- Elahere is an important new drug used to treat ovarian cancer that has developed resistance to certain chemotherapies. To be eligible the cancer must express high levels of folate receptor-α (FRα).
- Elahere is given intravenously once every 3 weeks, which makes up 1 cycle. The dosage depends on the patient’s body weight and the total number of cycles is determined by the prescribing oncologist.
- Elahere has common side effects, including nausea, vomiting, diarrhea, tiredness, visual changes, elevated liver enzymes, and decreased blood cell counts, among others. Doctors monitor these side effects through regular physical examinations and bloodwork.
- Serious side effects may also occur and include serious visual changes and numbness and tingling of the hands and feet. Because of the visual changes unique to Elahere, patients are required to undergo a thorough eye examination before starting treatment.
If your physician recommends Elahere for you, it is important to familiarize yourself with the treatment, how it is given, what tests are required, how you will be monitored during treatment, and what side effects you may experience.
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FRα is a protein present on the surface of ovarian cancer cells. More than 70% of newly diagnosed or recurrent ovarian cancers express this protein. Around 30-40% of those with the protein possess it in levels high enough to benefit from Elahere.
Will I Undergo Special Testing To Determine If Elahere Is Right For Me?
Patients with platinum-resistant ovarian cancers will require a FOLR1 test to determine their eligibility to receive Elahere. FOLR1 is an immunohistochemistry (IHC) test, which uses a protein stain to bind to the FRα molecules on the tumor cell surface to see how much of the FRα protein your tumor has.
This intensity of the staining is then assigned a score from 0 to +3, with 0 representing no staining, +1 weak staining, +2 moderate staining, and +3 strong staining. The aggregate results of the test are reported as either positive if more than 75% of the cancer cells stain either moderately or strongly, or negative if less than 75% of the cells stain with moderate or strong staining. Elahere is presently Food and Drug Administration (FDA)-approved for tumors with positive FOLR1 test results only.
As Elahare carries a unique risk of visual side effects (discussed in more detail below), a thorough eye examination is necessary before starting treatment. Dr. Noelle Cloven, a preeminent gynecologist-oncologist at Texas Oncology, says, “it is required that before you start treatment, you have an eye exam where they [fully evaluate your] cornea and make sure that you do not have any pre-existing problems.”
How Is It Given?
“[Elahere], kind of like chemotherapy, [is] given in through intravenous (IV) [infusion],” says Dr. Cloven. She continues, “you get hooked up to an IV, get the infusion, go home, and then [come back for] the next treatment in three weeks.” Every infusion is done in a medical setting, such as a hospital, or oncology clinic. Before each infusion, patients may be given medications to prevent nausea and infusion-related side effects.
Elahere dosage depends on your Ideal and Adjusted Body Weight. Each 3 week period makes up 1 cycle, and the total number of cycles a patient receives is usually determined by their prescribing oncologist.
What Side Effects Can I Experience During Treatment?
Elahere is generally very well-tolerated. However, like all medications, it does carry a risk of side effects, which can range from mild to severe. The most common side effects of the medication include:
- Stomach pain
- Feeling tired
- Visual disturbances
- Increased liver enzymes
- Decreased red and white blood cells
Serious side effects include:
- Serious Vision Problems: Blurry vision, visual disturbances, light sensitivity, dry and painful eyes are all side effects that may become severe during treatment with Elahere. It is very important to notify you doctor immediately if you start experiencing any of these side effects.
- “It’s one of the unique side effects that you need to look out for,” notes Dr. Cloven. She elaborates “From what I have understood from the [clinical studies], these [visual] changes are [thankfully] reversible… [If you experience visual changes, you may be started on] a regimen of eye drops to protect your eyes.”
- Neuropathy: More commonly known as numbness and tingling, neuropathy can also develop during treatment. While your doctor will monitor you for signs of neuropathy, it is important to proactively lookout for these changes and notify your doctor yourself. Starting medications, such as gabapentin, and physical therapy can usually help alleviate some of the neuropathic symptoms.
Doctors monitor their patients for these side effects through regular physical examinations and blood work. If patients experience one or more of these side effects, their doctors may adjust their Elahere dose, give them a treatment break, or, if the side effects are severe enough, discontinue the medication and switch to another therapy.