Management of ocular toxicities associated with belantamab mafodotin in RRMM: Latin American expert panel recommendations

Belantamab mafodotin (belamaf) is a novel B-cell maturation antigen-directed antibody–drug conjugate, which has been approved for the treatment of relapsed/refractory multiple myeloma (RRMM) in a number of regions. Although the pivotal DREAMM-7 (NCT04246047) and DREAMM-8 (NCT04484623) trials demonstrated the efficacy of belamaf in RRMM, ocular adverse events (OAEs) were frequent. 

An expert panel from Latin America, comprised of nine hematologists/oncologists and four ophthalmologists, convened for two virtual meetings to develop recommendations for managing ocular toxicities associated with belamaf in RRMM. These recommendations were published by Hungria et al. in Oncology and Therapy.

Key learnings

A thorough ophthalmic evaluation prior to treatment initiation and then once a month for the first 3 months of treatment with belamaf are recommended in patients with RRMM. Key assessments include corneal exam, tear film quality, and visual acuity.

Dose modifications should be considered and guided by the severity of OAEs, balancing disease control and ocular health. For mild keratitis, treatment continuation with supportive care is recommended. Moderate keratitis may require dose reductions and/or increased dosing interval. Severe keratitis may require further dose reductions and/or increased dosing interval, or treatment interruptions. Treatment discontinuation decisions should be made collaboratively by hematologists and ophthalmologists.

Multidisciplinary team collaboration and patient-centered care are central to the effective management of ocular toxicities in patients with RRMM treated with belamaf. Patients should be well-informed on the benefits, risks, and typically transient nature of most OAEs.

Although OAEs are common in patients treated with belamaf, proactive monitoring, dose adjustments, and supportive care enable most patients to continue treatment without significant impact on daily functioning or long-term damage to vision, emphasizing the importance of multidisciplinary collaboration and patient education to maintain treatment adherence and optimize outcomes.