There have been two studies containing belantamab mafodotin, one in combination with pomalidomide and dexamethasone and the other with bortezomib and dexamethasone. Both were randomised studies and they showed a significant progression free survival and overall response rate over the control arm.

Also, there were quality of life and patient-reported outcome questionnaires which were completed. The main finding was that there was no deterioration in any of the scales. So the patients did fairly well despite the established and well-known ocular toxicities which can be mitigated by adjusting the dose and delaying the administration of the drug.

How can we optimise benefit risk with these agents?

The main problem is the ocular toxicity. So over the years we have learned that as soon as there is evidence of blurred vision to hold the drug and restart when this complication, this side effect, has resolved and probably at a lower dose. So this is the best way to prevent a recurrence of this complication.

What conclusions can be drawn?

The risk versus benefit of the belantamab-based combination is favouring their use because they are associated with a very clinically meaningful and statistically significant prolongation of progression free survival which also has a trend towards a survival benefit.