Latest NewsFDA NewsAdverse Event ManagementSupportive CareDisparities in Cancer CareDrug SafetyRadiation OncologySurvivorship Practice ManagementPreventionContributorsSponsored
Expert ConnectionsMorning RoundsThe VitalsPodcastsVideosBetween the LinesFrom All AnglesMeeting of the MindsTraining Academy
Conference CoverageConference Listing
Publications
Continuing Education
Case-Based Digest Rx Road MapWebinarsCancer Summary SlidesMPN Symptom ManagementEvents
SubscribePartners
Brain Cancer
Breast CancerBreast Cancer
Gastrointestinal CancerGastrointestinal CancerGastrointestinal CancerGastrointestinal Cancer
Genitourinary CancerGenitourinary CancerGenitourinary CancerGenitourinary Cancer
Gynecologic CancersGynecologic CancersGynecologic CancersGynecologic Cancers
Head and Neck Cancers
HematologyHematologyHematologyHematologyHematologyHematology
Lung Cancer
Pediatric Cancer
Sarcomas
Skin CancerSkin Cancer
Advanced Practice Corner Logo
    Brain Cancer
    Breast CancerBreast Cancer
    Gastrointestinal CancerGastrointestinal CancerGastrointestinal CancerGastrointestinal Cancer
    Genitourinary CancerGenitourinary CancerGenitourinary CancerGenitourinary Cancer
    Gynecologic CancersGynecologic CancersGynecologic CancersGynecologic Cancers
    Head and Neck Cancers
    HematologyHematologyHematologyHematologyHematologyHematology
    Lung Cancer
    Pediatric Cancer
    Sarcomas
    Skin CancerSkin Cancer
    Advanced Practice Corner Logo
        • Publications
        • Subscribe
        • Partners
      Advertisement

      Coordination With Ophthalmologists Ideal for Mitigating Belantamab Mafodotin–Related Vision Problems in Multiple Myeloma

      March 4, 2022
      By Ryan Scott
      Article

      A proactive, multidisciplinary approach is the best way to address belantamab mafodotin—related keratopathy in patients with multiple myeloma.

      Sarah Sunshine, MD

      Sarah Sunshine, MD

      Because varying levels of keratopathy have been associated with treatment with belantamab mafodotin-blmf (Blenrep), patients with relapsed/refractory multiple myeloma often require coordinated adverse event (AE) management when receiving this therapy, according to Sarah Sunshine, MD.

      Patients who receive belantamab mafodotin can encounter mild, moderate, or severe forms of keratopathy, and Sunshine said management of these AEs should begin before the start of treatment. Between the care of oncologists and consultations with ophthalmologists, a multidisciplinary approach can benefit patients, she added.

      “If I am concerned that there is a higher grade of keratopathy or that there has been an acute change in [vision in] these patients, I reach out directly to the oncologist and let them know,” Sunshine said. “The ophthalmologist has to see these patients within a few days before [each infusion], so [oncologists and ophthalmologists] need to be in close communication.”

      In an interview with Oncology Nursing News®, Sunshine, assistant professor, Ophthalmology and Visual Sciences, and member, Program in Oncology, University of Maryland School of Medicine, discussed the management of keratopathy associated with belantamab mafodotin treatment in patients with multiple myeloma and explained why ophthalmologists play a vital role in addressing these AEs.

      Oncology Nursing News®: What are the differences between mild, moderate, and severe keratopathy associated with belantamab mafodotin treatment in multiple myeloma?

      Sunshine: Belantamab mafodotin is a BCMA-directed treatment for treatment-refractory multiple myeloma. About 75% of the patients experience some sort of corneal toxicity, which is keratopathy, and it is usually described as either microcystic-like epithelial changes or superficial punctate keratopathy. [Keratopathy] can cause either no symptoms, blurry vision, or dry-eye symptoms.

      Mild-to-moderate keratopathy is described as nonconfluent, microcystic-like changes that are predominantly in the periphery. What is interesting about these changes is they start in the periphery, and they work their way in. When you stop treatment or [a patient’s] symptoms get better, [the symptoms retreat to the periphery before resolving].

      The other [aspect of how we define mild-to-moderate keratopathy involves] best-corrected visual acuity. If there has only been a change in 1 line of the Snellen visual acuity, which is our standard way of measuring vision, then that is still considered mild [keratopathy]. Moderate [keratopathy] is [defined by] 2 to 3 lines [of change] on the Snellen Chart but no worse than 20/200 vision.

      Severe keratopathy is more of a diffuse, confluent corneal change; it is a combination of these microcystic epithelial cysts and punctate keratopathy, which is a breakdown of the epithelial cells, the skin of the cornea. Because [the cornea] is central, [severe keratopathy] is accompanied with a worsening of vision of at least 2 to 3 lines on the Snellen Chart.

      The most severe form of [keratopathy] is when there is an epithelial defect or loss of the skin of the cornea. That js usually accompanied with worse than 20/200 vision. That is what we are trying to prevent here.

      What steps should be taken to manage these AEs in this patient population? Is there a one-size-fits-all approach for these patients?

      This is where I find it challenging as an ophthalmologist. We do not have great treatment options [for keratopathy]. The only thing that has been helpful is lubrication with artificial tears. The other treatments have not been shown to work. Steroids, antibiotics, and other treatment has not helped patients [manage keratopathy].

      From a treatment standpoint, artificial tears and lubrication are the most important things. I try to get these patients on artificial tears preemptively. At the first visit before patients start treatment, I start artificial tears to increase the lubrication, and then we can increase its use from there. My personal favorite is preservative-free artificial tears because [patients] can use them as often as they want.

