Common Side Effects of FR-Alpha–Positive Ovarian Cancer Targeted Treatments and How to Manage Them
Published on June 5, 2026
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Ovarian cancer cells with high levels of the protein folate receptor alpha (FR-alpha) are known as FR-alpha–positive ovarian cancers. Testing your cancer cells for FR-alpha can help determine whether certain targeted treatments, such as antibody-drug conjugates (ADCs), may be an option for you. These treatments are designed to find FR-alpha–positive cancer cells and deliver chemotherapy directly to them. One example is mirvetuximab soravtansine-gynx, or MIRV (Elahere), currently the only ADC approved by the U.S. Food and Drug Administration (FDA) used to treat FR-alpha–positive ovarian cancer.
“The primary goal of targeted therapies is to increase the amount of the toxic drug at the cancer cells and minimize it everywhere else — in essence, increasing the effect of the therapy and minimizing side effects,” says Tracy Brooks, PhD, an associate professor of pharmaceutical sciences at the State University of New York at Binghamton.
That targeted approach can mean fewer widespread effects, like a weakened immune system, low blood counts, and hair loss, that are common with traditional chemotherapy. But ADCs still have side effects, and some need prompt attention from your healthcare team.
Eye and Vision Changes
The most notable side effect associated with MIRV is eye and vision changes. In fact, MIRV carries a black box warning for serious eye-related problems. A black box warning is the FDA’s strongest safety warning, and is used to call attention to side effects that can become severe or life-threatening if they’re not monitored and treated early.
Nearly 6 in 10 people treated with MIRV experience some form of eye-related side effect. On average, people develop eye symptoms about a month after treatment. Some people notice symptoms within the first few weeks of treatment.
Side effects can include:
- Blurry vision
- Dry or irritated eyes
- Sensitivity to light
- Eye pain
- Corneal changes (changes to the clear outer layer of the eye, often detected during an eye exam before you notice any symptoms)
- Cataracts or worsening of existing cataracts
- Feeling like something is persistently stuck in your eyes
Blurred vision is the most frequently reported symptom, affecting nearly half of patients, followed by corneal changes in about a third, says Miriana Hijaz, MD, a gynecologic oncologist and the division director of gynecologic oncology and women’s health services at Henry Ford Health in Detroit. For the majority of people, symptoms improve or resolve with care.
Managing Eye and Vision Changes
You’ll have an eye exam before your first dose of MIRV, and follow‑up eye exams every other cycle (approximately every six weeks) for the first eight cycles to watch for early changes.
To help lower the risk of eye problems, your care team will usually prescribe steroid eye drops to use the day before each infusion, and for a few days after, along with lubricating artificial tears. Steroid eye drops help reduce eye inflammation, and lubricating tears help keep the eyes moist and reduce irritation.
A few things you can do to prevent and manage vision changes include:
- Use your steroid eye drops and artificial tears exactly as prescribed.
- Avoid wearing contact lenses unless your eye doctor says they’re safe to use during treatment.
- Report any eye or vision symptoms to your oncology team right away.
- Don’t skip your scheduled eye exams, even if your eyes feel fine.
Fortunately, eye and vision side effects of MIRV are usually manageable and reversible with close monitoring and treatment adjustments, says David O’Malley, MD, the director of the division of gynecologic oncology at the Ohio State University Comprehensive Cancer Center in Columbus, Ohio.
If you develop eye and vision symptoms, your care team may pause treatment or space infusions farther apart until they improve. Treatment rarely needs to be stopped permanently, and there have, so far, been no reports of permanent vision loss or blindness, Dr. O’Malley says. Regular follow-up care helps your care team respond quickly if changes develop.
Gastrointestinal Changes
While common with MIRV, gastrointestinal symptoms are usually mild and manageable, says O’Malley.
Symptoms can include:
- Stomach pain
- Diarrhea
- Constipation
- Nausea
- Vomiting
- Decreased appetite
Managing Gastrointestinal Symptoms
Before each infusion, your care team will often give you medication to prevent nausea, and they generally prescribe medications to take at home if symptoms develop, says Dr. Hijaz.
Over-the-counter medications like loperamide (Imodium A-D) may help manage diarrhea, Hijaz says, but check with your oncology team before taking any new medications. Diarrhea can quickly lead to dehydration, so it’s important to replace lost fluids. Aim for at least 8 to 10 eight-ounce glasses of fluids throughout the day, such as water, broth, or electrolyte drinks, like Pedialyte or Rehydralyte.
For constipation, fluids, fiber, stool softeners, laxatives, or light physical activity are often helpful, depending on your symptoms and what your oncologist recommends.
A few things you can do to manage symptoms include:
- Take nausea medications as prescribed.
- Stay well-hydrated.
- Eat small, frequent meals if large portions don’t feel appealing.
- Choose bland foods if nausea develops.
- Follow your care team’s guidance on managing symptoms at home.
Report nausea or vomiting that interferes with your ability to eat or drink fluids to your care team right away. Also, notify them promptly of any ongoing or worsening abdominal pain, Hijaz says. Severe pain, bloating, inability to pass gas or have a bowel movement, or persistent vomiting can be signs of an intestinal blockage and need immediate medical attention.
Fatigue and Body Aches
Another commonly reported side effect of MIRV is fatigue that often peaks in the days following an infusion. It may persist even after rest and affect your ability to do your regular activities.
Muscle aches are also symptoms some people notice during treatment. Pain can also drain your energy, and some pain medications may cause tiredness or drowsiness.
