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Terpos E, Gavriatopoulou M, Ntanasis-Stathopoulos I, Malandrakis P, Fotiou D, Migkou M, Theodorakakou F, Spiliopoulou V, Kostopoulos IV, Syrigou RE, Eleutherakis-Papaiakovou E, Gkolfinopoulos S, Tsitsilonis OE, Kastritis E, Dimopoulos MA. Belantamab mafodotin, lenalidomide and dexamethasone in transplant-ineligible patients with newly diagnosed multiple myeloma: part 1 results of a phase I/II study. Haematologica 2024; 109:2594-2605. [PMID: 38356458 PMCID: PMC11290537 DOI: 10.3324/haematol.2023.284347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/06/2024] [Indexed: 02/16/2024] Open
Abstract
Preclinical and clinical data demonstrate synergy between belantamab mafodotin (belamaf) and immunomodulatory drugs with limited overlapping toxicities. We investigated the safety and efficacy of belamaf with lenalidomide 25 mg on days 1-21 every 28 days and dexamethasone 40 mg weekly (belamaf-Rd) in transplant-ineligible patients with newly diagnosed multiple myeloma. Thirty-six patients (median age, 72.5 years) were randomized to receive belamaf at three different doses (2.5, 1.9, or 1.4 mg/kg) every 8 weeks. The dosing schedule was extended to every 12 weeks to mitigate ocular toxicity. Most common grade ≥3 adverse events were fatigue (n=21, 58.3%), rash (n=6, 16.7%), diarrhea (n=8, 22.2%) and COVID-19 (n=5, 13.9%). Grade 3-4 ocular adverse events, comprising visual acuity decline from baseline and/or keratopathy, were reported in 39/216 (18.1%), 33/244 (13.5%), and 26/207 (12.6%) ophthalmological assessments in the 2.5, 1.9, and 1.4 mg/kg cohorts, respectively. Importantly, grade 3-4 keratopathy was identified in 9/216 (4.2%), 1/244 (0.4%) and 1/207(0.5%) assessments. Most patients (32/36, 88.9%) were treated with the extended, every-12-week schedule, during which 40, 33 and 16 doses were withheld due to ocular adverse events in the 2.5, 1.9, and 1.4 mg/kg cohorts, respectively. Overall, the rates of very good partial response and better and complete response and better were 83.3% and 52.8%, respectively, without significant differences among cohorts. Over a median follow-up of 20.3 months no disease progression was reported; six patients discontinued treatment due to infection-related death (4 cases of COVID-19, 2 cases of pneumonia) and one patient withdrew consent. Based on the toxicity/efficacy balance, the recommended phase II dose was 1.9 mg/kg every 8 weeks, extended to every 12 weeks because of toxicity. In conclusion, Belamaf-Rd, with the extended schedule for belamaf, showed important clinical activity and a significant improvement of ocular adverse events with minimal impact on vision-related functioning in an elderly, non-transplant eligible population.
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Affiliation(s)
- Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens.
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens
| | | | - Panagiotis Malandrakis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens
| | - Despina Fotiou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens
| | - Magdalini Migkou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens
| | - Foteini Theodorakakou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens
| | - Vasiliki Spiliopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens
| | - Ioannis V Kostopoulos
- Department of Biology, School of Science, National and Kapodistrian University of Athens, Athens
| | - Rodanthi-Eleni Syrigou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens
| | | | | | - Ourania E Tsitsilonis
- Department of Biology, School of Science, National and Kapodistrian University of Athens, Athens
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens
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Mateos MV, Weisel K, Terpos E, Delimpasi S, Kastritis E, Zamagni E, Delforge M, Ocio E, Katodritou E, Gay F, Larocca A, Leleu X, Otero PR, Schjesvold F, Cavo M, Dimopoulos MA. Belantamab mafodotin: an important treatment option for vulnerable patients with triple class exposed relapsed and/or refractory multiple myeloma. Haematologica 2024; 109:2337-2340. [PMID: 38385280 PMCID: PMC11215350 DOI: 10.3324/haematol.2023.284694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/13/2024] [Indexed: 02/23/2024] Open
Abstract
Not available.
