Drug Interactions between mirvetuximab soravtansine and nirmatrelvir / ritonavir

MONITOR CLOSELY: Coadministration with potent CYP450 3A4 inhibitors may increase the plasma concentrations and effects of unconjugated DM4, the microtubule inhibitor component of mirvetuximab soravtansine. Mirvetuximab soravtansine is a folate receptor alpha (FR-alpha)-directed antibody-drug conjugate (ADC) that releases DM4 via proteolytic cleavage, and DM4 has been shown to be primarily metabolized by CYP450 3A4. Increased concentrations of unconjugated DM4 may increase the risk of adverse effects including ocular toxicity (e.g., visual impairment, corneal disorders, dry eye, photophobia, eye pain, and uveitis), pneumonitis, and peripheral neuropathy. Clinical data are not available. Other, less potent CYP450 3A4 inhibitors are not expected to interact.

MANAGEMENT: Caution is recommended if mirvetuximab soravtansine is administered in combination with potent CYP450 3A4 inhibitors. Close monitoring for adverse reactions including ocular toxicity, pneumonitis, and peripheral neuropathy is advised. Mirvetuximab soravtansine treatment may need to be discontinued, interrupted, or dosage reduced in patients with serious or life-threatening toxicities in accordance with the product labeling. Alternative treatment that does not interfere with mirvetuximab soravtansine metabolism should be considered whenever possible.