KOL Pulse — Trial Profile

DREAMM-9 Trial

Transplant-ineligible newly diagnosed multiple myeloma (TI NDMM) — GSK

Transplant-ineligible newly diagnosed multiple myeloma (TI NDMM)Blenrep + Velcade/Revlimid/dexASH 2024
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Top KOLs Discussing DREAMM-9

Aaron Goodman - “Papa Heme”
Aaron Goodman - “Papa Heme”
@AaronGoodman33
2.6K impressions
Robin Tuohy
Robin Tuohy
@IMFsupport
965 impressions
Rahul Banerjee, MD, FACP
Rahul Banerjee, MD, FACP
@RahulBanerjeeMD
883 impressions
Rafael Fonseca MD
Rafael Fonseca MD
@Rfonsi1
351 impressions
Rakesh Popat
Rakesh Popat
@DrRakeshPopat
240 impressions
International Myeloma Foundation
International Myeloma Foundation
@IMFmyeloma
227 impressions

DREAMM-9 Key Slides & Visuals

Official trial slides and relevant visuals shared by KOLs at ASH 2024. Click any image to expand.

Robin Tuohy
Robin Tuohy @IMFsupport
DREAMM-9 Data
558 impressions · 4 likes · Dec 8, 2024
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[Slide 1] Conclusions Across all dosing schedules, belamaf + VRd delivered highly effective tumor responses and MRD negativity in patients with TI NDMM ORR was 71-100% across cohorts with 4 cohorts having 100% ORR. CR+ was 30-92% across cohorts MRD[-] was 0-75% across cohorts: MRD[-] continued to increase into the Maintenance phase Higher starting doses of belamaf were generally associated with higher and faster rates of MRD[-] across dosing intervals MRD[-] was 75% in 1.9 mg/kg Q3/4W and 67% in 1.9 mg/kg Q6/8W cohorts In cohorts with comparable follow-up durations, longer dosing intervals were associated with increased time to lann, onset of clinically meaningful BCVA changes Ocular events were effectively managed with dose modification, including extending the dosing interval or dose reduction, while maintaining patients on treatment across all cohorts. These data are consistent with prior clinical studies of belamaf in the relapsed/refractory MM setting¹⁻⁴ A phase 3, randomized, study of belamaf + Rd (BRd) versus daratumumab + Rd (DRd) in patients with TI NDMM (NCT06679101, DREAMM-10) is planned⁵
Rafael Fonseca MD
DREAMM-9 Data
351 impressions · 6 likes · Dec 8, 2024
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[Slide 1] Efficacy I MRD-negativity rate* Higher belamaf starting doses were associated with deeper and faster MRD[-] rates 100 92 91 90 80 75 75 Patients (ITT population), % 67 71 70 62 60 54 53 50 45 41 43 CR+ 40 29 27 30 30 MRD[-] 20 10 0 0 1.9 mg/kg 1.9 mg/kg 1.4 mg/kg 1.4 mg/kg 1.9 (9W) to 1.0 mg/kg 1.4 (9W) to 1.0 mg/kg Q3/4W Q6/8W Q3/4W Q6/8W 1.4 mg/kg Q3/4W 1.0 mg/kg Q12W Q9/12W Q9/12W MRD[-]. n (% of patients with CR+) 9 (100) 8 (73) 7 (88) 5 (50) 5 (71) 6 (60) 4 (50) 0 Median time to MRD[-]. 8.3 7.9 12.2 14.6 4.4 3.8 5.1 0 months (range) (2.1-17.5) (4.2-14.7) (2.3-24.9) (2.1-23.1) (2.2-10.2) (2.5-12.3) (2.1-9.2) Median follow-up. months 37.6 32.3 20.2 32.4 17 31.0 18.2 7.8 "MRDI-] was measured by next-generation sequencing [10*] in patients achieving CR+ and is shown as proportion of the ITT population belamaf, belantamab mafodotin; CR,+ complete response or better; ITT, intention-to-treat MRD[-]. minimal residual disease negativity; QxW, every X weeks --- [Slide 2] Safety I Ocular events Cohorts with lower doses and longer Maximum Grade 1 KVA events were reported in 11% of patients, maximum