Mulligan on the Quest for Optimal Combinations in Myeloma Treatment

On Thursday, June 17, the FDA's Oncologic Drugs Advisory Commitee (ODAC) voted that the benefit-risk profile of belantamab mafodotin (Blenrep) in combination with bortezomib (Velcade) and dexamethasone or pomalidomide and dexamethasone was not favorable for the treatment of relapsed/refractory multiple myeloma. The ODAC concurred that while the efficacy findings were strong, there were still unanswered questions surrounding ocular toxicities and optimized dosing strategies.

In an interview with Targeted Oncology, George Mulligan, PhD, chief scientific officer of the Multiple Myeloma Research Foundation (MMRF), discusses belantamab mafodotin's role in the myeloma treatment landscape and the unmet needs that still exist in the space.

Mulligan believes belantamab mafodotin holds significant promise for multiple myeloma due to its unique mechanism of action and the unmet need in the field. However, incorporating this new agent into existing treatment strategies presents a challenge. The backbones of myeloma treatment are triplet and quadruplet regimens, and with over 10 agents already available for myeloma, it is impossible to test every possible combination. Therefore, Mulligan emphasizes the critical need for exploratory studies and research to determine the most effective combinations, particularly those that can be moved to upfront treatment.

The ultimate goal is to identify reproducible, curative strategies for myeloma. While some patients currently experience what appears to be a cure, this is often a fortunate outcome of a particular drug combination rather than a planned, optimized approach. Mulligan hopes that new drugs combined with ongoing research into optimal combinations will provide a stable foundation for achieving higher cure rates, even if initially only for a subset of patients.

"Right now, that foundation to build upon is still shifting sands of not knowing," Mulligan said. This research is crucial for both relapsed and newly diagnosed myeloma.