      The only other option that we have is holding treatment. What is promising is that when you do hold treatment, those corneal changes tend to regress. The exact timing is variable, but the [keratopathy] does regress.

      Can dose modifications affect keratopathy events in this patient population?

      Dose modifications can help, [including] lengthening the time between the treatments. The standard is 3 weeks, but if you go further than that, it tends to give the cornea time to resolve somewhat.

      How does multidisciplinary management between oncologists and ophthalmologists play a role in monitoring these AEs?

      [The management of corneal toxicity] is a great example of collaborating, working together, and making sure you have a great team. At the University of Maryland, we are lucky that we have such a coordinated care system. I have a clinic in the cancer center, so it makes it a much easier, integrated system for the patients. That is not standard at most institutions, but it is a great model for how closely ophthalmology and oncology should try to work together.

      How involved should ophthalmologists be throughout the course of treatment? How frequent should those visits be to help manage AEs?

      We see [patients] initially before they start the treatment. We see them at their baseline exam to find out if there are any underlying ophthalmic conditions and what their baseline vision is, so we can use that to monitor them as they move forward.

      We need to see [patients] every 3 weeks if they’re on [belantamab mafodotin] or 4 to 6 weeks if they are on a longer regimen, but it tends to be every 3 weeks. The most challenging part is the scheduling because it can sometimes be hard to ensure that we can get [the visit] in exactly [at the 3-week mark] around the infusion schedule.

      What else would you like to add about treatment-related keratopathy?

      The biggest point I would like to emphasize is the collaboration between ophthalmology and oncology and how critical that is for patient care. [It is also important] to understand and educate the patients on [keratopathy]. Even if there is a vision change or corneal changes, we do have good options. [Keratopathy] is not a long-term toxicity, and we can stop treatment or increase lubrication [to mitigate it].

      This article was originally published on OncLive as “Proactive Care Is Required to Manage Belantamab Mafodotin–Associated Keratopathy in Myeloma”

      Newsletter

      Stay up to date on recent advances in oncology nursing and patient care.

      Subscribe Now!
      Recent Videos
      A panel of 3 experts on CML
      A panel of 3 experts on CML
      Related Content

      Photo of a woman undergoing radiation therapy

      What Should Oncology Nurses Know About Biology-Guided RT?

      Bridget Hoyt
      August 7th 2025
      Article

      The Vitals

      Finley-Oliver Talks Talquetamab and Other Later Line Multiple Myeloma Therapies

      Lindsay Fischer
      August 7th 2025
      Podcast

      Graphic of malignant B cells

      Sonrotoclax/Zanubrutinib Generates Durable Response in R/R MCL

      Chris Ryan
      August 7th 2025
      Article

      Laura Zitella Discusses the Growing Arsenal of Bispecific Antibodies in DLBCL

      Laura Zitella Discusses the Growing Arsenal of Bispecific Antibodies in DLBCL

      Lindsay Fischer
      August 7th 2025
      Podcast

      Graphic depicting red blood cells

      Generic Ibrutinib Tablet Given Tentative FDA Approval in CLL/SLL, WM

      Bridget Hoyt
      August 7th 2025
      Article

      Photo of a main holding his lower back in pain with a graphic of a kidney overlaying

      Opinion: IV Magnesium May Help Prevent Cisplatin-Induced AKI

      Amanda Brink, DNP, APRN, FNP-BC, AOCNP
      August 7th 2025
      Article
      Related Content

      Photo of a woman undergoing radiation therapy

      What Should Oncology Nurses Know About Biology-Guided RT?

      Bridget Hoyt
      August 7th 2025
      Article

      The Vitals

      Finley-Oliver Talks Talquetamab and Other Later Line Multiple Myeloma Therapies

      Lindsay Fischer
      August 7th 2025
      Podcast

      Graphic of malignant B cells

      Sonrotoclax/Zanubrutinib Generates Durable Response in R/R MCL

      Chris Ryan
      August 7th 2025
      Article

      Laura Zitella Discusses the Growing Arsenal of Bispecific Antibodies in DLBCL

      Laura Zitella Discusses the Growing Arsenal of Bispecific Antibodies in DLBCL

      Lindsay Fischer
      August 7th 2025
      Podcast

      Graphic depicting red blood cells

      Generic Ibrutinib Tablet Given Tentative FDA Approval in CLL/SLL, WM

      Bridget Hoyt
      August 7th 2025
      Article

      Photo of a main holding his lower back in pain with a graphic of a kidney overlaying

      Opinion: IV Magnesium May Help Prevent Cisplatin-Induced AKI

      Amanda Brink, DNP, APRN, FNP-BC, AOCNP
      August 7th 2025
      Article

      Latest Conference Coverage

      PI3K and AKT Inhibitor Toxicity Advice From a Breast Cancer Expert

      Sonrotoclax/Zanubrutinib Generates Durable Response in R/R MCL

      Q&A: Nursing Considerations From Immune Cell Effector Therapy Experts

      Proactive Rash Management Vital for PI3K, AKT Inhibition in Breast Cancer

      View More Latest Conference Coverage
      About Us
      Editorial Board
      Contact Us
      CancerNetwork.com
      CureToday.com
      OncLive.com
      TargetedOnc.com
      Advertise
      Privacy
      Terms & Conditions
      Do Not Sell My Information
      Contact Info

      2 Commerce Drive
      Cranbury, NJ 08512

      609-716-7777

      © 2025 MJH Life Sciences

      All rights reserved.