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Affiliation(s)
| | | | - Evangelos Terpos
- National and Kapodistrian University of Athens, Medicine School, Athens, Greece
| | | | | | | | | | - Enrique Ocio
- Hospital Universitario Marques de Valdecilla (IDIVAL), Santander, Spain; University of Cantabria, Santander, Spain
| | | | - Francesca Gay
- University of Torino, Italy; AOU Citta della Salute e della Scienza of Turin
| | - Alessandra Larocca
- University of Torino, Italy; AOU Citta della Salute e della Scienza of Turin
| | | | - Paula Rodriguez Otero
- Clinica Universidad de Navarra, Pamplona. Spain; Centro de Investigacion Medica Aplicada (CIMA), Pamplona. Spain; Instituto de Investigacion Sanitaria de Navarra IDISNA, Pamplona. Spain; Centro de Investigacion Biomedica en Red en Cancer (CIBERONC) Pamplona, Spain
| | - Fredik Schjesvold
- Oslo Myeloma Center, Oslo, Norway; Oslo University Hospital, Oslo, Norway; KG Jebsen Center for B Cell Malignancies, University of Oslo, Oslo, Norway
| | - Michele Cavo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seragnoli", Bologna, Italy; Universita di Bologna, Bologna
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Fazio F, Petrucci MT, Corvatta L, Piciocchi A, Della Pepa R, Tacchetti P, Musso M, Zambello R, Belotti A, Bringhen S, Antonioli E, Conticello C, Renzo ND, De Stefano V, Musto P, Gamberi B, Derudas D, Boccadoro M, Offidani M, Morè S. Belantamab mafodotin in triple-refractory multiple myeloma patients: A retro-prospective observational study in Italy. EJHAEM 2024; 5:485-493. [PMID: 38895069 PMCID: PMC11182418 DOI: 10.1002/jha2.907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 06/21/2024]
Abstract
Belantamab mafodotin is the first-in-class antibody-drug conjugates targeting B-cell maturation antigen to have demonstrated effectiveness in triple-class refractory multiple myeloma (TCR-MM) patients. We performed a retrospective study including 78 TCR patients, with at least four prior lines of therapy (LOTs), who received belantamab mafodotin within named patient program and expanded access program in Italy between 2020 and 2022. Median age was 65 years (range 42-86 years), ECOG performance status was ≥1 in 45% of patients. Overall, a clinical benefit was obtained in 36 out of 74 evaluable patients (49%), with 43%, 28%, and 13.5% achieving at least partial response, very good partial response, and complete response, respectively. After a median follow-up of 12 months (range 6-21 months), median duration of response, progression-free survival (PFS), and overall survival (OS) were 14, 5.5, and 12 months, respectively. Age >70 years, good performance status and response were associated with longer PFS and OS. Keratopathy occurred in 58% of patients (G3 2.5%), corneal symptoms in 32% (G3 1.2%) and a reduction in visual acuity in 14%. Grade 3 thrombocytopenia occurred in 9% of patients. Only 3% of patients discontinued belantamab mafodotin because of side effects. This real-life study demonstrated significant and durable responses of belantamab in TCR-MM patients with four prior LOTs, otherwise ineligible for novel immunotherapies.
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Affiliation(s)
- Francesca Fazio
- Hematology Unit, Department of Translational and Precision MedicineAzienda Ospedaliera Policlinico Umberto ISapienza University of RomeRomeItaly
| | - Maria Teresa Petrucci
- Hematology Unit, Department of Translational and Precision MedicineAzienda Ospedaliera Policlinico Umberto ISapienza University of RomeRomeItaly
| | - Laura Corvatta
- Unità Operativa Complessa di MedicinaOspedale ProfiliFabrianoItaly
| | | | - Roberta Della Pepa
- Hematology Unit, Department of Clinical Medicine and SurgeryUniversity of Naples “Federico II”NaplesItaly
| | - Paola Tacchetti
- IRCCS Azienda Ospedaliero‐Universitaria di Bologna‐Istituto di Ematologia “Seràgnoli”BolognaItaly
| | - Maurizio Musso
- Oncoematology and BMT Unit, Oncology DepartmentOspedale La maddalena PalermoPalermoItaly
| | - Renato Zambello
- Hematology UnitDepartment of MedicineUniversity of PadovaPaduaItaly
| | - Angelo Belotti
- Department of HematologyASST Spedali Civili di BresciaBresciaItaly
| | - Sara Bringhen
- SSD Clinical Trial in Oncoematologia e Mieloma MultiploDepartment of OncologyAzienda Ospedaliero‐Universitaria Città della Salute e della Scienza di TorinoTurinItaly
| | | | | | - Nicola Di Renzo
- Hematology and Stem Cell Transplant Unit“Vito Fazzi” HospitalLecceItaly
| | - Valerio De Stefano
- Section of HematologyDepartment of Radiological and Hematological SciencesCatholic UniversityFondazione Policlinico A Gemelli IRCCSRomeItaly
| | - Pellegrino Musto
- Department of Precision and Regenerative Medicine and Ionian Area“Aldo Moro” University School of Medicine, and Unit of Hematology and Stem Cell TransplantationAOUC PoliclinicoBariItaly
| | - Barbara Gamberi
- Hematology UnitAzienda USL‐ IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Daniele Derudas
- SC di Ematologia e CTMO ‐ Oncologico Oncologico di Riferimento Regionale “A. Businco” ‐ ARNAS “G. Brotzu”CagliariItaly
| | | | - Massimo Offidani
- Department of HematologyAzienda Ospedaliero Universitaria delle MarcheAnconaItaly
| | - Sonia Morè
- Department of HematologyAzienda Ospedaliero Universitaria delle MarcheAnconaItaly
