Belantamab Mafodotin and BCMA Therapy Sequencing in Relapsed/Refractory Multiple Myeloma

Dr. Joshua Richter and Dr. Surbhi Sidana discuss the evolving role of belantamab mafodotin in relapsed/refractory multiple myeloma following its reapproval based on the DREAMM-7 trial and additional evidence from DREAMM-8. Dr. Sidana reviews the efficacy of belantamab-based combinations and considers how they compare with BCMA-directed CAR T-cell therapies and bispecific antibodies. The discussion highlights the importance of treatment sequencing, particularly the potential impact of prior continuous BCMA-targeted therapy with an antibody-drug conjugate or bispecific antibody on subsequent CAR T-cell outcomes. Dr. Sidana explains her preference for considering CAR T-cell therapy before other continuous BCMA-directed approaches when feasible. For patients who are not candidates for CAR T-cell therapy, she discusses the choice between bispecific antibodies and belantamab mafodotin based on efficacy, access, and patient characteristics. She also addresses belantamab-associated ocular toxicity, ophthalmologic monitoring requirements, and the potential role of dose modifications and treatment-interval adjustments.