Management of belantamab mafodotin-associated corneal events in patients with relapsed or refractory multiple myeloma (RRMM)

Abstract

Belantamab mafodotin (belamaf) demonstrated deep and durable responses in patients with heavily pretreated relapsed or refractory multiple myeloma (RRMM) in DREAMM-2 (NCT03525678). Corneal events, specifically keratopathy (including superficial punctate keratopathy and/or microcyst-like epithelial changes (MECs), eye examination findings with/without symptoms), were common, consistent with reports from other antibody–drug conjugates. Given the novel nature of corneal events in RRMM management, guidelines are required for their prompt identification and appropriate management. Eye examination findings from DREAMM-2 and insights from hematology/oncology investigators and ophthalmologists, including corneal specialists, were collated and used to develop corneal event management guidelines. The following recommendations were formulated: close collaboration among hematologist/oncologists and eye care professionals is needed, in part, to provide optimal care in relation to the belamaf benefit–risk profile. Patients receiving belamaf should undergo eye examinations before and during every treatment cycle and promptly upon worsening of symptoms. Severity of corneal events should be determined based on corneal examination findings and changes in best-corrected visual acuity. Treatment decisions, including dose modifications, should be based on the most severe finding present. These guidelines are recommended for the assessment and management of belamaf-associated ocular events to help mitigate ocular risk and enable patients to continue to experience a clinical benefit with belamaf.

“Real-life” data of the efficacy and safety of belantamab mafodotin in relapsed multiple myeloma—the Mayo Clinic experience

“…Keratopathy led to treatment discontinuation, dose reductions, and dose delays in 4%, 50%, and 95% of the DREAMM-2 cohort, respectively. Baseline and sequential (prior to each dose) ophthalmic examination are mandatory, and prophylactic corticosteroid eye drops are used to mitigate corneal events [ 15 ].…”

Belantamab Mafodotin-blmf: A Novel Antibody-Drug Conjugate for Treatment of Patients With Relapsed/Refractory Multiple Myeloma

“…Corticosteroid eye drops are not recommended due to a lack of benefit found in the DREAMM-2 study. Investigation of the mechanism and pharmacokinetics of ocular toxicity is underway, as are evaluations of various mitigation and management strategies ( Lonial et al, 2021b ).…”

“…The advanced practitioner should counsel patients to report signs and symptoms of ocular toxicity, such as dry eyes, changes in eyesight, or vision problems; anemia; thrombocytopenia; and infusion-reactions ( GlaxoSmithKline, 2020 ). Guidelines for the management of belamaf-associated corneal events highlight the importance of the advanced practitioner in educating the patient, encouraging them to report ocular symptoms, making referrals to eye care specialists, and collaborating with hematologists/oncologists and ocular specialists to ensure optimal management ( Lonial et al, 2021b ).…”

Management of Adverse Events and Supportive Therapy in Relapsed/Refractory Multiple Myeloma

“…Symptoms include blurred vision and dry eyes, but corneal lesions may also remain asymptomatic. Diagnosis is based on slit lamp exam and Snellen visual acuity testing [ 143 ]. Ocular toxicity increases with higher doses and history of dry eyes but is reversible upon drug discontinuation.…”

“…Regular monitoring before treatment initiation and at every cycle is recommended. In case of ocular toxicity, a dose reduction or treatment interruption for severe disease is recommended [ 143 ].…”