Management of Belantamab Mafodotin–Associated Corneal Events in Patients with RRMM

2021 Year in Review - Multiple Myeloma

Corneal event management guidelines were developed with the goal of assisting practicing hematologists/oncologists in assessing and managing belantamab mafodotin–associated ocular events so that patients may continue to maximize clinical benefit with belantamab mafodotin therapy.

Safety data from the DREAMM-2 study reported corneal events associated with the first-in-class anti–B-cell maturation antigen antibody–drug conjugate (ADC) belantamab mafodotin therapy, which is currently approved for the treatment of patients with relapsed/refractory multiple myeloma (RRMM). The corneal events primarily related to keratopathy include superficial punctate keratopathy and/or microcyst-like epithelial changes, eye examination findings with/without symptoms. These events appear to be class effects, and have been reported with other ADCs, particularly for microtubule inhibitor monomethyl auristatin F ADC. Available evidence indicates that the corneal events were frequent, presented early in treatment, might not always be symptomatic, and occurred with risk not decreasing over time and recurring with repeated dosing. Given that hematologist/oncologists may not be familiar with the management of such corneal events, corneal event management guidelines are needed for prompt identification and appropriate management of these events and for optimized patient care.

Corneal event management guidelines were developed based on experiences from the DREAMM-2 study as well as insights from hematology/oncology investigators and ophthalmologists; the recommendations are outlined below:

  • Multidisciplinary approach to the management of corneal events is recommended, with close collaboration among hematologist/oncologists and eyecare professionals.
  • Patients should undergo eye examinations at baseline, during every treatment cycle, and upon worsening of symptoms.
  • Severity of corneal events should be determined based on corneal examination findings and changes in best-corrected visual acuity.
  • Management of corneal events consists of dose modifications (dose delays and/or reductions) and supportive care such as preservative-free lubricant eye drops.
  • Dose modifications should be based on the keratopathy and visual acuity scale of severity.

These guidelines may assist practicing hematologist/oncologists to assess and manage belantamab mafodotin–associated ocular events and enable patients to maximize clinical benefit with belantamab mafodotin therapy.

Source: Lonial S, Nooka AK, Thulasi P, et al. Management of belantamab mafodotin-associated corneal events in patients with relapsed or refractory multiple myeloma (RRMM). Blood Cancer J. 2021;11:103.

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