Mirvetuximab soravtansine (Specialist drug)

How it works

The antibody binds folate receptor alpha on tumour cells and delivers a maytansinoid microtubule inhibitor (DM4) intracellularly, disrupting the microtubule network and causing cell death.

Prescribing in practice

• It causes ocular toxicity including keratopathy and visual impairment, so an eye examination is required before and during treatment and prophylactic eye care (such as lubricant and corticosteroid drops) is used.
• Peripheral neuropathy and pneumonitis can occur and may require dose modification or discontinuation.
• It is given by intravenous infusion and used only in patients with confirmed folate-receptor-alpha expression.

Monitoring

Monitor ophthalmic status before and periodically during treatment, together with assessment for neuropathy and respiratory symptoms.

Counselling the patient

• Attend all eye checks and report blurred vision, dry or painful eyes, or any change in sight.
• Use prescribed eye drops as directed and avoid contact lenses unless your team agrees.
• Report numbness, tingling, new cough or breathlessness.

Evidence & guidelines

The MIRASOL trial demonstrated benefit in folate-receptor-alpha-positive platinum-resistant ovarian cancer; use within licensed and specialist arrangements.