Data from the DREAM 7 trial reveals that holding belantamab doses for 12 weeks or longer to manage ocular toxicity did not negatively impact progression-free survival (PFS). Responding patients often maintain their response, challenging the conventional wisdom that strict dosing schedules are paramount for efficacy.
Belantamab mafadotin was withdrawn from the market after failing as a single agent. However, its strong performance in the DREAM 7 trial when combined with bortezomib and dexamethasone led to its re-approval. This demonstrates a key oncology development strategy: combining a drug with good activity but poor monotherapy trial results can unlock its full potential.
A major logistical barrier to using belantamab is the required ophthalmic monitoring. However, these exams don't require a specialist ophthalmologist. Routine tests can be performed by a community optometrist, making the drug more accessible for patients and providers outside of large academic centers and lowering adoption barriers.
The DREAM 9 trial suggests that standard every-3-week dosing of belantamab is too frequent. Extending the interval to every 6, 8, or 12 weeks maintained high efficacy while significantly improving patients' vision-related functioning and quality of life, pointing towards a new, more tolerable standard of care.
The introduction of ADCs, bispecific antibodies, and CAR-T therapies has rendered established myeloma treatment pathways obsolete. Clinicians can no longer rely on familiar triplets at first progression. This rapid evolution requires a complete rethinking of sequencing, described by the speaker as putting the old algorithm 'into a blender.'