Stewart Megan A, Rives Taylor A, Blanton Kimberly, Baldwin Lauren
University of Kentucky College of Medicine, University of Kentucky, Lexington, KY 40536, USA.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA.
Gynecol Oncol Rep. 2024 Jul 6;54:101452. doi: 10.1016/j.gore.2024.101452. eCollection 2024 Aug.
Patients with platinum resistant epithelial ovarian cancer have limited treatment options which are further limited by hypersensitivity reactions to first line medications such as paclitaxel. Paclitaxel is a taxane that inhibits microtubules and has a high incidence of hypersensitivity reactions. Mirvetuximab soravtansine-gynx (MIRV) is a folate receptor alpha (FRα) directed antibody and microtubule inhibitor that is approved for patients with FRα positive platinum resistant recurrent epithelial ovarian cancer. Both medications are microtubule-targeting agents with similar binding sites, therefore a theoretical risk of cross reactivity between paclitaxel and MIRV may exist. Additionally, phase II clinical trial, SORAYA, did not include data on patients with prior hypersensitivity to paclitaxel.
This is the case of a 33-year-old female with recurrent stage IIIC epithelial ovarian cancer with a history of severe anaphylaxis to paclitaxel. She was deemed eligible for MIRV after progression on multiple regimens, but MIRV was given with caution given her severe reaction history. With proper pre-treatment and monitoring, she was treated with MIRV without a reaction.
It is suspected that most paclitaxel reactions are due to the cremophor solvent rather than paclitaxel itself; however, cross reactivity with docetaxel which is suspended in a polysorbate solution can also occur. Therefore, there is no clear way to determine the risk of cross reactivity between paclitaxel and similar medications. MIRV is also suspended in polysorbate and has a similar mechanism to taxanes, therefore it was unknown if a patient with a prior grade 5 reaction to paclitaxel would also have a reaction to MIRV. Though this is one case, patients with a history of severe hypersensitivity to paclitaxel and meet the criteria for MIRV could be treated with MIRV with careful monitoring.
铂耐药上皮性卵巢癌患者的治疗选择有限，且因对一线药物（如紫杉醇）过敏反应而进一步受限。紫杉醇是一种抑制微管的紫杉烷，过敏反应发生率高。mirvetuximab soravtansine-gynx（MIRV）是一种靶向叶酸受体α（FRα）的抗体和微管抑制剂，已被批准用于治疗FRα阳性铂耐药复发性上皮性卵巢癌患者。这两种药物都是靶向微管的药物，结合位点相似，因此紫杉醇和MIRV之间可能存在交叉反应的理论风险。此外，II期临床试验SORAYA未纳入既往对紫杉醇过敏患者的数据。
本病例为一名33岁女性，患有复发性IIIC期上皮性卵巢癌，有对紫杉醇严重过敏反应史。在多种方案治疗进展后，她被认为符合使用MIRV的条件，但鉴于其严重反应史，给予MIRV时需谨慎。经过适当的预处理和监测，她接受了MIRV治疗，未出现反应。
怀疑大多数紫杉醇反应是由于聚氧乙烯蓖麻油溶剂而非紫杉醇本身；然而，与悬浮在聚山梨醇酯溶液中的多西他赛也可能发生交叉反应。因此，没有明确的方法来确定紫杉醇与类似药物之间交叉反应的风险。MIRV也悬浮在聚山梨醇酯中，作用机制与紫杉烷相似，因此既往对紫杉醇有5级反应的患者是否也会对MIRV产生反应尚不清楚。尽管这只是一个病例，但有紫杉醇严重过敏史且符合MIRV标准的患者在仔细监测下可以用MIRV治疗。
