Belantamab Mafodotin Updates & How to Manage Eye Side Effects | Evangelos Terpos, MD, PhD | #EHA2025

I'm Evangelos Terpos from the University of Athens School of Medicine in Greece and I'm here in Milan for the European Hematology Association annual meeting. I'm presenting here two posters presentation about first of all the role of belantamab, mafodotin, which is an antibody drug conjugate that is used against BCMA for the treatment of relapsed refractory multiple myeloma in combination with bortezomib or pomalidomide indexamethasone. But I have a phase one to study here in combination with lenalidomide indexamethasone in intermediate fit and frail patients with newly diagnosed multiple myeloma who are not eligible for transplant. What we have shown in this study that among the 66 patients who have been enrolled in this one to phase study, we have only three patients who progressed in a median follow-up of around two and a half to three years depending on the phase of the study. Very importantly we found that the best dose that has to be given in first line therapy is 1.9 milligram per kilogram every eight weeks for the belantamab mafodotin and the majority of the patients go to every 12 week schedule because of some ocular problems. So the vast majority of the patients received into this study belantamab once every three months and despite that all patients responded to treatment and more than 50 percent had achieved a complete response. So based on this study, a phase three study comparing belantamab lenalidomide indexamethasone versus daratumab lenalidomide indexamethasone, the dream 10 is going to start. One of the problems of belantamab mafodotin and I would say probably the most common is the ocular problem that it creates in the cornea. Belantamab mafodotin affects the first layer of the corneal. Corneal has five layers, the epithelium and it creates some small cysts there that may create some problems with either gritty eye, sore eye, painful eye or sometimes problems in the visual acuity and this reduction may create problems in reading, watching tv or even driving. Is it common? I would say that from the studies in the relapsed refractory setting because these are the two approvals of the drug at least in Europe belantamab with bortezomib indexamethasone or belantamab with pomalidomide indexamethasone, almost 60 to 65 percent of the patients will have no visual acuity problem. The other one third of the patients that may have some ocular problems, this may last for a very short period of time, it is totally irreversible and in more than 90 percent of the patients is totally irreversible and I can tell you that the vast majority of patients and when I say vast majority I talk about 95 percent of the patients will not have any problems in stopping reading or driving. There may be a subset of patients very small around two to three percent that they may stop for a specific period of time to drive or to read but as I previously mentioned this is totally reversible within two to four weeks. So the majority of the patients in the relapsed refractory setting receive the drug every eight to 12 weeks without having any problems with the efficacy as the two studies dream seven and dream eight have shown. Along with other colleagues from all over the world and also with ophthalmologists we created some guidance for the everyday practice hematologist how to deal with the ocular toxicity of belantamab. This is a poster presentation here and the paper is going to be submitted to American Journal of Hematology for publication. What we suggest is that during the first four doses of belantamab it is good to have an ophthalmology examination at baseline definitely to my opinion because almost all patients above the age of 70 may have some ocular problems like cataract, glaucoma or something like that and then before each one of the next three doses but to my opinion if there is a problem in my clinical practice and as I previously mentioned to you 60 to 65 percent will have no problem then if the patient says doctor I have no problem to me I would not send him to the ophthalmologist again however in the SPC of the drug this is going to be seen for four doses to have an ophthalmology evaluation before. How about after the four doses then what we suggest to the hematologist is to use the so-called vision related an amnestic tool this is a questionnaire of nine questions the first five of them deal with symptoms sore eye, dry eye, painful eye or blurred vision or impaired vision. The other four questions have to do with daily activities problems in driving, reading, watching tv or watching my mobile or the smartphone. If the patient answers yes to each one of these questions during the last 24 hours and especially if the patient has that symptom for more than eight hours within a day then the hematologist have to delay the treatment of the patient the dose till the patient has no symptoms and if these symptoms continue for more than eight weeks then the up to 12 weeks then the doctor the hematologist have to refer the patient to the ophthalmologist but I believe that with the delays and probably with lowering of the dose very few patients will need to go to the ophthalmology again. So these were the most important part of my presentations here in EHA and I hope that I will be again with your tv channel in a next conference. Thank you.