Table 2.

Pneumonitis grading system along with package label dosing recommendations and future management considerations.

Grade Toxicity	Mirvetuximab Administration Recommendations per Package Labeling	Future Management Considerations
Grade 1 Asymptomatic	Monitor.	Dose reduction and close monitoring. Hold mirvetuximab. Pulmonary consultation.
Grade 2 Symptomatic, limiting instrumental ADL	Withhold dose until Grade 1. When return to grade 1 either resume at prior dose or reduce dose.	Prednisone 1 mg/kg/day (IBW) for at least 14 days and tapered over > 4 weeks. Hold mirvetuximab. Pulmonary consultation.
Grade 3 Severe symptoms; limiting self-care ADL; oxygen indicated	Permanently discontinue.	1–2 mg/kg/day methylprednisolone. After improvement in symptoms/oxygenation transition to prednisone 1 mg/kg/day (IBW) for at least 2 weeks and taper over > 4 weeks. Permanently discontinue. Pulmonary consultation.
Grade 4 Life-threatening respiratory compromise; urgent intervention indicated	Permanently discontinue.	At least 1–2 mg/kg/day methylprednisolone. Consider “pulse dose” steroids (ie 500 mg – 1000 mg/day of methylprednisolone). After improvement in symptoms/oxygenation transition to prednisone 1 mg/kg/day (IBW) for at least 2 weeks and taper over > 4 weeks. Permanently discontinue. Pulmonary consultation.
Grade 5 Death	−	−

Per package labeling and CTCAE criteria v 5.0.

Pneumocystis jirovecii (PJP) prophylaxis is indicated with prednisone doses ≥ 20 mg.