My name is Rakesh Popat and I'm a hematologist based at University College Hospital in London in the UK. Pleased to be at ASH 2024. And I'll be presenting the results of the Promise study, which was held in the UK, and this study was investigating the use of belantamab mafodotin in combination with cyclophosphamide and dexamethasone.
So belantamab mafodotin is an antibody drug conjugate that targets BCMA or B-cell maturation antigen. It was shown to be effective for patients with relapsed refractory multiple myeloma, but unfortunately in a phase three clinical trial, it was not shown to be beneficial compared to the standard pomalidomide and dexamethasone.
So what we did here was to combine it with other standard of care drugs, because what we do know is that when you combine belantamab with velcade and pomalidomide, you get very good results.
We use cyclophosphamide for two reasons. The first is that scientifically, cyclophosphamide is able to try and reduce some of the breaks on the immune system, so it makes biological sense to combine it with another drug, which can also affect the immune system.
But secondly, cyclophosphamide is a very easy drug to take as a tablet. As you can take it once a week. And it's also quite cheap, which means that most people across the world can use cyclophosphamide very easily.
So this was a dose finding study where we started off with cohort one, which was a low dose of belantamab with cyclophosphamide and dex. And then in cohort two, we increased the dose of belantamab and gave it with cyclophosphamide and dex.
In the end, we suggested that the higher dose of belantamab was the most effective. But what was very interesting was when we started to look at more detail with the side effects.
What we know is that belantamab does cause some eye side effects, in that it causes blurring of vision and can cause some grittiness in the eyes. And we know that as a result, patients can't always tolerate belantamab and they end up missing a lot of doses.
So when we looked in more detail, we found that the lower dose of belantamab actually was more likely to be associated with patients receiving their dose on time, which means that they were able to tolerate that dose a lot better. The side effect profile was better.
And then when you look at the response rates, it turns out the response rates are better. And that's probably because the patients were receiving the drugs on time.
So in the end, we recommend that belantamab mafodotin with cyclophosphamide dexamethasone is safe and tolerable. The response rate was 85% for patients who had 2 to 4 prior lines of therapy. So that's really good.
And at the lower dose it was much, much better tolerated. And when I mean low dose, I mean 1.9mg/kg, which is lower than the standard. And we gave the belantamab every eight weeks compared to every three weeks, which was done in the other studies.
And I think that gives you a much better risk-benefit profile.
HealthTree • December 13, 2024