Belamaf is ‘First-In-Class’ New Therapy for Relapsed/Refractory Myeloma, But What’s Its Role in the Toolkit?

Belamaf has key advantages in myeloma treatment

• Belamaf has overall response rates of 31%, and response durations of 6 months or more in relapsed or refractory multiple myeloma
• There is no need for steroids, which is an advantage over selinexor
• Ocular toxicity is a concern and should be managed in conjunction with an ophthalmologist

In August, the FDA granted belantamab mafodotin (Belamaf) accelerated approval for patients with relapsed or refractory multiple myeloma who’ve received at least four prior therapies, including an anti-CD38 monoclonal antibody, a proteasome inhibitor, and an immunomodulatory agent. The approval followed the DREAMM-2 trial, which found overall response rates (ORR) of 31%, and response durations of 6 months or more.

“That ORR is as long as, if not longer, than any other drugs in the triple-class refractory setting,” Dr. Sagar Lonial, chief medical officer at Winship Cancer Institute, tells SurvivorNet. “In that sense, I think it’s really exciting.”

Belamaf is first-in-class in a number of ways. “It’s hitting BCMA, which other drugs don’t do, and it’s an antibody-drug conjugate, which is a new mechanism of action for myeloma,” adds Dr. Nina Shah, hematologist-oncologist at UCSF Medical Center.

That belamaf is given without steroids is a key advantage over selinexor (Xpovio). “Dexamethasone ends up probably the least favorite drug for many people. So that I think was a real benefit,” Dr. Natalie Callander, hematologist-oncologist at UW Health, tells SurvivorNet. Given the “spectacular responses” of some patients to Xpovio, both drugs will likely prove useful in myeloma treatment.

Providers do need to be aware of a unique ocular side effect — changes in the corneal epithelium that can result in symptoms such as blurred vision and dry eyes, and sometimes severe vision loss. “It can be managed, but you’ve got to partner with an ophthalmologist or eye care professional,” Dr. Lonial says.

Still, the benefits of this drug are unmistakeable, SurvivorNet’s experts say. “One of the nice things we found in our experience with this is, even if patients needed to have a dose reduction or a dose delay, they were able to hold their responses very nicely,” says Dr. Robert Orlowski, chairman, ad interim, and director of myeloma at MD Anderson Cancer Center.

See More Highlights from Our Discussion

How Would You Treat a 60-Year-Old Woman with Relapsed Refractory Myeloma?
Weighing the Risks of Multiple Myeloma Therapy in the Time of COVID-19
Giving More Black Patients Access to Clinical Trials Has Real Benefits
Isatuximab Combo Offers a New Therapeutic Option to Multiple Myeloma Patients
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