Rapidly progressing bilateral cataracts during mirvetuximab soravtansine therapy: a case series

Introduction Mirvetuximab soravtansine is an antibody-drug conjugate approved for the treatment of folate receptor alpha-expressing ovarian cancer and is associated with ocular adverse events. Patients treated with mirvetuximab soravtansine often develop moderate to severe keratopathy, requiring topical steroids. Recent studies suggest a higher incidence of cataract formation than initially reported. This case series describes rapid development of visually significant cataracts in three patients receiving mirvetuximab therapy. Case Presentations Three female patients undergoing treatment with mirvetuximab soravtansine for platinum-resistant serous ovarian cancer experienced significant visual decline after 11, 18, and 19 treatment cycles, in one case progressing from 20/25 to counting fingers in both eyes within 10 weeks. All patients had baseline ophthalmic examinations and were treated with prophylactic topical corticosteroids to mitigate corneal complications. Despite standard management, each patient developed bilateral posterior subcapsular cataracts with substantial loss of visual acuity (Table 1). Patients underwent sequential or same-day bilateral cataract extraction without complication. Postoperatively, all patients regained their baseline vision, and oncologic therapy was continued. Conclusion Rapidly progressing posterior subcapsular cataracts may occur in patients receiving prolonged mirvetuximab soravtansine therapy and may reflect drug-related toxicity, steroid exposure, or a synergistic interaction. Given that these patients did not develop cataracts until later cycles, ophthalmologic monitoring may be warranted beyond the duration specified in current treatment protocols. Early recognition and cataract surgery can restore vision without requiring cessation of oncologic therapy.