All About Elahere
- Elahere is the first and only fully approved treatment for ovarian cancer that has come back and does not respond to chemotherapy.
- Clinical studies suggest that Elahere increases survival rates by 33% and delays disease spread by 35% compared to standard treatments.
- Side effects can include vision issues and lung inflammation even though Elahere generally causes fewer problems than traditional chemotherapy.
- A specialized test that looks for high levels of a protein called FRα protein in the cancer cells helps determine who will have the most benefit from Elahere.
Called Elahere, a large study showed that the drug lowers the risk of death by 33% compared to standard chemotherapy and lowered the chances of the cancer growing and spreading by 35%. Some patients saw their tumors completely disappear.
Read MoreOvarian cancer cells can sometimes build up a tolerance for the platinum-based drugs often used in chemotherapy. When they do, doctors refer to this as platinum resistance.
The problem often occurs in folate receptor positive ovarian cancer. An excess of a protein called folate receptor alpha (FRα) acts as a door for the vitamin B9 (folate) to flood into the cells.
While folate is important for cell growth, when there is too much of it, it fuels the growth and spread of cancer.
Related: Am I Eligible For The New Ovarian Cancer Treatment Elahere?
How does Elahere work?
Elahere is a type of drug known as an antibody-drug conjugate (ADCs).
By attaching itself to FRα on the cancer cells it can effectively block the protein and stop it from getting signals that tell them to grow and spread. Consequently, these cancer cells lose their ability to multiply rapidly, slowing down their aggressive expansion.
By blocking FRα, Elahere also disrupts the cancer cells’ ability to absorb folate. This weakens the cancer cells and also helps slow their spread.
“Data from the phase III MIRASOL trial would support promising results with Elahere and these results have been practice changing in platinum-resistant ovarian cancer,” Dr. Kelley says.
The MIRASOL Study compared Elahere with standard chemotherapy in patients with platinum-resistant ovarian cancer who had already undergone up to three different treatments.
The trial, involving 453 patients, primarily looks at how long patients live without their cancer worsening. It also examines overall survival and response to treatment. Final results showed:
- It reduced the chances of death compared to chemotherapy by 33%. Patients taking Elahere lived for an average of 17 months compared to about 13 months for the patients on chemotherapy.
- It reduced the chance of the cancer progressing by 35%. Patients on Elahere went nearly 6 months without their cancer spreading compared to 4 months for the patients on chemotherapy.
- More than 40% of patients taking Elahere saw their tumors shrink — and for 5% they disappeared completely.
- Elahere was also better tolerated than chemotherapy. Very few patients in the study had to stop taking it because of side effects.
Does Elahere have side effects?
Elahere tends to have fewer side effects than many other chemotherapy drugs but it is not entirely free of side effects. A big concern doctors look out for is how it can damage eyesight.
Some common eye problems that occur during Elahere treatment include:
- Blurred vision
- Dry eyes
- Light sensitivity
- Eye pain
- Vision changes
- Uveitis (eye inflammation)
If you experience any eye problems, your doctor might recommend artificial tears to keep the eyes most and topical steroids to reduce inflammation
In severe cases, your doctor might temporarily stop Elahere until your eyes clear up. Once improvement occurs, they might resume treatment at the same or a lower dose.
Another potentially serious side effect is lung inflammation, also known as pneumonitis, which can be severe or even life-threatening. Let your doctor know if you have new or worsening symptoms like trouble breathing, shortness of breath, cough, or chest pain.
Elahere may also cause nerve problems. Numbness, tingling, or weakness in the hands and feet are caused by a condition called peripheral neuropathy.
“Often these side effects can be managed with medications or dose reductions of Elahere,” Dr. Kelley says. “However if symptoms are severe I would recommend permanent discontinuation.”
She points out that in the MIRASOL trial, 9% of patients had to discontinue Elahere due to a treatment-related adverse effect versus 16% of patients given standard chemotherapy.
Other side effects seen with Elahere include:
- Fatigue
- Elevated liver enzymes
- Nausea or abdominal pain
- Reduced red or white blood cell counts
- Diarrhea or constipation
- Lower blood albumin levels
- Reduced blood magnesium levels
Women who are pregnant or breastfeeding or plan to get pregnant should definitely discuss the risks of taking Elahere.
Related: When Ovarian Cancer Returns, Is the New Drug Elahere an Option & Will Insurance Cover It?
Am I a good candidate for Elahere?
A test can help determine if Elahere is likely to have benefit for a patient.
Eligibility for Elahere depends on having exceptionally high levels (exceeding 75%) of the FRα protein. If there is not very much of the protein, Elahere is less likely to work.
While research suggests that roughly 80% of both new and recurring ovarian cancers might have this protein, only around 35-40% of cancers resistant to platinum treatment exhibit such high levels.
Your doctor will consider Elahere if your ovarian cancer has returned after 1-3 prior platinum-based chemotherapy treatments that did not show benefit, indicating platinum resistance.
Your doctor can order an immunohistochemistry (IHC) test at no cost for patients who:
- Have ovarian, fallopian tube, or peritoneal cancer
- Get treatment in the US or a territory
- Haven’t had this test before
- Doctor says it medically necessary
Two companies offer a free IHC test in Salt Lake City and elsewhere in the US:
- FR-ASSIST program: Partnered with NeoGenomics and ImmunoGen, your oncologist can request a free test.
- Labcorp FR-ASSIST™ program: Offers a free FOLR1 IHC test for eligible patients.
This is not a standard test that most doctors order automatically.
If your ovarian cancer does come back, it’s certainly worth having a conversation with your doctor to see if testing can help expand your treatment options.
“With increased time and experience with this drug and recent data released in December 2023 confirming overall survival benefit with Elahere over physician’s choice chemotherapy I will likely start using this upfront for platinum resistant disease in patients who have had at least one prior treatment line,” Dr. Kelley says.
Should I consider joining a clinical trial?
If your doctor finds that you are not a good candidate for Elahere or it stops working, your doctor may want you to consider joining a clinical trial, a type of study that follows patients on experimental drugs to see if they are safe and effective.
Many therapies go through clinical trial before being approved by the government for wider use.
Two drugs are currently in clinical trials for platinum-resistant ovarian cancer:
- Farletuzumab uses a kind of protein known as an antibody to target FRα and stop the tumor from growing and spreading. Like Elahere, it is an ADC.
- STRO-002 is an investigational antibody-drug conjugate (ADC) that combines an antibody with a potent toxin to find the FRα-positive cancer cells and then poison them.
If think a clinical trial makes sense for you, your doctor can help you identify and apply for the one nearest you.
Related: SurvivorNet Clinical Trial Finder
Questions for your doctor
- Is my cancer platinum resistant?
- Should I be tested to see how much FRα is present in my cancer cells?
- Am I a good candidate for Elahere?
- What are the potential side effects of Elahere, and how can they be managed?
- Will testing and treatment be covered by insurance or some type of financial assistance program?
- Should I consider a clinical trial?
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