Belantamab: Lowering Administration Burden for Myeloma Patients | Attaya Suvannasankha, MD

Hi, my name is Attaya Sucannasankha.

I'm a myeloma physician at the Indiana School of Medicine and also the Simon Cancer Center.

I'm also a practicing physician at Annapolis VA Medical Center in Indianapolis, Indiana.

Today I'm sharing with you the way to measure not only whether the drug works, but also what is the true impact on patients' lives.

Using this combination of a drug, the combination has just been recently approved.

The drugs in the recipe are belantamab mafodotin, bortezomib, and dexamethasone.

So what is this drug with such a long name?

Belantamab mafodotin is an interesting compound.

That was first actually approved several years back when it was tested in patients with relapsed refractory multiple myeloma.

The drug is an antibody conjugate.

What it is, is it's an antibody designed to bind bispecifically onto the cancer cell.

But also, it has a linker that attaches this molecule to a toxin.

If you imagine what it is, it's an antibody that's carrying toxin with it.

When it binds onto the cancer cell, the whole complex gets integrated into the cell, and then the enzyme within the cell chops off that poison, releasing it so that it kills the cancer cells from inside out, unlike any other chemicals we use, which typically kill everything they touch from the outside in.

So if you think about what this is, it's delivering the toxin just where we want it to be, to kill the cancer cells.

Now, I had said that it was already approved a few years back, and then it was removed from the market.

What was that story about?

Well, it was approved based on what we called accelerated approval, together with dexamethasone.

There are some unique side effects of the drug, and that is what we call eye side effects.

It turns out that once the cancer cells are dying, they get leaky.

That poison gets back out into the bloodstream, and it actually deposits itself in a very small amount in the lining of the eye called the cornea.

Well, that kind of makes the cornea cloudy.

And patients then have some blurry vision.

They also sometimes have the sensation of irritation or eye dryness.

While it seems scary, the key thing is that as long as patients have an eye evaluation before their dose, and they get a dose delay if they are experiencing these side effects, everybody's eyes actually return back to baseline.

And patients actually do derive benefit from it.

So why was it taken from the market?

It was really because it was a phase three clinical trial that was comparing this drug, belantamab mafodotin, with pomalidomide and dexamethasone.

Well, when you compare two things together, what turns out is we need to set up a bar for how to define, how to decide whether it's successful.

The drug kind of came close, but not quite crossed that mark.

So it was taken away from the market.

Now, recently there's this clinical trial that's combining it.

So now it's not useless anymore, but it's actually used together with bortezomib and dexamethasone.

And that clinical trial was comparing this three-drug regimen with another standard regimen that has bortezomib, dexamethasone, and daratumumab.

So that is a CD38 antibody.

So if you think about what this looks like, it's actually comparing two different antibodies against each other, really.

So the belantamab component was successful, meaning that it led to its approval.

So now we have a lot of choices for patients who've had relapsed myeloma, who have had at least two prior lines of therapy.

What does it mean?

We wanted to understand:

Well, how do we think about not just the length of time, but the quality of time?

What is the burden to patients?

So this study that I'm presenting is assessing what we call quality-adjusted life years.

So we're asking, based on the life year, across the multiple drugs we have in that second line, could we take some quality, some burden, into the conversation so that this three-drug recipe is being compared with pomalidomide, bortezomib, dexamethasone, with carfilzomib, daratumumab, dexamethasone, carfilzomib, dexamethasone.

And of course, also the bortezomib, daratumumab, and dexamethasone.

So it turns out that, based on this cross-trial comparison, taking into account the burden of patients, it would appear that this belantamab in combination with bortezomib and dexamethasone actually beats out these other choices in terms of burden to patients.

Now, this isn't necessarily asking patients which one they like.

This is using modeling to actually help us try to understand better what's the true value.

But this was a pretty encouraging data set to say that not only are we offering something that affects us, but hopefully we're also keeping in mind that when people have a lot of choices, they don't always just look at response versus not, but also what these treatments will affect in our lives.

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