OP-4 Characterising mirvetuximab-induced ocular surface disease

• Published in: BMJ open ophthalmology Vol. 9; no. Suppl 2; p. A2
• Main Authors: Neo, Yan Ning, Ahmad, Sajjad
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.04.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Microscopy; Oral Abstract Presentation; Ovarian cancer
• ISSN: 2397-3269; 2397-3269
• DOI: 10.1136/bmjophth-2024-BCM.4

BackgroundMirvetuximab soravtansine (MIRV) is the first antibody-drug conjugate targeting folate receptor alpha recently approved for use in advanced platinum-resistant ovarian, fallopian tube or primary peritoneal cancer and is rapidly gaining popularity. This study aims to report the clinical features, treatment strategies and outcomes of MIRV-induced ocular surface disease.MethodsTen patients were included from Aug 2017 - October 2023. Ocular symptom assessment and comprehensive ophthalmic examination, including slit lamp biomicroscopy, anterior segment optical coherence tomography (AS-OCT), and confocal microscopy were performed.ResultsAll patients were female treated for advanced ovarian cancer (mean age 66.7±5 years). Seven (70%) had grade 1–2 superficial punctate keratopathy. Five (50%) developed bilateral mid-peripheral microcystic subepithelial opacities, two of which progressed to involve the central cornea. AS-OCT confirmed the corneal opacities were limited at the subepithelial layer. Confocal microscopy demonstrated a rosette pattern for these subepithelial opacities. Two required MIRV dosage reduction due to ocular adverse events. No discontinuation of MIRV was necessary. Ocular surface and corneal changes resolved with recovery to baseline best corrected visual acuity for all patients.ConclusionDry eyes and microcystic subepithelial changes were the commonest MIRV-induced ocular adverse events but these were transient and reversible. We hypothesise the insult and centripetal migration of transient amplifying cells (TACs) to be responsible for the pathogenesis but further investigation is required. Prophylactic use of topical corticosteroid which delays TACs migration is recommended for all patients starting on MIRV. MIRV dosage reduction for patients with more severe ocular surface disease resulted in good resolution of symptoms.