Optimizing BCMA-directed therapies: Balancing efficacy, safety, and PROs

On March 5, 2026, the Multiple Myeloma Hub held a virtual symposium, titled Optimizing dosing of BCMA-directed therapies for improved quality of life in multiple myeloma. During the symposium, Hang Quach, St Vincent’s Hospital Melbourne and University of Melbourne, Melbourne, AU, delivered a presentation on optimizing dosing strategies for B-cell maturation antigen (BCMA)-directed therapies in multiple myeloma (MM). 

In this presentation, Quach discusses the importance of dose modification in the real-world use of BCMA-directed therapies and emphasizes the need to balance efficacy and safety with long-term quality of life (QoL). Quach outlines dosing strategies for belantamab mafodotin and bispecific antibodies, and shares key clinical and patient-reported outcome (PRO) data demonstrating the impact of dose adaptation on toxicity and QoL (Figures 1, 2, and 3). 

Key points 

• Dose modification is a key component of optimizing outcomes with BCMA-directed therapies, particularly in the real-world setting. 
• Unlike CAR T-cell therapy, bispecific antibodies and ADCs are administered continuously and therefore require ongoing management of toxicity. 
• Dose optimization aims not only to reduce toxicity, but also to maintain patients on effective treatment for longer and preserve efficacy. 
• Treatment-related toxicity and early discontinuation are associated with poorer outcomes, particularly in older and frail patients with relapsed/refractory MM.⁴ 
• Recommended dosing strategies for bispecific antibodies include step-up dosing followed by interval extension in patients who achieve a predefined response level or duration of response. 
• Extended dosing intervals with bispecific antibodies have been associated with a reduced incidence of severe infections.² 
• Early dose de-escalation in real-world practice may occur in response to adverse events and patient frailty.^2,5,6 
• Transient declines in QoL may occur early during treatment, particularly in association with cytokine release syndrome, but these are generally temporary.⁷ 
• Belantamab mafodotin, an ADC, is associated with ocular adverse events, which are typically reversible and often guide dose modification in clinical practice.^8,9  
• In clinical trials, dose delays have been used to manage ocular toxicity without compromising efficacy. 
• PROs from clinical studies indicate that, despite treatment-related adverse events, overall QoL is maintained or improved over time. 
• Fatigue and appetite changes may have a greater impact on QoL than treatment-specific adverse events such as ocular toxicity. 
• Improvements in QoL are associated with early disease control achieved with BCMA-directed therapies.^1–3  
• Personalized dosing strategies are important to balance treatment efficacy with tolerability and QoL. 

This independent educational activity was supported by GSK. All content was developed independently by SES in collaboration with the faculty. The funder was allowed no influence on the content of this activity.