Grade 2 KVA events in 19%, dosing intervals generally had lower and maximum Grade 3/4 KVA events in 55% of patients. Of 2142 KVA assessments, only 15% were rates of Grade 3/4 Grade 3/4 events KVA events Belamaf schedule 1.9 mg/kg 1.9 mg/kg 1.4 mg/kg 1.9 (9W) to 1.0 mg/kg 1.4 (9W) to 1.4 mg/kg 1.0 mg/kg Q3/4W Q6/8W Q3/4W Q6/8W 1.4 mg/kg Q3/4W 1.0 mg/kg Total Q12W Q9/12W Q9/12W n 12 12 13 12 17 14 15 10 N=105 Median follow-up, months (range) 37.6 (7-50) 32.3 (6-38) 20.2 (1-37) 32.4 (5-37) 17.1 (1-23) 31.0 (0-38) 18.2 (2-22) 7.8 (5-10) - Grade 3/4 KVA events, n (%) 10 (83) 11 (92) 11 (85) 9 (75) 5 (29) 9 (64) 1 (7) 2 (20) 58 (55) Grade 4 KVA events, n (%) 4 (33) 0 4 (31) 2 (17) 0 2 (14) 0 0 12 (11) Total Grade 3/4 KVA events, no. of events (% of all 97 (26) 36 (10) 42 (14) 50 (18) 14 (6) 73 (22) 10 (4) 2 (3) 324 (15) assessments) Total Grade 4 KVA events, no. of events (% of all 13 (3) 0 6 (2) 3 (1) 0 5 (2) 0 0 27 (1) assessments) Discontinuation due to 1 (8) 0 2 (15) 0 0 2 (14) 0 0 5 (5) Grade >3 KVA events, n (%) belamaf, belantamab mafodotin; KVA, Keratopathy and Visual Acuity QxW, every X weeks
Rahul Banerjee, MD, FACP
Rahul Banerjee, MD, FACP @RahulBanerjeeMD
DREAMM-9 Data
282 impressions · 2 likes · Dec 8, 2024
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[Slide 1] Efficacy I MRD negativity (higher-dose cohorts)* and RDI Higher belamaf starting doses and shorter dosing intervals achieved a higher MRD[-] rate 80 F MRD[-] rate continues to increase regardless of dose modifications used to manage KVA Grade 2+ Proportion of ITT 60 into the Maintenance phase, population, % 40 20 0 events (30%) 0 6 12 18 24 30 36 42 48 54 Maximum follow up, months 1.9 mg/kg Q3/4W 1.9 mg/kg Q6/8W 1.4 mg/kg Q3/4W 1.4 mg/kg Q6/8W t Longer belamaf dosing intervals End of induction (BVRd) Maintenance (BRd) allowed for a higher mg/kg/cycle Belamaf schedule 1.9 mg/kg 1.9 mg/kg 1.4 mg/kg 1.4 mg/kg 1.9 mg/kg 1.9 mg/kg 1.4 mg/kg 1.4 mg/kg to be given Q3/4W Q6/8W Q3/4W Q6/8W Q3/4W Q6/8W Q3/4W Q6/8W Belamaf median RDI, % 59.3 90.4 70.8 91.9 19.6 31.5 27.1 49.1 Belamaf mg/kg/cycle, median 1.13 1.72 0.99 1.29 0.37 0.60 0.38 0.69 Bortezomib median RDIt, % 53.6 70.2 79.0 77.1 - - - - Lenalidomide median RDII, % 84.2 66.9 91.2 89.0 54.8 53.1 68.7 57.3 *MRD[-] was measured by next-generation sequencing [10-5] in patients achieving CR+; Belamaf dose Interruptions, reductions, and delays 58% of patients; Bortezomib and lenalidomide RDI data were analyzed at the previous data cut (March 27, 2023). B, belantamab mafodotin; CR+, complete response or better, KVA, Keratopathy and Visual Acuity; MRD[-], minimal residual disea methasone; RDI, relative dose intensity, VRd, bortezomib, lenalidomide, and dexamethasone
Samer Al Hadidi, MD,MS,FACP
DREAMM-9 Data
161 impressions · 1 likes · Dec 8, 2024
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[Slide 1] Study design Inclusion criteria Belamaf dosing cohorts* Primary endpoint: 1.9 mg/kg Q3/4W MM diagnosis per every SOC cycle Safety (DLTs and AEs) (n=12) IMWG criteria Cohorts with lower ECOG performance status 1.9 mg/kg Q6/8W, Secondary endpoints every other SOC cycle doses and longer of 0-2 (n=12) Efficacy (ORR, >CR, schedules were opened Not a candidate for HDT with ASCT due to 1.4 mg/kg Q3/4W, 2VGPR per IMWG criteria) to assess the potential to every SOC cycle frailty and/or significant (n=13) RDI of lenalidomide improve tolerability while comorbid condition(s) and bortezomib after maintaining efficacy > 1.4 mg/kg Q6/8W, 4 cycles Measurable disease per every other SOC cycle (n+12) IMWG criteria Cumulative administered All cohorts received 1.9 (9W) to 1.4 mg/kg Q9/12W, belamaf dose after 4 cycles belamaf with VRd for Exclusion criteria Screening every third SOC cycle Safety with VRd Cycles 1-8 (21-day phase (n=19) follow up Incidence and titers of cycle), followed by Prior systemic therapy ADAs belamaf with Rd for for MM or SMM 1.0 mg/kg Q3/4W, every SOC cycle PK Cycles 9+ Current corneal (n-15) (28-day cycle)1 epithelial disease 1.4 (9W) to 1.0 mg/kg Q9/12W, Exploratory endpoint every third SOC cycle Ocular events (n=15) MRD negativity were managed by (assessed in bone 1.0 mg/kg Q12W, dose modifications every third/fourth SOC cycle marrow aspirate samples (n-10) using next-generation or extending the sequencing [10-5]). dosing interval 21 days Randomized assignment 70-day safety SOC (VRd [Cycles 1-8], Rd [Cycles 9+])¹ follow up visit "Cohorts of the same color opened at the same time Cohorts with longer rectangles opened earlier ADA anti-drug antibodies; AE, adverse event ASCT. autologous stem cell transplant; belamaf, belantamab mafodotin CR, complete response; DLT, dose-limiting toxicities; ECOG Eastem Cooperative Oncology Group: HDT, high-dose chemotherapy IMWG, International Myeloma Working Group, MM, multiple myeloma; MRD. minimal residual disease ORR, overall response rate; PK, pharmacokinetics; PR. partial response, QxW. every K weeks, RDI, relative dose intensity, SMM, smouldering MM; SOC, standard of care; VGPR, very good partial response; VRd, bortezomib, lenalidomide and dexamethasone 1. Durie BGM, et al Lancet, 2017;389:519-27 --- [Slide 2] Patient demographics Patient Between December 18, 2019 and March 4, 2024 (data cut-off), 108 patients were recruited in 8 cohorts demographics containing 10-19 patients/cohort; enrollment continued through the 2020 coronavirus pandemic were comparable across cohorts Overall, median age was 74 years, 46% were female, 15% had high-risk cytogenetics, and 11% had EMD 1.9 (9W) to 1.4 (9W) to Belamaf schedule 1.9 mg/kg 1.9 mg/kg 1.4 mg/kg 1.4 mg/kg 1.0 mg/kg 1.0 mg/kg Q3/4W Q6/8W Q3/4W Q6/8W 1.4 mg/kg Q3/4W 1.0 mg/kg Total Q12W Q9/12W Q9/12W n=12 n=12 n=13 n=12 n=19 n=15 n=15 n=10 N=108 Median age, years (range) 72.5 (63-77) 73.0 (69-78) 74.0 (65-88) 73.0 (69-80) 76.5 (59-88) 73.0 (51-85) 74.0 (52-86) 75.0 (67-85) 74.0 (51-88) >75 years, n (%) 5 (42) 4 (33) 6 (46) 4 (33) 13 (68) 3 (20) 6 (40) 6 (60) 47 (44) Female, n (%) 4 (33) 6 (50) 5 (38) 6 (50) 9 (47) 8 (53) 7 (47) 5 (50) 50 (46) Ethnicity, n (%) White 10 (83) 8 (67) 11 (85) 10 (83) 17 (89) 12 (80) 15 (100) 10 (100) 93 (86) Black 0 0 0 0 1 (5) (7) 0 0 2 (2) Asian 2 (17) 4 (33) 2 (15) 2 (17) 1 (5) 2 (13) 0 0 13 (12) ISS stage at screening, n (%) I 2 (17) 5 (42) 7 (54) 3 (25) 5 (26) 6 (40) 7 (47) 2 (20) 37 (34) II 6 (50) 6 (50) 3 (23) 5 (42) 10 (53) 7 (47) 6 (40) 7 (70) 50 (46) III 3 (25) 1 (8) 2 (15) 4 (33) 2 (11) 1 (7) 2(13) 1 (10) 16 (15) Unknown 1 (8) 0 1 (8) 0 2,(11) 1 (7) 0 0 5 (5) High-risk cytogenetics", n 4 (33) 2 (17) 3 (23) 1 (8) 3 (16) 2 (13) 1 (7) 0 16 (15) (%) EMD, (%) 2 (17) 3 (25) 0 1 (8) 4 (21) 1 (7) 1 (7) 0 12 (11) "High cytogenetic risk was defined by the presence of at least one