Mirvetuximab soravtansine-gynx (Elahere™)

Author: Karen Arnold-Korzeniowski, MSN RN
Content Contributor: Kristin Markiewicz, PharmD- Oncology Clinical Pharmacy Specialist
Last Reviewed: November 16, 2022

Pronounce: mir-ve-tux-i-mab soe-rav-tan-seen

Classification: Monoclonal Antibody and Antibody Drug Conjugate

About: Mirvetuximab soravtansine-gynx (Elahere™)

Mirvetuximab soravtansine-gynx is a type of monoclonal antibody. It is a medicine designed to target a specific protein or cell – in this case, the target is a folate receptor alpha. This medication is also a microtubule inhibitor conjugate.

How to Take Mirvetuximab soravtansine-gynx

This medication is given as an intravenous (IV, directly into a vein) infusion. The dose will be based on your size. You will be given medications before the infusion to prevent infusion related side effects. You will be given medications such as acetaminophen (Tylenol), dexamethasone (corticosteroid), diphenhydramine (Benadryl), and medications to prevent nausea and vomiting. You will also be given topical steroids to be put into your eyes and lubricating eye drops to help prevent eye issues related to the infusion.

This medication can interact with other medications you are taking. Be sure to tell your providers about all medications and supplements you are taking, both prescribed and over the counter.

Possible Side Effects of Mirvetuximab soravtansine-gynx

There are a number of things you can do to manage the side effects of Mirvetuximab soravtansine-gynx. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:

Eye Problems

This medication can cause serious eye problems like changes in your vision, dry eye, light sensitivity, and pain. You will need an eye exam before starting this medication, before every other cycle for the first 8 cycles, and as needed. You will be given steroid eye drops and artificial tears to put in your eyes to prevent any eye issues. You will also be taught how to give yourself these eye drops. Often, you will be instructed to:

  • Administer one drop of ophthalmic topical steroid in each eye 6 times daily starting the day before each infusion until day 4. Administer one drop in each eye 4 times daily for days 5-8 of each cycle.
  • Use lubricating eye drops at least four times daily and as needed during treatment.

Ask your provider exactly how you should be using these eye drops. If you notice any change in your eyes or vision, contact your provider right away.

Fatigue

Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.

Liver Problems

This medication can cause liver toxicity, which your oncology care team may monitor for using blood tests called liver function tests. Notify your healthcare provider if you notice yellowing of the skin or eyes, your urine appears dark or brown, or you have pain in your abdomen, as these can be signs of liver toxicity.

Nausea and Vomiting

Talk to your oncology care team so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try saltines, or ginger ale to lessen symptoms.

Call your oncology care team if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Infection and Low White Blood Cell Count (Leukopenia or Neutropenia)

This medication can cause life threatening infections, with or without a decrease in white blood cell counts.

White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips to preventing infection:

  • Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
  • Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
  • When working in your yard, wear protective clothing including long pants and gloves.
  • Do not handle pet waste.
  • Keep all cuts or scratches clean.
  • Shower or bathe daily and perform frequent mouth care.
  • Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
  • Ask your oncology care team before scheduling dental appointments or procedures.

Ask your oncology care team before you, or someone you live with has any vaccinations.

Diarrhea

Your oncology care team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses of non-alcoholic, un-caffeinated fluid a day to prevent dehydration.

Peripheral Neuropathy (Numbness or Tingling in the Hands and/or Feet)

Peripheral neuropathy is a toxicity that affects the nerves. It causes numbness or a tingling feeling in the hands and/or feet, often in the pattern of a stocking or glove. This can get progressively worse with additional doses of the medication. In some people, the symptoms slowly resolve after the medication is stopped, but for some, it never goes away completely. You should let the oncology care team know if you experience numbness or tingling in the hands and/or feet, as they may need to adjust the doses of your medication.

Constipation

There are several things you can do to prevent or relieve constipation. Include fiber in your diet (fruits and vegetables), drink 8-10 glasses of non-alcoholic fluids a day, and keep active. A stool softener once or twice a day may prevent constipation. If you do not have a bowel movement for 2-3 days, you should contact your healthcare team for suggestions to relieve the constipation.

Electrolyte Abnormalities

This medication can affect the normal levels of electrolytes (magnesium) in your body. Your levels will be monitored using blood tests. If your levels become too low, your care team may prescribe specific electrolytes to be given by IV or taken by mouth. Do not take any supplements without first consulting with your care team.

Low Red Blood Cell Count (Anemia)

Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your oncology care team know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion.

Less common, but important side effects can include:

  • Pneumonitis: Patients can develop an inflammation of the lungs (called pneumonitis) while taking this medication. Notify your oncology care team right away if you develop any new or worsening symptoms, including shortness of breath, trouble breathing, cough, or fever.

Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant while on this medication. Effective birth control is necessary during treatment and for at least 7 months after treatment. Even if your menstrual cycle stops you could still be fertile and conceive. You should not breastfeed while taking this medication or for 1 month after your last dose.

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