Targeting B-Cell Maturation Antigen in Resistant Multiple Myeloma
Posted: Tuesday, February 18, 2020
Belantamab mafodotin, an immunoconjugate that targets B-cell maturation antigen, showed antimyeloma activity and a “manageable” safety profile in patients with relapsed or refractory multiple myeloma. The results of the DREAMM-2 trial were published in The Lancet by Sagar Lonial, MD, of Emory University, Atlanta, and colleagues. Further studies of this novel immunotherapy in combination with the standard of care are underway or planned.
The trial is an open-label phase II study that was completed at 58 multiple myeloma specialty centers in 8 countries from June 2018 to January 2019. In total, 293 patients who had relapsed or refractory multiple myeloma and disease progression after at least three lines of therapy were assessed, and 196 patients were included in the intention-to-treat population. Patients were randomly assigned to receive either 2.5 mg/kg or 3.4 mg/kg of belantamab mafodotin via intravenous infusion every 3 weeks until disease progression or unacceptable toxicity.
At the time of the primary data analysis cutoff date, 30 of the 97 patients (31%) in the 2.5-mg/kg group had achieved an overall response, compared with 34 of 99 patients (34%) in the 3.4-mg/kg group. The probability of patients having a duration of response for at least 4 months was estimated at 78% for the 2.5-mg/kg group and 87% in the 3.4-mg/kg group. There were 32 and 31 deaths in the 2.5-mg/kg and 3.4-mg/kg cohorts, respectively.
Common grade 3 or 4 adverse effects were keratopathy, thrombocytopenia, and anemia. Serious adverse events were reported in 40% and 47% of patients in the 2.5-mg/kg and 3.4-mg/kg groups. Two deaths were potentially related to treatment.
The investigators noted that this novel immunotherapy may prove to be a “viable treatment option” for patients with resistant myeloma, particularly those who are refractory to immunomodulatory drugs and proteasome inhibitors and refractory or intolerant (or both) to anti-CD38 monoclonal antibodies as a single-agent treatment.”
Disclosure: For full disclosures of the study authors, visit thelancet.com.
