Sagar Lonial, MD, FACP, emphasizes the importance of partnering with eye care specialists to manage optical toxicities of patients taking belantamab mafodotin.
Sagar Lonial, MD, FACP: When we talk about the best way to maximize the duration that a patient gets the benefit of belantamab mafodotin, there are some key pieces that are important. The first is partnership with an eye care professional, and we typically mean an ophthalmologist, but an optometrist is trained to be able to evaluate microcyst with a slit lamp exam, so you can partner with either of these eye care professionals. The patients need to see them the day of the infusion or potentially the day before the infusion of belantamab mafodotin.
For the most part, the management of keratopathy is related to dose holding or dose modification. The use of lubricating eye drops is recommended for patients even at the beginning of treatment. There are subsets of patients who sail through this without any issues, and there are other patients who perhaps always get dosed on an every-6-week cycle. That is OK, as long as their disease is well controlled and they are not having other major adverse events as a consequence of treatment. The impact of prolonged dose delays or dose holds can be mitigated through the use of a good partnership with your eye care professional.
In the DREAMM 2 trial, we noticed that most patients stabilized or improved their disease response despite dose holds or dose modifications. Unlike other agents, missing a dose does not mean you are at risk for losing your response, which often occurs with many of these patients going forward. To me, the key advice is to find that eye care professional with whom you can partner, so you can get your patients in to be seen relatively quickly, who is willing to do that give-and-take that you are going to need to keep a patient on schedule. That first patient may require some challenges from a logistics or scheduling perspective, but once you have dosed a patient or 2 with belantamab mafodotin and have found the right partner from the ophthalmologist or optometrist perspective, then it usually goes pretty well.
Patients usually declare how they are going to do in the first few cycles of therapy, so if you are having trouble with issues with vision, which occurs relatively uncommonly, knowing who that eye care professional is and working with them to update or change the prescription can often help recognize the patients who may have had myeloma for a long time and are more likely to have cataracts. Cataracts can have a modest impact on visual acuity as well, so getting a lot of that sorted out early on will let you maximize the benefit of belantamab mafodotin for those patients for whom this is a good treatment approach.
Transcript edited for clarity.