Moving BCMA-Directed Therapies Into Earlier-Line Treatment in Relapsed/Refractory Multiple Myeloma

The panel discusses the movement of BCMA-directed therapies from relapsed/refractory multiple myeloma into earlier-line and newly diagnosed disease. Dr. Jing Christine Ye reviews the rationale for evaluating belantamab mafodotin in the DREAMM-10 study, including the potential for less heterogeneous disease and less T-cell exhaustion earlier in the treatment course. She discusses the lower dose and less frequent dosing schedule being investigated and the importance of balancing treatment benefit with toxicity management, including baseline and ongoing ophthalmologic monitoring. Dr. Douglas Sborov considers whether using belantamab mafodotin earlier could preserve BCMA expression and potentially allow subsequent use of BCMA-directed CAR T-cell therapy or bispecific antibodies. Dr. Paul Richardson then discusses combining BCMA-directed therapy with CD38-targeted therapy and references emerging data from belantamab-based combinations. The panel considers the potential rationale for multi-antigen targeting and the future integration of BCMA-directed therapies with CD38-directed approaches in earlier-line treatment. The discussion highlights ongoing questions regarding optimal sequencing and combination strategies as BCMA-directed therapies move earlier in multiple myeloma.