Elahere For Ovarian Cancer That Has Stopped Responding To Other Treatments
- Elahere offers hope for women with a type of ovarian cancer known as platinum-resistant because it has stopped responding to chemotherapy that contains a chemical called platinum.
- The drug works by attaching to a protein known as FRα and blocking it from telling cancer cells to grow and spread.
- Clinical trials show Elahere increases survival rates by a significant 33% and reduces disease spread by 35% compared to standard treatments.
- Potential side effects of Elahere include eye issues, lung inflammation, nerve problems, and more though they are typically fewer and less serious than chemo side effects.
Elahere is the first and only medication specifically designed to combat an aggressive and fast-spreading form of the disease known as folate receptor positive ovarian cancer which is a type of cancer that develops when cancer cells have an excessive amount of a protein called folate receptor alpha (FRα) on their surface. This protein acts like a gatekeeper, allowing vitamin B9 (folate) to enter into the cells.
Read MoreHow beneficial is Elahere?
Elahere was fully approved by the US Food and Drug Administration (FDA) based on the successful final results of the MIRASOL study:
- 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.
Dr. Gaillard says she has seen results in her practice that are similar to what was seen in the MIRASOL study.
“Some patients have had responses on treatment. Some patients it has perhaps helped to stabilize their disease for a period of time. And then some patients have had no benefit,” she points out.
How does Elahere work?
Elahere belongs to a category of drugs called antibody-drug conjugates (ADCs).
Its unique action starts with attaching itself to FRα on the cancer cells. This attachment effectively blocks the protein, preventing it from receiving signals that trigger cancer cell growth and division.
Consequently, these cancer cells lose their ability to multiply rapidly, slowing down their aggressive expansion.
Furthermore, by blocking FRα, Elahere disrupts the cancer cells’ ability to absorb folate, starving them of a critical way to fuel their growth. This weakens the cancer cells and stops them from spreading.
Potential Side Effects:
While generally manageable, Elahere does come with potential side effects. One serious concern is eye issues, which can show up as:
- Blurred vision
- Dry eyes
- Light sensitivity
- Eye pain
- Vision changes
- Uveitis (eye inflammation)
These problems can severely affect sight.
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 for eye lubrication
- Topical steroids to reduce inflammation
In severe cases, your doctor might temporarily pause Elahere until your eyes improve. Once improvement occurs, they might resume treatment at the same or a lower dose.
In rare, exceptional circumstances, if the eye problems are very serious, they might discontinue Elahere altogether.
Another potential side effect is lung inflammation, also known as pneumonitis, which can be severe or even life-threatening. Inform your doctor immediately if you experience new or worsening symptoms like trouble breathing, shortness of breath, cough, or chest pain.
Elahere can also cause nerve problems, leading to numbness, tingling, or weakness in the hands and feet, a condition called peripheral neuropathy.
More common, less serious side effects 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
A very important to note: Elahere is not recommended for pregnant or breastfeeding women due to potential risks to unborn babies or nursing infants.
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
Although Elahere expands the options for women whose ovarian cancer returns, not everyone qualifies for the treatment.
“By definition, in order to be eligible for the drug under the FDA guidelines there has to be expression, meeting a bar of 75% of the folate receptor,” Dr. Gaillard says. “And so all of the patients who are getting treated with the drug would have to meet that bar.”
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 ineffective platinum-based chemotherapy treatments, 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 Phoenix 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.
Most doctors don’t order this test automatically.
If you haven’t had it and are considering treatment options for folate receptor, you should have a talk with your doctor about it.
“Sometimes it’s on at the time of diagnosis for certain circumstances. Sometimes it’s done later on down the line. It can be variable. It is dependent on the treating physician when they choose to perform the testing,” Dr. Gaillard says.
Clinical trials
If Elahere is not right for you or if it stops working, your doctor may bring up the idea of a clinical trial.
A clinical trial is a study run by medical researchers. They test real patients with experimental treatments to see if they are safe and effective before they are 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.
Ask your doctor if a clinical trial makes sense for you. They 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?
- In the event Elahere stops working, what alternatives do I have?
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