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A dose-finding study presented at the recent American Society of Hematology annual meeting showed deep and durable responses with belantamab mafodotin (Blenrep) plus lenalidomide (Revlimid) and dexamethasone in relapsed or refractory multiple myeloma, with lower dosing of the B-cell maturation antigen (BCMA) proving more tolerable and feasible.

Rakesh Popat, BSc, MBBS, PhD, of University College London Hospitals NHS Foundation Trust, discusses the dose schedules that were assessed in the phase I .

Following is a transcript of his remarks:

The DREAMM-6 clinical trial was a phase I study investigating the use of belantamab mafodotin -- which is a BCMA-targeted antibody-drug conjugate -- in combination with lenalidomide and dexamethasone for patients with relapsed and refractory multiple myeloma. And the aims of this study was to try and elucidate what the recommended dose of both belantamab and lenalidomide should be in the combination in order to take us forward for a phase III clinical trial.

So we looked at a number of different doses and number of different schedules. We worked out that lenalidomide 25 mg was the appropriate recommended dose. But we also looked at different schedules of belantamab, mainly to try and minimize toxicity, but to try and maximize efficacy. We looked at 2.5 mg to be given every Q4W [every 4 weeks], but we also looked at a split dosing regimen and 1.9 mg Q4W and 1.9 mg Q8W [every 8 weeks].

Now, that's a very different regimen to what you've seen in the current schedules of belantamab monotherapy. But what we found was that by giving the lower dose, that's 1.9 mg Q8W, the compliance and ability to deliver treatment was much higher than compared to the more intense dosing schedules. And also when we look at the toxicity profile, the incidence of ocular side effects, namely blurring of vision, reduction in visual acuity, was significantly lower in the 1.9 Q8W dosing compared to the 2.5 [Q4W]. In terms of efficacy, it's still a little bit early to tell, but broadly speaking, the efficacy looks fairly similar across the different groups.

So in summary, we've presented the initial phase I data for belantamab-Revlimid-dexamethasone. It shows activity in patients with relapsed/refractory multiple myeloma. But importantly what it shows is that a lower intensity of dosing of belantamab seems to be better tolerated and more feasible compared to the higher dosing. And I think that will work out in better outcomes in the longer term.

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