Clinical experience with belantamab mafodotin: Management strategies for ocular toxicity

The Multiple Myeloma Hub spoke with Rakesh Popat, University College Hospital, London, UK. We asked about clinical experience with belantamab mafodotin, with a focus on strategies for managing ocular toxicity.

During this interview, Popat discussed clinical experience using belantamab mafodotin for patients with relapsed or refractory multiple myeloma (RRMM), highlighting its mechanism as a B-cell maturation antigen (BCMA)-directed antibody–drug conjugate and the practical management of associated ocular toxicities. Popat emphasized key considerations in patient selection, treatment sequencing, and individualized dosing strategies to optimize outcomes while minimizing adverse events. The discussion also covered real-world approaches to monitoring, dose adjustment, and maintaining long-term treatment benefit without compromising safety or efficacy.

Key takeaways

• Belantamab mafodotin is a BCMA-directed antibody–drug conjugate that provides a treatment option for patients with RRMM.

• Sequencing of BCMA-targeted therapies should be based on overall treatment goals and patient eligibility for CAR T-cell therapy, which may be prioritized when available.

• Ocular toxicity is the most common adverse event associated with belantamab mafodotin, typically presenting as blurred vision or a gritty sensation within 2–3 weeks following infusion; it is generally transient.

• Regular ophthalmic assessments, especially before the first four treatment infusions, are recommended to monitor for corneal changes and guide dosing.

• Management of ocular events includes pausing treatment until symptoms resolve, adjusting the dose, or extending dosing intervals to allow ocular recovery.

• After initial treatment cycles, treatment decisions can be guided by patient-reported symptoms such as visual discomfort or blurring.

• Although the approved dosing schedule is every 3 weeks, many patients benefit from extended intervals ranging from 4 to 12 weeks, depending on disease aggressiveness and tolerance.

• Initiating treatment at 2.5 mg/kg with early reduction to 1.9 mg/kg can help balance disease control with reduced ocular toxicity.

• Further adjustments, including extending dosing intervals to 8 or 12 weeks, or reducing the dose to 1.4 mg/kg, can minimize toxicity while maintaining efficacy.

• As shown by data from the DREAMM-8 (NCT04484623) trial, interruption of, or spacing, belantamab mafodotin doses does not negatively impact treatment efficacy.¹

• Patients who experience disease progression typically do so because of underlying disease biology rather than treatment interruption.

• Proactively increasing dose intervals from the outset can help prevent severe ocular events and extended treatment delays.

• Over time, spacing infusions to every 3–6 months in patients with good responses can support durable remission and improved tolerability.

This educational resource is independently supported by GSK. All content was developed by SES in collaboration with an expert steering committee. Funders were allowed no influence on the content of this resource.