Understanding the Patient Experience With Belantamab Mafodotin for RRMM

New evidence obtained from a qualitative interview study may help to better customize treatment with belantamab mafodotin for patients who have relapsed/refractory multiple myeloma (RRMM), according to findings in a recent issue of Frontiers in Oncology.¹ Belantamab mafodotin is used when patients have failed at least 4 prior lines of treatment, including an anti-CD38 monoclonal antibody.²

Caucasian elderly male on phone call stressed | Image credit: Prins Productions - stock.adobe.com

The responses, which followed 2 recorded phone interviews that took place within 21 days of the fourth treatment cycle (C4) and end of treatment (EOT) as part of the DREAMM-2 trial (NCT03525678), were focused on health-related quality of life (QOL) from limited physical and social functioning. There were 142 interviews from 111 patients at 40 clinical sites in Australia, Canada, France, Germany, Italy, Spain, the United Kingdom, and the United States; all were conducted in a patient’s native language.

At each interview, most patients were male patients, older than age 63, of a White ethnicity, a median 6 years out from receiving their MM diagnosis, and from the United States, and had failed 5 or more prior lines of therapy. International Myeloma Working Group Response Criteria by Independent Review Committee classified patients as partial or complete responders, and patient-perceived symptom severity and treatment satisfaction, respectively, were rated on a scale of 0 (not severe or not at all satisfied) to 10 (extremely severe or extremely satisfied).

“MM remains a challenging and incurable disease, with almost all patients experiencing relapse and eventually becoming refractory to available therapies,” the investigators wrote. “In addition to efficacy and safety results, there has been growing interest in incorporating patient-reported outcomes data to guide evidence-based decision-making and treatment selection.”

At study initiation, the top 3 most severe patient-reported MM symptoms among the patients who responded to belantamab mafodotin were bone pain (6.9), numbness (6.0), and bone fractures and constipation (5.8 each). By the C4 interview, these showed significant severity reductions to 3.6, 5.8, 3.3, and 3.7, respectively. However, also at that interview, the top complaints among these patients were neuropathy/numbness (67%), fatigue (53%), and tiredness and bone/joint pain (41% each).

For this group at the EOT interviews, the most common symptoms were neuropathy/numbness (52%), tiredness (48%), and fatigue (42%), but the ones reported as most severe during the study were back pain (7.3), fatigue (6.7), and weakness (6.3). By this interview, each symptom’s severity had dropped, to 2.3, 3.5, and 5.5, respectively.

Among the nonresponders when the study began, the top 3 symptoms with the worst severity were pain (8.0), weakness (5.4), and bone pain (4.9). Again, however, by the C4 interview, these had dropped to 4.3, 4.8, 4.4, and 4.2, respectively. Unlike the responder group, 2 symptoms that did not receive top severity scores showed greater severity reductions: constipation’s rating fell from 3.6 to 1.5 and numbness’, 3.3 to 1.7. Bone/joint pain (59%), neuropathy/numbness and tiredness (52% each), and fatigue (50%) similarly were the most common reported symptoms at the C4 interview.

For this group at the EOT interviews, bone/joint pain, tiredness, and frequent urination were the most common symptoms, reported by 57%, 43%, and 43%, respectively. The most severe symptoms reported for the study were shortness of breath (9.0), nausea (6.0), and weakness and frequent urination (5.5 each). Again, as with the C4 group, each showed severity reduction, to 8.0, 0, 4.5, and 3.5, respectively.

QOL was a principal concern expressed by both groups throughout the study. Those citing changes to daily performance and lifestyle rose from 67.5% to 74.5% among responders and 63.2% to 66.7% among nonresponders, with specific examples including limits on physical functioning (20.7% and 26.1%, respectively) and walking (20.7% and 21.7%). In addition, treatment responders frequently expressed anxiety/worry (20.7%) and a want of more rest (22.4%) and more than a quarter of treatment nonresponders said their QOL and treatment burden had worsened.

Ocular symptoms were also evaluated, and 3 specific areas showed improvement in symptom severity rating among both responders and nonresponders a the EOT interview. These were evaluated from their worst point during the study to the 2 weeks before the interview:

• Eye pain: 7.1 to 1.4
• Eye irritation: 6.9 to 2.4
• Visual impairment: 8.0 to 3.5

Not surprisingly, treatment responders overall were more satisfied with their treatment compared with nonresponders, with these satisfaction scores being 8.5 and 8.1 at the C4 and EOT interviews, respectively, vs 5.7 and 7.7.

Participants also cited belantamab mafodotin administration as easy most often vs difficult (60.6% vs 28.7%). Treatment is via intravenous infusion, which typically takes 30 minutes every 3 weeks.³

“The interviews revealed a range of patient experiences, including positive, negative, and neutral perspectives on their treatment with belantamab mafodotin,” the authors noted, “consistent with previous reports that emphasize the importance of HRQOL in patients with RRMM.”

They further state that this evidence may enable health care providers to improve the overall patient experience on belantamab mafodotin through better symptom management (understanding and anticipating their symptomatic experience) and improved clinical practices.

References

1. Cardellino A, Correll JR, Martin M, Gorsh B, Sapra S, Popat R. Patient-reported experiences during and following treatment with belantamab mafodotin for relapsed/refractory multiple myeloma in the DREAMM-2 study. Front Oncol. 2023;13:1274659. doi:10.3389/fonc.2023.127465
2. FDA approves GSK’s BLENREP (belantamab mafodotin-blmf) for the treatment of patients with relapsed or refractory multiple myeloma. News release. GSK. August 6, 202. Accessed January 4, 2024. http://tinyurl.com/2s3w3ccx
3. Blenrep-belantamab injection. Prescribing information. GlaxoSmithKline LLC; 2022. Accessed January 4, 2024. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=16a160a4-3ec0-4ddf-99ce-05912dd3382d&type=display