic medical record does not calculate adjusted weights for us, which means we have to be very specific in our documentation about which weight we are using to calculate the dose. We provide the math used in a patient’s treatment plan to make sure everyone on the team is aware of what the dose needs to be so that we are following guidelines on that medication.

Amy Ly Indorf, PharmD, BCOP:
Often patients want to talk about the potential ocular toxicity with mirvetuximab soravtansine. We build prescriptions for eye care medicines into our patient treatment plans so that everyone gets the same instructions. We also have a supportive care calendar built out for patients that outlines the treatment plan. 

Sarah Hayward, PharmD, BCOP:
As more antibody‒drug conjugates become available, it is important to educate patients that they do not all have ocular toxicities. This is specific to the agent. Of more importance, we make sure our patients have access to some sort of eye care specialist or professional and tell them that the professional does not have to be an ophthalmologist. An optometrist can provide the same level of supportive care to ensure that the appropriate medication monitoring and eye care support is exactly what is needed for a patient.

Amy Ly Indorf, PharmD, BCOP:
Conversation with patients should be about demystifying the concerns they have around ocular toxicity. Patients inevitably ask: “Will this be permanent? If something happens, will this be permanent?” The clinical trial data with mirvetuximab soravtansine demonstrated that most of the ocular toxicities are reversible and that there is less risk for these AEs with the recommended accompanying steroid regimen. As an entire field, we are learning more about ocular toxicities with antibody‒drug conjugates and feeling a little bit more comfortable in discussing them with our patients in a less scary way.

Your Thoughts?
Have you encountered any of the AEs discussed here in your patients with ovarian cancer receiving PARP inhibitors or mirvetuximab soravtansine? Answer the polling question and join the conversation by adding a comment in the discussion section.

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