Dr Krishnan on the Evolving Role of Belantamab Mafodotin in Multiple Myeloma

Amrita Krishnan, MD, executive medical director, Hematology, City of Hope Orange County; director, the Judy and Bernard Briskin Multiple Myeloma Center; professor, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, discusses the evolving role of belantamab mafodotin-blmf (Blenrep) in the treatment paradigm for multiple myeloma, particularly in the context of early relapse.

Recently published results from the phase 3 DREAMM-7 (NCT04246047) and DREAMM-8 (NCT04484623) trials have demonstrated that belantamab mafodotin combined with standard-of-care combinations could have a role in the treatment of patients with early relapsed multiple myeloma, Krishnan notes. The agent was previously approved by the FDA for patients with relapsed/refractory multiple myeloma after at least 4 prior lines of therapy, but GSK withdrew the agent in that indication in 2022.

Findings from the DREAMM-7 trial were presented during the 2024 February ASCO Plenary Series showed that the addition of belantamab mafodotin to bortezomib (Velcade) and dexamethasone significantly prolonged progression-free survival (PFS) vs daratumumab (Darzalex) plus bortezomib and dexamethasone in patients with relapsed/refractory multiple myeloma.

Additionally, findings from the DREAMM-8 trialpresented at the 2024 ASCO Annual Meeting demonstrated that the combination of belantamab mafodotin, pomalidomide (Pomalyst), and dexamethasone improved PFS vs bortezomib plus pomalidomide and dexamethasone in patients with relapsed/refractory multiple myeloma.

Krishnan notes that the results suggest belantamab mafodotin could have a role in the early relapse setting as a part of combination regimens. Anti-CD38 monoclonal antibodies are generally part of the standard of care in this setting, she explains, adding that belantamab mafodotin–containing regimens have demonstrated improved outcomes for for patients who are naive to anti-CD38 agents. This finding could open a potential new line of therapy for these patients, potentially offering a different mechanism of action and extending the duration of disease control, Krishnan says.

However, Krishnan highlights the ongoing concerns regarding the safety profile of belantamab mafodotin, particularly in regard to ocular toxicity. This adverse effect has been a consistent issue across studies, and it require careful monitoring and management The ocular toxicity observed in these trials is not insignificant and necessitates further research to determine how best to mitigate this risk without affecting the potential benefits of this agent, she concludes.