Mitigating Ocular Toxicities via Optimized Dosing in Belantamab Trials

Saad Z. Usmani, MD, MBA, FACP, chief of the myeloma service at Memorial Sloan Kettering Cancer Center, discusses the DREAMM-9 trial and provides an update on clinical experiences with belantamab mafodotin (bela-maf; Blenrep), focusing on strategies implemented to manage its well-recognized profile of ocular adverse events.

The antibody-drug conjugate is known to cause corneal epithelial changes, which can manifest clinically as blurred vision or a sensation of grittiness in the eyes. Crucially, Usmani notes that these microcyst-like epithelial changes are fully reversible. Data from the phase 1 DREAMM-9 trial presented at the 2026 ASCO Annual Meeting, underscore that modifying the therapeutic regimen to utilize less frequent dosing significantly can significantly clinicians manage and mitigate these toxicities as it is being investigated in the frontline setting.

A key clinical takeaway from the compiled trial data is that although bela-maf can be administered more frequently early in the treatment course, a more regular every-3- or every-4-week schedule is not required. Instead, providers can safely space out doses to an every-8-week schedule during the induction phase, and further extend intervals to an every-12-week schedule during maintenance therapy. This optimized, spaced-dosing strategy is currently being actively deployed across phase 3 clinical trials in the frontline, transplant-ineligible setting. These include the DREAMM-10 trial (NCT06679101), which compares a bela-maf, lenalidomide (Revlimid), and dexamethasone regimen against a daratumumab (Darzalex), lenalidomide, and dexamethasone standard, as well as the PrE1005 trial (NCT07285239) evaluating a bela-maf quadruplet against standard daratumumab, bortezomib (Velcade), lenalidomide, and dexamethasone.

Ultimately, early recognition stands as the single most critical factor in successfully mitigating ocular symptoms. Healthcare teams must prime patients to immediately report any subjective vision changes. Proactive management protocols include advising all patients to routinely use artificial tears during treatment. If visual symptoms develop, therapy should be held immediately. Depending on severity, patients are referred to an eye care specialist and may be counseled to avoid driving if their symptoms worsen, ensuring patient safety remains paramount while preserving therapeutic continuity.