The hosts open the program and set out what the discussion will cover in relapsed or refractory multiple myeloma: the area of unmet need in patients who have already received a proteasome inhibitor (PI) and an immunomodulatory drug (IMiD), the regulatory path that led from monotherapy to a combination, the DREAMM-7 trial design and efficacy outcomes, safety and monitoring, and where an antibody-drug conjugate (ADC) fits among the many options available at early relapse.
The faculty describe the approval of belantamab mafodotin with bortezomib and dexamethasone for patients who have had at least 2 prior lines of treatment including a proteasome inhibitor (PI) and an immunomodulatory drug (IMiD), noting the boxed warning for ocular adverse effects.
The faculty discuss the DREAMM-7 eligibility and exclusion criteria, including the exclusion of patients refractory to daratumumab or bortezomib. They consider how well the trial population reflects patients seen in practice, given limited prior anti-CD38 exposure. The conversation then turns to the enrolled population vs the approved indication of at least 2 prior lines, which was based on a subgroup. Finally, the faculty share their views on that restriction and discuss the survival benefit seen in the study.
The faculty turn to the safety and practical aspects of using belantamab mafodotin, drawing on earlier experience with the drug. They discuss how lines of therapy are defined and whether the definition needs refinement, and how efficacy endpoints translate into clinical relevance. Health-related quality of life is reviewed, with the view that good disease control is a driver of better quality of life. The panel describes holding the drug for eye symptoms, restarting at a lower dose, and adjusting dosing frequency to keep responding patients on therapy. They also note the overall response rate and MRD negativity in the study and discuss their interpretation of the data.
The faculty consider how to apply belantamab mafodotin in community practice, where clinicians typically see fewer patients with myeloma and want clear guidance and quick decisions. They discuss the therapy options available to patients and how access and distance from an academic center may shape the choice. They note that antibody-drug conjugates are familiar from other cancers, such as solid tumors and lymphomas, and proceed to describe an approach of assessing response and eye side effects after the first doses and then delaying or spacing doses as needed if the patient is responding to treatment.
The faculty discuss how CAR T-cell therapy, bispecific antibodies, and an antibody-drug conjugate differ in infection management and in how often patients need to be seen. They review the restricted access program and the eye exam before dosing, and a short segment covers working with an optometrist or ophthalmologist, and how brief the exam and form are. The panel then looks ahead to dosing schedule evolution, earlier-line use, and patient convenience. The panel closes with key takeaways on the head-to-head DREAMM-7 results, ocular monitoring, differences between the trial and the label, and room for different options in practice depending on the patient.
