Management of ocular toxicity in patients with gynecologic cancer receiving novel antibody-drug conjugates: a narrative review

Abstract

Antibody-drug conjugates (ADCs) represent a promising therapeutic approach in gynecologic cancers, particularly ovarian and cervical malignancies. Agents such as mirvetuximab soravtansine, and tisotumab vedotin, targeting folate receptor alpha and tissue factor, respectively, reported clinical efficacy in patients with limited options. However, their use is associated with ocular toxicities, including keratopathy, blurred vision, and dry eye, which may impact adherence and quality of life. This review summarizes current evidence on the incidence, pathophysiology, and clinical presentation of ADC-related ocular adverse events in gynecologic oncology. It also provides practical, evidence-based strategies for the prevention, monitoring, and management of these adverse events. Interventions include prophylactic topical therapies, supportive care measures, treatment delays or dose modifications, and herpes zoster vaccination. Comprehensive management of ocular toxicities is essential to ensure the safe and sustained use of ADCs, preserving both therapeutic benefit and patient well-being. Further research is warranted to optimize preventive and management protocols.

Keywords: Antibody–drug conjugates; Gynecologic cancers; Mirvetuximab soravtansine; Ocular toxicity; Prevention and management; Tisotumab vedotin.