Elahere For Treatment-Resistant Ovarian Cancer
- Elahere is a new medicine for treating ovarian cancer, particularly the aggressive type known as folate receptor positive ovarian cancer.
- The drug works by blocking a protein known as folate receptors in cancer cells, slowing down the cancer’s growth and spread.
- A clinical trial showed Elahere to be effective, increasing survival rates by 33% and reducing cancer spread by 35%ccompared to standard treatments.
- Potential side effects include eye problems, lung inflammation, nerve issues, and other common symptoms like fatigue and nausea.
Elahere treats an aggressive form of ovarian cancer called folate receptor positive ovarian cancer where the cancer cells have excessive amounts of a protein called folate receptor alpha (FRα) that allows a flood of vitamin B9 (folate) into the cells.
Read MoreWhat are the Benefits of Elahere?
The US Food and Drug Administration fully approved Elahere because it showed a lot of benefit for patients in the phase 3 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.
“Results from MIRASOL are promising and show significant improvement in overall response rate, overall survival and progression-free survival compared to standard of care chemotherapy,” Dr. AlHilli told SurvivorNet. ” These results are practice-changing.”
How Does Elahere Work?
Elahere is part of a class of drugs known as an antibody drug conjugate (ADC).
It works by attaching to FRα in the cancer cells. This attachment blocks FRα from receiving signals that tell the cancer cells to grow and divide. As a result, the cancer cells can’t multiply as quickly, slowing down their growth.
Additionally, by blocking FRα, Elahere prevents the cancer cells from absorbing folate, which they need to grow. Without folate, the cancer cells become weaker and less able to spread to other parts of the body.
Related: When Ovarian Cancer Becomes Resistant to Chemotherapy, New Drug Elahere Provides Hope
Does Elahere have side effects?
Elahere’s side effects are generally manageable. However, it can cause problems.
Taking Elahere can cause serious eye problems including
- Blurred vision
- Dry eyes (also known as keratoconjunctivitis sicca or dry eye syndrome)
- Sensitivity to light
- Eye pain
- Changes in vision
- Uveitis (inflammation of the eye)
These problems can affect your ability to see clearly.
“Common side effects were GI related and low grade ocular events. These side effects did not significantly impact patients or lead to discontinuation of treatment. Treatment discontinuation can be considered for severe ocular toxicity,” says Dr. AlHilli,
Before starting Elahere, your doctor will check your eyes. During treatment, they’ll monitor your eyes every other cycle for the first 8 cycles.
If you experience eye issues, your doctor may have you use artificial tears to keep your eyes moist. They may also give you topical steroids to reduce inflammation.
Lung inflammation
Elahere can lead to severe or life-threatening inflammation of the lungs, a condition called pneumonitis. Tell your doctor if you experience new or worsening symptoms such as trouble breathing, shortness of breath, cough, or chest pain.
Nerve problems
Some patients get numbness, tingling, or weakness in the hands and feet during treatment with Elahere, a condition called peripheral neuropathy. This is caused by damage to the nerves.
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
Pregnant or breastfeeding women should not take Elehare, as its effects on unborn babies or nursing infants are not yet known. It’s essential for women in these stages to discuss potential risks and alternative treatments with their healthcare provider.
Who is a good candidate for Elahere?
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.
About 80% of both new and recurring ovarian cancers might have this protein, but only around 35-40% of cancers that don’t respond well to platinum treatment show levels that high.
Your doctor will consider Elahere if your ovarian cancer has returned and you have had 1-3 previous chemotherapy treatments containing platinum, which were ineffective, indicating platinum resistance.
To check to see if you have an overabundance of FRα in the cancer cells, your doctor will take a biopsy and order a test known as immunohistochemistry, or IHC.
You can qualify to have the test for free if you:
- Have ovarian, fallopian tube, or peritoneal cancer
- Live and receive treatment in the US or a US territory
- Haven’t had this test before
- You doctor thinks it’s medically necessary
Two organizations offer this free test in Cleveland and elsewhere in the US:
- FR-ASSIST program: Partnered with NeoGenomics and ImmunoGen, your oncologist can request a free IHC test.
- Labcorp FR-ASSIST™ program: Offers a free FOLR1 IHC test for eligible patients.
Doctors don’t always order this test. If you haven’t had it yet and you’re thinking about treatment options for folate receptor positive or platinum-resistant cancer, it’s a good idea to have a discussion with your doctor.
What if Elahere stops working and my cancer comes back?
If ovarian cancer comes back after taking Elahere, it may indicate that the cancer has become resistant to the treatment.
In this case your doctor may suggest a clinical trial, which is a type of study that gathers valuable information about a drugs’ effectiveness, side effects, and best use. The results of clinical trials help decide if the treatment will be approved by the government for wider use.
Two promising drugs for folate receptor positive ovarian cancer are currently in clinical trial:
- Farletuzumab is like a “smart protein” that targets the cancer cells to stop them from growing and spreading.
- STRO-002 is an antibody-drug conjugate (ADC) that combines a special protein called an antibody with a powerful toxin. The antibody targets FRα while the toxin destroys it, leaving the surrounding healthy tissue alone.
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 Elehare?
- What are the potential side effects of Elehare, and how can they be managed?
- In the event Elehare stops working, what alternatives do I have?
Watch: AM I eligible for Elahere?
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