Managing Fatigue and Body Aches
Boosting your energy, and even getting ahead of body aches are possible. A few things you can do include:
- Rest when needed, but keep in mind that too much rest can lower your energy levels.
- Stay as active as you can with short walks when possible to help improve energy.
- Try light stretching or yoga to help with both fatigue and body aches.
- Eat a balanced diet with protein, fruits, vegetables, and whole grains to fuel your body.
- Stay hydrated throughout the day.
- Aim for 7 to 8 hours of sleep at night and limit daytime naps to 30 minutes.
- Check with your care team before taking any over-the-counter pain relievers.
- Apply heating pads or cold packs for 10 or 20 minutes at a time to help ease muscle aches.
Let your oncology team know if fatigue or body aches are becoming harder to manage, as there may be other treatable underlying causes to consider.
Peripheral Neuropathy
About 1 in 3 people treated with MIRV develop peripheral neuropathy, nerve damage that affects the hands, feet, arms, and legs.
Symptoms can include:
- Tingling or a “pins and needles” sensation
- Numbness in the hands or feet
- Burning or shooting pain
- Muscle weakness
Because targeted therapies can be more effective than older chemotherapy, treatment may continue for longer periods, which can allow nerve-related side effects to accumulate over time, says O’Malley.
Managing Peripheral Neuropathy
With peripheral neuropathy, reporting any new or changing symptoms early is key, O’Malley says. MIRV rarely needs to be discontinued because of peripheral neuropathy, though your care team may pause treatment or reduce your dose depending on how severe your symptoms are.
Medications such as duloxetine (Cymbalta) may help relieve painful neuropathy, and gabapentin (Neurontin) or pregabalin (Lyrica) may be used in some cases, Hijaz says. Some early research suggests that wearing cooling gloves and socks, known as cryocompression therapy, during infusions, may help reduce nerve-related symptoms in the hands and feet.
A few things you can do to manage peripheral neuropathy include:
- Report any tingling, numbness, or pain in your hands or feet right away, even if it seems minor.
- Be careful with hot and cold surfaces, as neuropathy can affect your ability to sense temperature changes.
- Pay attention to changes in hand coordination, balance, or walking.
- Check your feet regularly for cuts or injuries if numbness develops.
- Ask your care team about wearing cooling gloves or socks during infusions, which may help prevent and relieve symptoms.
Neuropathy symptoms may persist even after a treatment dose reduction or pause. The earlier symptoms are recognized and treated, the better the chances of preventing serious nerve damage.
Pneumonitis
Pneumonitis is inflammation of the lung tissue. It’s rare with MIRV, affecting about 1 in 10 people in clinical trials, but it is serious and can become life-threatening if not caught and treated early.
Symptoms can include:
- New or worsening cough
- Shortness of breath
- Trouble breathing
- Breathing discomfort
- Low oxygen levels
Report any breathing-related symptom, especially one that comes on suddenly, right away to your care team, says Dr. Brooks.
Managing Pneumonitis
Because pneumonitis is a serious condition, your oncology team will keep a close eye on your lung health and act quickly if you develop any new or worsening respiratory symptoms, Hijaz says.
A few things you can do include:
- Notify your care team of any breathing symptoms promptly
- Pay attention to changes in your breathing during your daily activities
Your oncologist will generally pause treatment if you develop pneumonitis. Mild cases may improve enough for treatment to restart at a lower dose, but more serious cases of pneumonitis may mean MIRV needs to be stopped permanently.
When to Call Your Doctor Immediately
Unlike traditional chemotherapy, MIRV is designed to work more precisely, which often means fewer widespread side effects than traditional chemotherapy. That said, side effects do happen, and most can be managed well when caught early. Some symptoms, though, should never be ignored.
Contact your cancer care team right away if you experience:
- Sudden shortness of breath, trouble breathing, or lower oxygen levels if you monitor at home
- New or worsening cough
- Any new or worsening eye or vision changes
- Severe abdominal pain, bloating, or trouble passing stool or gas
- Nausea, vomiting, or diarrhea that you cannot control
- New or worsening numbness, tingling, or weakness in the hands or feet
- Extreme fatigue that suddenly worsens or makes it difficult to get out of bed
- Fever
- Intense or shaking chills
Staying in close contact with your care team helps them respond quickly, and if something feels concerning, it’s always best to notify them.
The Takeaway
- Eye and vision changes are among the most closely watched side effects of mirvetuximab soravtansine-gynx (Elahere), and regular eye exams can help prevent serious problems.
- While it occurs rarely with MIRV, pneumonitis (or lung inflammation) can be life-threatening, so report any new or worsening cough, shortness of breath, or trouble breathing to your care team right away.
- Digestive symptoms and nerve-related side effects can occur during treatment. Staying hydrated and taking medications as prescribed can help make them easier to manage.
- Call your care team if you have trouble breathing, changes in vision changes, severe abdominal pain, uncontrolled vomiting or diarrhea, or worsening numbness in the hands and feet.
Resources We Trust
- Cleveland Clinic: Antibody-Drug Conjugates (ADCs)
- Mayo Clinic: Mirvetuximab Soravtansine-Gynx (Intravenous Route) - Side Effects and Uses
- American Academy of Ophthalmology: New Ovarian Cancer Drug Can Affect the Eyes
- American Cancer Society: Targeted Therapy for Ovarian Cancer
- National Ovarian Cancer Coalition: Breakthroughs in Ovarian Cancer Treatment and Clinical Trials
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
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