Examining BelaDRd, BCMA Targeting, and Contextualizing Early MRD Data

In 'Examining BelaDRd, BCMA Targeting, and Contextualizing Early MRD Data,' our panel of experts delve into the following critical questions:

1. BelaDRd adds a fourth agent, belantamab mafodotin, on top of an already established DRd backbone. As we think about the frontier of quadruplet and even quintuplet regimens in NDMM, where does a BCMA-targeting antibody-drug conjugate fit into your mental model of frontline therapy sequencing, and could its use upfront affect how you think about later lines?
2. The MRD negativity rates in this study were 81% in Part 1 and 71% in Part 2 among evaluable patients. How do you contextualize these results against MRD negativity rates we've seen with DRd and DVRd, acknowledging the early nature and small sample sizes of this study?

Led by the moderator, the panelists examined where a BCMA-targeting antibody-drug conjugate like belantamab mafodotin fits within the evolving frontline therapy landscape, with the discussion acknowledging the compelling rationale for targeting residual clones that may not respond to standard quadruplet induction, particularly in high-risk patients who tend to relapse early, while also raising important concerns about the real-world feasibility of mandatory pre-dose ophthalmologic monitoring, which poses significant logistical challenges in community settings where immediate access to eye care is limited. The panelists also highlighted the encouraging finding from the BelaDRd abstract that physician and independent assessor toxicity ratings were comparatively aligned, which may help build confidence in managing ocular toxicity in practice, though concerns about the impact of visual side effects on patients' ability to drive and work remain a meaningful quality-of-life consideration that warrants careful patient selection and counseling in the upfront setting. Regarding the MRD negativity rates of 81% in Part 1 and 71% in Part 2, the panelists contextualized these figures as impressive relative to rates seen with DRd and DVRd, while urging caution given the very small evaluable patient denominators, noting that a shift of just one or two patients could meaningfully change the percentages. They emphasized that larger, prospective studies are needed before these early signals can definitively inform frontline treatment selection.

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

The next episode in this series, 'MRD Negativity as a Benchmark: Testing Approaches, Treatment Implications, and the Evolving Role of Response Depth,' features the panelists advancing their conversation on multiple myeloma and focusing on whether MRD negativity is becoming the primary benchmark for assessing frontline regimen performance, how institutions are approaching sample collection for MRD testing, and the current and future role of MRD results in guiding treatment decisions.