How is belantamab mafodotin currently used in clinical practice for MM?

The Multiple Myeloma Hub spoke with Fredrik Schjesvold, Oslo University Hospital, Oslo, NO. We asked how belantamab mafodotin is currently used in clinical practice for multiple myeloma (MM).

In this interview, Schjesvold discusses the current use of belantamab mafodotin-based combinations in early relapsed/refractory multiple myeloma (RRMM), including their positioning alongside other available treatment options, such as B-cell maturation antigen (BCMA)-directed therapies. Schjesvold also outlines how toxicities, patient characteristics, and individual preferences influence treatment selection in routine clinical practice.

Key points

• Belantamab mafodotin is a BCMA-directed antibody–drug conjugate (ADC) comprising an anti-BCMA monoclonal antibody conjugated to the cytotoxic agent monomethyl auristatin F (MMAF). Following binding to BCMA on myeloma cells, the cytotoxic payload is released. Unlike BCMA-directed CAR T-cell therapies and T-cell-engaging bispecific antibodies, the primary cytotoxic mechanism of belantamab mafodotin is T-cell independent.¹
• Belantamab mafodotin in combination with bortezomib + dexamethasone (BVd) or pomalidomide + dexamethasone (BPd) is approved in the EU after at least one prior line of therapy, with BPd requiring prior lenalidomide exposure, while BVd is approved in the US after at least two prior lines of therapy, including a proteasome inhibitor and an immunomodulatory agent.^2,3
• Belantamab mafodotin-based combinations provide an off-the-shelf, T-cell-independent treatment option for RRMM, including at first relapse where approved.^1,4 Treatment selection should consider eligibility for and access to chimeric antigen receptor (CAR) T-cell therapy, alongside the safety and tolerability profiles of available treatments, patient characteristics, and individual preferences.^1,4,5
• Belantamab mafodotin is associated with ocular toxicities, including keratopathy and blurred vision, which are generally reversible and can be managed through dose modifications, including dose reductions and increasing dosing intervals, and supportive care.^6–8 
  • The potential impact of ocular toxicities on daily activities, including working, driving, and using a computer, should be considered alongside patient preferences when selecting treatment.^7,8
• Overall, treatment selection in RRMM is influenced by the efficacy and safety profiles of available therapies, treatment eligibility and accessibility, and individual patient characteristics and preferences.⁵
• Schjesvold summarizes that, in routine clinical practice, belantamab mafodotin-based combinations are used primarily in second- or third-line MM treatment for patients not receiving CAR T-cell therapy or bispecific antibody treatment.

This educational resource is independently supported by GSK. All content is developed by SES in collaboration with an expert steering committee. Funders are allowed no influence.