Session: 654. Multiple Myeloma: Pharmacologic Therapies: Poster I
Hematology Disease Topics & Pathways:
Research, Clinical trials, Clinical Research, Plasma Cell Disorders, Diseases, Lymphoid Malignancies
Methods: The single-arm phase 2 study CMG012022 (EudraCT 2022-002515-34) is designed to assess whether a lower dose of belantamab (1.9 mg/kg) given less frequently (Q8W) in combination with weekly Vd in RRMM pts can achieve at least similar efficacy (63% ORR) while improving the toxicity profile (14% incidence rate of Grade ≥3 ocular AE) than intensive dosage regimen used in the DREAMM-6 trial (2.5 mg/kg Q3W) (R Popat, ASH 2020). Therefore, RRMM pts after ≥1 line of therapy were intended for enrollment. The inclusion/exclusion criteria matched those of the DREAMM-7 study, however, belantamab dose and frequency were reduced. The patients receive eight 28-day cycles of bortezomib: 1.3 mg/m2 SC days 1, 8, 15, 22 and dexamethasone: 20mg PO days 1, 2, 8, 9, 15, 16, 22, 23 plus belantamab: 1.9 mg/kg IV every 8 weeks until progression or unacceptable toxicity. The primary endpoints consist of the overall response rate (ORR) and the incidence rate of Grade (gr.) ≥3 ocular AE according to the keratopathy visual acuity (KVA) scale, which combines grading of corneal events and changes in the best corrected visual acuity. The data cut-off for this review was June 30, 2024. Informed consents were obtained.
Results: At the data cut-off, 45 pts after a median of 3 (range 1-7) prior lines of therapy had started the treatment at seven Czech university hematooncology centers. The median age at the screening was 71 (range 44-89) years with male/female ratio of 1.04. High-risk cytogenetics [t(4;14), t(14;16), del(17p)] was found in 35% (15/43) of pts, 9% (4/45) and 31% (14/45) of pts were double and triple-class refractory, respectively. After a median follow-up of 145 days (IQR 68; 258) and a median of 4 (range 1-11) cycles of belantamab Vd, the response is evaluable in 39 patients. Despite a significantly reduced belantamab intensity, ORR has reached 64% (25/39) so far with CR in 10% (4/39), VGPR in 28% (11/39) and PR in 25% (10/39) of pts. Out of 10 pts evaluated for minimal residual disease (MRD), four were MRD negative representing 10% (4/39) of the whole cohort. Two pts progressed and one withdrew the informed consent shortly after an initiation of the therapy. Six pts in total died; none of the death causes (progression, infection, surgical complication, heart failure) were related to the treatment. Any treatment-related AE was observed in 64% (29/45) of patients, of whom 34% (10/29) had gr. 3/4 AE. Ocular AE developed in 34% (11/32) of pts who were evaluated for ocular findings - maximum gr. 3 in one patient (3%; 1/32), gr. 2 in eight pts (25%; 8/32) and gr. 1 in two pts (6%; 2/32). Four pts had dose reduction of belantamab (12.5%; 4/32) and 11 pts experienced dose delays to manage ocular findings (34%; 11/32). One patient terminated the treatment after the first dose of study drugs due to hepatopathy gr. 3 (related to bortezomib, possibly related to belantamab) and one patient decided to discontinue belantamab because of vision changes. The study fulfilled patient recruitment.
Conclusion: The ocular findings seem to be limited due to the significantly de-escalated belantamab dosing and still the ORR reaches 64% (25/39) with MRD negativity rate of 10% (4/39). The clinical trial is ongoing, these results will have to be confirmed by the final analysis.
Disclosures: Popkova: Sanofi: Other: travel support; Johnson and Johnson: Honoraria. Radocha: Jonhson & Jonhnson: Consultancy, Honoraria; BMS: Consultancy, Honoraria; GSK: Consultancy; Sanofi: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria. Stork: Jonhson & Jonhnson: Consultancy, Honoraria, Other: Travel support. Minařík: Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Honoraria; GSK: Membership on an entity's Board of Directors or advisory committees; BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Hajek: Celgene: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Novartis: Consultancy; Bristol Myers Squibb: Consultancy, Honoraria; AbbVie: Consultancy; PharmaMar: Consultancy, Research Funding; Takeda: Consultancy, Research Funding.
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