The DREAM-7 trial showed a belantumab combination had an overall survival benefit versus a daratumumab regimen, a "premier drug" that previously changed the myeloma treatment landscape. This surprising result establishes a new, higher standard of care and positions belantumab as a top-tier therapy, not merely another option.
Due to significant ocular toxicity affecting most patients, the approved starting dose for belantumab is likely not optimal long-term. Effective management requires clinicians to proactively hold, delay, and reduce doses at the first sign of side effects, meaning real-world application will differ from the initial protocol.
Clinicians must weigh the immediate benefit of using community-accessible belantumab against the risk of reducing the efficacy of future BCMA-targeted therapies like CAR-T or bispecifics. This decision hinges on a patient's ability to travel and access advanced care, creating a complex treatment sequencing challenge.