According to a new study, adding belantamab mafodotin to pomalidomide and dexamethasone for the treatment of relapsed or refractory multiple myeloma was more effective at slowing disease progression or death compared to current standard-of-care bortezomib plus pomalidomide and dexamethasone.

The research was presented at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting taking place May 31-June 4 in Chicago, Illinois.

Belantamab mafodotin is an antibody-drug conjugate that binds to a protein called BCMA on myeloma cells and then delivers a chemotherapy drug to destroy the cell.

The recent DREAMM-7 clinical trial showed that a combination of belantamab mafodotin plus bortezomib and dexamethasone slowed the progression of multiple myeloma if the first treatment did not work when compared to daratumumab plus bortezomib and dexamethasone.

The DREAMM-8 study combines belantamab mafodotin with another common myeloma drug, pomalidomide (a medication that stimulates the immune system), and dexamethasone (a steroid).

In the DREAMM-8 study, people with relapsed and refractory multiple myeloma whose disease had progressed after at least one previous treatment (including lenalidomide) were randomised to receive belantamab mafodotin plus pomalidomide and dexamethasone, or BPd (n=155) or pomalidomide plus bortezomib and dexamethasone, or PVd (n=147).

Of all the participants, 60% were men, 86% were White, and the average age was around 67 years. The participants were followed for a median of nearly 22 months.

Key Findings

After a median follow-up of 22 months, the median progression-free survival (PFS) was not reached for the participants who received BPd. For those who received PVd, the median PFS was 12.7 months.

At the end of the first year, PFS was 71% for those receiving BPd compared to 51% of those receiving PVd. 

The overall response rate was 77% for those receiving BPd compared to 72% for those receiving PVd. Additionally, 40% of patients treated with BPd achieved a complete response or better compared to 16% of patients who were treated with PVd.

Among those with disease that responded to treatment, the median duration of response was not yet reached in those who received BPd, and it was 17.5 months in those who received PVd. 

Nearly all participants (>99%) receiving BPd experienced side effects, as did 96% of those receiving PVd. Eye-related side effects were common, such as changes in the cornea and blurred vision, affecting 89% of those in the BPd group and 30% of those in the PVd group.

Eye-related side effects often went away and could be managed by adjusting or holding the dose of belantamab mafodotin, which allowed most patients to keep receiving the study treatment and benefit from it.

“This regimen could become an important treatment option for patients with multiple myeloma at first relapse and for subsequent relapses. It is suitable for a broad range of patients and can be given in a community oncology setting without the need for specialised cancer centre support,’ said lead study author Suzanne Trudel, MSc, MD, Associate Professor at the Princess Margaret Cancer Centre in Toronto, Ontario.

“The DREAMM-8 trial demonstrates that the first-in-class BCMA-targeted antibody-drug conjugate - belantamab mafodotin - plus pomalidomide and dexamethasone (BPd) is significantly more effective than the PVd regimen (pomalidomide, bortezomib, and dexamethasone), cutting the risk of disease progression or death by nearly half in patients with relapsed or refractory multiple myeloma. The findings of this trial suggest that BPd is poised to be a potential new treatment strategy for relapsed or refractory multiple myeloma.” - Oreofe O. Odejide, MD, MPH, Assistant Professor of Medicine, Dana-Farber Cancer Institute  

Next Steps

The researchers will continue to follow the study participants to evaluate if patients live longer and stay free of disease. They will also continue to collect data to find out the median PFS and duration of response for those who received BPd.

Source: ASCO