The New Drug Elahere Offers Hope in Ovarian Cancer That Has Stopped Responding to Chemotherapy

Studies show that Elahere can decrease the risk of death in advanced ovarian cancer by 33% and slow the growth and spread of the disease by 35%. Some patients even see their tumors vanish entirely.

Elahere is now fully approved by the US Food and Drug Administration (FDA) for the treatment of folate receptor positive ovarian cancer, an aggressive form of cancer that develops when cancer cells have too much of a protein called folate receptor alpha (FRα) on their surface which allows the vitamin B9 (folate) to flood into the cells.

Too much folate, especially in cancerous cells, fuels their growth, while also making the cancer “platinum-resistant” which means it no longer responds to chemotherapies containing platinum drugs.

“FDA approval of this drug gives us an exciting new treatment option for patients with FRα-positive, platinum resistant ovarian cancer and really shows the importance of biomarker-driven clinical trials in this disease.” Dr. Melissa Geller, an associate professor in the department of obstetrics, gynecology and women’s health, division of gynecologic oncology at the University of Minnesota, tells SurvivorNet.

Related: Am I Eligible For The New Ovarian Cancer Treatment Elahere?

How Elahere works

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.

Clinical evidence of its effectiveness was proven in a phase 3 clinical trial calledThe MIRASOL Study which compared treatment with Elahere to standard chemotherapy.

The final results from the study showed:

• Elahere 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.

“Treatment with the folate receptor alpha (FRα)-targeted antibody-drug conjugate mirvetuximab soravtansine-gynx benefited patients with FRα-high, platinum-resistant ovarian cancer, even after multiple lines of prior therapy with highest responses seen when the drug is used as a first-line treatment for platinum resistant ovarian cancer,” Dr. Geller says.

Potential 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)

Before starting Elahere, your doctor will examine your eyes. During treatment, they will monitor your eyes closely, particularly at the start.

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.

If the eye problems become very serious, they might recommend discontinuing Elahere altogether.

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.

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?

How to know If you are a good candidate for Elahere

Your eligibility for Elahere depends on having exceptionally high levels (exceeding 75%) of the FRα protein.

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.

A test called immunohistochemistry (IHC) determines the presence and level of FRα in your cancer cells. Your doctor can order this test through a biopsy if:

• You have ovarian, fallopian tube, or peritoneal cancer
• You get your treatment in the US or a territory
• You haven’t had this test before
• Your doctor says it medically necessary

Two companies offer a free IHC test in Minneapolis 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. It’s worth having a conversation with your doctor about it to see if it might offer more information about your cancer and help explore treatment options.

When to consider 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 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?
• In the event Elahere stops working, what alternatives do I have?

Learn more about SurvivorNet's rigorous medical review process.

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