EBMT 2022 | Managing belantamab mafodotin-associated corneal adverse events in multiple myeloma

One of the issues that I think we’ve all learned to deal with through practice with belamaf is the issues of corneal or keratopathy. And I think that there are a couple of measures that I think are really important. The first is, in terms of prevention, there may not be a lot that can be done, but if you look at the data, even emerging data from ongoing combination trials, what we’re seeing is that a majority of patients have grade 1, grade 2 keratopathy, and that keratopathy in general is reversible. And this I think is really exciting and important because today there are no patients that I’m aware of that have had irreversible issues with vision or visual acuity as a consequence of the use of belamaf. And that, again, speaks to patients’ comfort, knowing that for the most part, this does resolve or recur with appropriate supportive care. Now what we know the best supportive care at this time really is, is holding the dose or dose reductions, dose modifications. And I think once you get past that initial couple doses and get a sense for whether this strategy is going to be effective, thinking about alternative dosing schedules becomes really very important. As an example, I had a patient who would end up missing every other dose because of the development of keratopathy, and so what we ended up doing was just putting them on a six-week schedule. We showed that the drug worked, and they had a response and rather than sort of thinking, “Well, are we going to dose it three weeks or not?” We just ended up dosing every six weeks, and that patient did well for over two years suggesting that the half-life may be variable among patients, and so it’s okay to be flexible with dosing, not sort of sticking to that every three-week dosing if a patient doesn’t necessarily need it.
The other piece of advice that I would give is reassurance for the patient, that holding the dose doesn’t necessarily impact efficacy. And if you’ve gotten past the first few doses and see a response, and then you’re in and every other, every six weeks, every four weeks, every five weeks dosing schedule, that may be optimal for that patient, and that’s okay. That if you look at dose holes, even beyond 12 weeks, most patients actually maintained or deepened their response. It was really only a minority of patients that had progression because of dose attenuation or dose holding. So there’s something unique about this compound that really allows its dosing to be a little bit more flexible. Take advantage of that flexibility to optimize the outcomes for your patient.