Transcript Related Guidelines

BCMA-Targeted Immunotherapy (Belantamab) for Relapsed/Refractory MM With ≥4 Prior Lines of Therapy

Joshua Richter, MD · Icahn School of Medicine at Mount Sinai

Disclosures

September 10, 2021

Key Takeaways:

  • Belantamab mafodotin, an antibody drug conjugate targeting the B-cell maturation antigen, is approved for the management of relapsed/refractory myeloma for patients who have received more than 4 prior lines of therapy.

  • One of the adverse events associated with the drug is corneal keratopathy; therefore, prior to each administration, an eye exam is required. This keratopathy can be reduced by increasing the dosing intervals.

  • Clinical trials, such as the DREAMM-6 trial, which combines belantamab mafodotin with bortezomib and dexamethasone or lenalidomide and dexamethasone, are ongoing, with encouraging preliminary results.

This transcript has been edited for clarity.

Belantamab mafodotin, or Blenrep, was FDA approved in August of 2020[1,2] for the management of relapsed/refractory myeloma for patients who have received more than four prior lines of therapy. Belantamab is an antibody drug conjugate. The main target is something called BCMA, which stands for B-cell maturation antigen. This is found on essentially all plasma cells.

The drug was approved as a single agent to be given intravenously at 2.5 mg per kg every 3 weeks. In the study called the DREAMM-2 study,[3] which led to the FDA approval, we found that belantamab had an overall response rate of approximately 30% when given as a single agent. One of the key advantages of the drug is that it can be given without the need for steroids, whereas many of the other therapies in the myeloma world require the addition of steroids in order to provide adequate treatment.

The drug is given intravenously every 3 weeks. However, it is approved with the requirement for a REMS (Risk Evaluation and Mitigation Strategy) program, which requires a need for an ophthalmologic or optometric evaluation at least 1 week prior to each dosing.[1,2] The drug is associated with known corneal events, specifically keratopathy. One of the ways that we have seen of how to reduce this is by giving the drug at longer intervals. Instead of every 3 weeks, giving it every 4 to 6 weeks and potentially every 8 weeks.

There are ongoing amazing studies in different combinations with belantamab. Most notably the DREAMM-6 protocol,[4] which is combining belantamab mafodotin with bortezomib and dexamethasone, which is seeing excellent response rates in early data presented when given earlier on in the relapsed/refractory setting for myeloma.

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