Blenrep (belantamab mafodotin-blmf) is used in combination with bortezomib and dexamethasone to treat multiple myeloma. It is for people whose multiple myeloma has been previously treated with at least two medicines and either returned (relapsed) or did not go away with treatment (refractory).
How Does Blenrep Work for Multiple Myeloma?
Blenrep is an antibody-drug conjugate (ADC), which is a type of targeted cancer medicine. ADCs contain two parts, a protein called an antibody and an anti-cancer drug. The antibody acts as the guide seeking out and attaching to a target called B-cell maturation antigen (BCMA). BCMA is a protein found on the surface of multiple myeloma cells.
Once the antibody portion attaches to the surface of the cancer cell, the anti-cancer drug, monomethyl auristatin F (MMAF), is taken in by the cell and released, destroying the cancer cells.
How Was Blenrep Studied?
Blenrep was approved for multiple myeloma based on results of a clinical trial called DREAMM-7. The study included adults with relapsed or refractory multiple myeloma who had received at least one prior treatment. Several groups of people were not able to take part in the study, including people who had certain problems affecting their corneas (the clear front part of the eye).
There were 217 people who had received at least two prior treatments. These people were split into two groups. The Blenrep group included 108 people who received Blenrep with bortezomib and dexamethasone. The other group included 109 people who received daratumumab with bortezomib and dexamethasone. People ranged in age from 39 to 86 (median 65 years, meaning half were older and half were younger than 65). Over half of the people were male (53%), and 86% were White, 11% were Asian, and 2% were Black.
Both regimens were given on a 21-day cycle (a three-week repeating schedule). The first eight cycles were given as the combination regimens, and then people were switched to either Blenrep or daratumumab alone starting with cycle nine. Treatment was continued until the cancer started to progress or people had side effects that prevented them from continuing.
Cycles 1 through 8 (first six months)
Blenrep Combination | |
| Day 1 | Blenrep intravenous (IV) infusion |
| Days 1, 4, 8, and 11 | Bortezomib injection under the skin (subcutaneously) |
| On the day of and day after bortezomib treatment | Dexamethasone by mouth or IV |
Daratumumab Combination | |
Cycles 1-3: Once every week Cycles 4-8: Once every 3 weeks | Daratumumab IV infusion |
| Days 1, 4, 8, and 11 | Bortezomib injection under the skin (subcutaneously) |
| On the day of and day after bortezomib treatment | Dexamethasone by mouth or IV |
What Benefits Were Seen With Blenrep?
The Blenrep combination showed significant benefits compared to the daratumumab combination.
The main goal of the study was to compare the time people lived without their cancer getting worse (progression-free survival), but other results also looked promising. For the Blenrep combination, half of the patients lived about 31.3 months without their cancer worsening, compared to 10.4 months for half of the patients taking the daratumumab combination.
Other findings suggested that the Blenrep combination had a better overall response rate (81.5%, compared to 56.9% for the daratumumab combination) and improved overall survival, suggesting a 51% lower chance (relative risk) of death. More time and evidence are needed to confirm these results.
The median overall survival, which represents the time at which half of the people in a study group are still alive, was not reached by the Blenrep combination group. This means more than half of the people in this group were still alive when the data from the study was collected. In comparison, the median overall survival was 35.7 months for the daratumumab combination group. This means that half of the people receiving this treatment had died by the time 35.7 months had passed since the start of the study.
What Are the Side Effects?
Blenrep can cause serious side effects. Your health care team will monitor you closely during treatment.
Eye problems
Eye problems are the most important and common serious side effect of Blenrep. They happen because Blenrep causes changes to the clear outer layer of your eye, the cornea. Common eye symptoms to watch for include decreased or blurred vision, dry eyes, sensitivity to light (photophobia), feeling like something is in your eyes (foreign body sensation), and eye irritation or pain.
Serious eye problems can also happen while using Blenrep. In the clinical studies, some people developed corneal ulcers, which are open sores on the surface of the eye, and these sometimes included infection. Severe vision problems can occur.
How to manage eye problems (prevention and monitoring):
- Report symptoms: Tell your health care provider right away if you notice any new or worsening eye symptoms or vision changes.
- Eye exams: You will be referred to an eye care specialist (ophthalmologist or optometrist) for exams before starting Blenrep, before each dose, if you have new or worsening eye symptoms, and as needed.
- Artificial tears: Use preservative-free artificial tears at least four times a day, starting with your first Blenrep dose and throughout your treatment.
- Contact lenses: Avoid wearing contact lenses while you are using Blenrep, unless your eye care specialist tells you to use a special type of lens (a bandage contact lens).
- Driving: Use caution when driving or operating machinery, as Blenrep can affect your vision.
Decrease in platelets
A decrease in platelets (thrombocytopenia) is common and can be severe. Platelets are blood cells that help your blood to clot. Tell your health care provider if you get any unusual bleeding or bruising. Your health care provider will check your complete blood cell counts at the start of treatment and regularly throughout. If your platelet count drops, your health care provider may need to stop or reduce your dose of Blenrep.
Risk to a fetus
Blenrep can harm a fetus because it contains a drug that is toxic to actively dividing cells.
- For people who can become pregnant. Your health care provider will perform a pregnancy test before you start treatment. You must use effective birth control during treatment and for four months after the last dose.
- For people with partners who can become pregnant. You must use effective birth control during treatment and for six months after the last dose.
Breastfeeding
It is not known if Blenrep passes into breast milk. Do not breastfeed during treatment with Blenrep and for three months after the last dose because of the potential for serious side effects in the breastfed child.
Lung problems
In some cases, lung inflammation (pneumonitis) has been reported. Tell your health care provider or get emergency help right away if you get any new or worsening unexplained signs or symptoms of lung problems, such as shortness of breath, chest pain, or coughing.
How Do I Take Blenrep?
Blenrep is given as an intravenous (IV) infusion over about 30 minutes. Most people using Blenrep will receive it once every three weeks in combination with bortezomib and dexamethasone for the first eight cycles. After cycle eight, Blenrep is usually continued by itself once every three weeks until your condition gets worse or you have side effects that make you stop treatment.
Because side effects are common, especially eye problems, your health care provider may need to temporarily stop your dose or reduce it. For eye problems, the dose is usually stopped until the eye problems improve to a mild level. Some people may need to stop treatment altogether if side effects are severe.
How Can I Tell if Blenrep Is Working?
You may not notice a dramatic change yourself, but your health care provider will monitor key factors. Your health care provider will do tests to check if the amount of myeloma protein in your blood or urine is decreasing. They may also do imaging (like CT scans) to see if any tumors are shrinking or disappearing.
How Can I Get Blenrep?
Because of the risk of serious eye problems, Blenrep is available only through a restricted program called the Blenrep Risk Evaluation and Mitigation Strategy (REMS). You must be enrolled in the Blenrep REMS program to get Blenrep.
Your health care provider must counsel you on the risk of eye toxicity, the need for eye exams before each dose, and provide you with the Blenrep REMS Patient Guide. You must follow the required eye monitoring schedule.
Is There Any Cost Assistance Available?
A copay savings program from the drugmaker can help reduce your out-of-pocket cost for Blenrep. Whether or not you are eligible depends on your insurance coverage. Call 844-447-5662 for more information and to apply.
This content was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