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Jimenez A, Scholl AR, Wang B, Schilke M, Carlsen ED. Characteristics of isatuximab-derived interference in serum protein electrophoresis and immunofixation, and an absence of sustained in vivo interference due to belantamab mafodotin and denosumab. Clin Biochem 2024; 127-128:110761. [PMID: 38565341 DOI: 10.1016/j.clinbiochem.2024.110761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/18/2024] [Accepted: 03/30/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Some therapeutic monoclonal antibodies, like daratumumab and elotuzumab, produce interfering monoclonal bands on serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE). Whether other common therapeutic antibodies also produce interference has not been systematically evaluated. DESIGN AND METHODS SPEP/IFE from patients receiving isatuximab (48 patients), belantamab mafodotin (BM; 41), and denosumab (41) were retrospectively reviewed for therapeutic antibody interference. Cases exhibiting isatuximab interference were quantified and the maximum duration of isatuximab effect was evaluated. To characterize band position, neat human serum was spiked with BM or denosumab at supratherapeutic concentrations. Band migration patterns were compared on SPEP and IFE, with band position expressed relative to other constant protein fractions. RESULTS Isatuximab-induced IFE interference was common (81.3 % of evaluated patients) with a maximum observed duration of 8 weeks. 10.4 % of isatuximab patients had IgG kappa monoclonal gammopathies that co-migrated with the drug; this subset could benefit from HYDRASHIFT 2/4 isatuximab testing. 8.3 % of IFE cases were negative for an isatuximab band but showed large, endogenous M-spikes migrating elsewhere. All patients in this group expired within 1 year of this finding. We hypothesize that an inability to detect isatuximab in this setting corresponds to a large residual myeloma burden that reduces isatuximab serum concentration. This observation may serve as a negative prognostic factor. Spiking studies demonstrated that BM and denosumab produce interference in vitro, but sustained interference was not observed in >40 treated patients. CONCLUSIONS Therapeutic antibody interference in patients receiving isatuximab is common, and can persist for at least 8 weeks after administration. >10 % of patients receiving isatuximab may benefit from HYDRASHIFT testing post-therapy. In contrast, BM and denosumab fail to produce sustained interference in treated patients.
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Affiliation(s)
- Adam Jimenez
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Ashley Rose Scholl
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Bangchen Wang
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Michael Schilke
- Department of Pharmacy, Duke University Medical Center, Durham, NC, USA
| | - Eric D Carlsen
- Department of Pathology, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Durham, NC, USA.
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Gavriatopoulou M, Ntanasis-Stathopoulos I, Malandrakis P, Fotiou D, Migkou M, Theodorakakou F, Spiliopoulou V, Kanellias N, Eleutherakis-Papaiakovou E, Roussou M, Psarros G, Kastritis E, Dimopoulos MA, Terpos E. Belantamab mafodotin, lenalidomide, and dexamethasone in transplant-ineligible patients with newly diagnosed multiple myeloma: Analysis of belantamab mafodotin-associated ocular adverse events and their impact on daily functioning from the part 1 of a phase 1/2 study. Am J Hematol 2024; 99:502-504. [PMID: 38270219 DOI: 10.1002/ajh.27219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Affiliation(s)
- Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Panagiotis Malandrakis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Despina Fotiou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Magdalini Migkou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Foteini Theodorakakou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Vasiliki Spiliopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nikolaos Kanellias
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Maria Roussou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Avivi I, Shragai T, Luttwak E, Trestman S, Cohen YC. Treatment with low-dose, single-agent belantamab mafodotin is safe and provides long-term responses in heavily pretreated multiple myeloma patients. Eur J Haematol 2024; 112:367-370. [PMID: 37882735 DOI: 10.1111/ejh.14120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES To evaluate whether low-dose belantamab mafodotin (B-MAF) dosing results in lower toxicity and better overall outcome. METHODS We retrospectively evaluated nine consecutive patients treated with low-dose (1.9 mg/kg) B-MAF. RESULTS The median age was 70 years. Most patients were penta-refractory. Ocular toxicity was observed in 77.7%. Adverse events resulting in treatment delays were recorded in 9 out of 124 cycles being given. Overall response rate was 66% (6/9), and all responding patients achieved very good partial response or better. Within a median follow-up of 12 (range 0.5-13.8) months, median progression-free survival and overall survival were 14 (CI95% 6-22) and 20 (95%CI 0-41) months, respectively. CONCLUSION Low-dose B-MAF regimen showed high-efficacy and low-toxicity profile.
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Affiliation(s)
- Irit Avivi
- Department of Haematology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tamir Shragai
- Department of Haematology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Efrat Luttwak
- Department of Haematology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Svetlana Trestman
- Department of Haematology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Yael C Cohen
- Department of Haematology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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