high-risk abnormality 1(4,14), 1(14,16). or del(17p13) belamaf, belantamab mafodotin; EMD, extramedullary disease; ISS, International Staging System; QxW, every X weeks --- [Slide 3] Safety I Ocular events Cohorts with lower doses and longer Maximum Grade 1 KVA events were reported in 11% of patients, maximum Grade 2 KVA events in 19%, dosing intervals generally had lower and maximum Grade 3/4 KVA events in 55% of patients. Of 2142 KVA assessments, only 15% were rates of Grade 3/4 Grade 3/4 events KVA events 1.9 (9W) to Belamaf schedule 1.9 mg/kg 1.4 mg/kg 1.4 mg/kg 1.0 mg/kg 1.4 (9W) to 1.9 mg/kg 1.0 mg/kg Q3/4W Q6/8W Q3/4W Q6/8W 1.4 mg/kg Q3/4W 1.0 mg/kg Total Q12W Q9/12W Q9/12W n 12 12 13 12 17 14 15 10 N=105 Median follow-up, months 37.6 (7-50) (range) 32.3 (6-38) 20.2 (1-37) 32.4 (5-37) 17.1 (1-23) 31.0 (0-38) 18.2 (2-22) 7.8 (5-10) - Grade 3/4 KVA events, n (%) 10 (83) 11 (92) 11 (85) 9 (75) 5 (29) 9 (64) 1 (7) 2 (20) 58 (55) Grade 4 KVA events, n (%) 4 (33) 0 4 (31) 2 (17) 0 2 (14) 0 0 12 (11) Total Grade 3/4 KVA events, no. of events (% of all 97 (26) 36 (10) 42 (14) 50 (18) 14 (6) 73 (22) 10 (4) 2 (3) 324 (15) assessments) Total Grade 4 KVA events, no. of events (% of all 13 (3) 0 6 (2) 3 (1) 0 5 (2) 0 0 27 (1) assessments) Discontinuation due to 1 (8) 0 2 (15) 0 0 2 (14) 0 0 5 (5) Grade >3 KVA events, n (%) belamaf, belantamab mafodotin; KVA Keratopathy and Visual Acuity QxW. every X weeks --- [Slide 4] Efficacy I ORR VGPR+ was 100% in 3 ORRs ranged from 71% to 100% cohorts including those with lower doses Time to achieve VGPR+ was consistent across the cohorts (median 2.1-3.2 months) and response and less frequent deepened over time schedules In the first 4 cohorts, CR+ was 62-92% ORR*, % 100 100 92 100 71 86 87 100 VGPR+ / CR+, % 92/75 100/92 92/62 100 91 59/41 79/71 73/53 100/30 100 8 9 9 17 PR 80 7 13 Proportion of 31 VGPR patients, % 60 25 58 64 12 20 70 18 36 7 CR 40 46 12 sCR 20 50 47 33 27 29 36 30 15 0 1.9 mg/kg Q3/4W 1.9 mg/kg Q6/8W 1.4 mg/kg Q3/4W 1.4 mg/kg Q6/8W 1.9 (9W) to 1.4 1.0 mg/kg Q3/4W 1.4 (9W) to 1.0 1.0 mg/kg Q12W mg/kg Q9/12W mg/kg Q9/12W n=12 n=12 n=13 n=11 n=17 n=14 n=15 n=10 Median follow-up, months 37.6 32.3 20.2 32.4 17.1 31.0 18.2 7.8 (range) (7-50) (6-38) (1-37) (5-37) (1-23) (0-38) (2-22) (5-10) Median time to VGPR+, 2.8 2.9 2.2 2.1 2.2 3.0 3.1 3.2 months (range) (0.7-4.2) (0.8-14.7) (0.8-16.8) (0.8-5.0) (0.7-8.1) (1.4-6.8) (0.8-4.9) (1.3-4.9) Median time to CR+, months 8.3 12.0 6.2 8.8 9.5 8.2 6.1 6.5 (range) (2.1-19.4) (4.4-22.9) (1.4-15.7) (1.4-18.4) (3.7-11.1) (2.1-19.8) (1.4-13.8) (2.1-9.1) Median follow-up varied as cohorts opened at different times; some patients had not been treated for long enough to achieve response CI, confidence interval; CR+, complete response or better, ORR overall response rate; PR, partial response, QxW, every X weeks; sCR, stringent complete response VGPR+, very good partial response or better.
Hamza Hashmi
Hamza Hashmi @hhashmi87
DREAMM-9 Data
152 impressions · 6 likes · Dec 8, 2024
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[Slide 1] AMERICAN SOCIETY OF MEMATOLOGY Pacific Ballroom Salons 18-19 Phase I Study of Belantamab Mafodotin in Combination with Standard of Care in Transplant- Ineligible Newly Diagnosed Multiple Myeloma: DREAMM-9 Updated Interim Analysis Saad Z. Usmani, MD', Michał Mielnik, MD, PhD, Mamta Garg, MD, FRCP, FRCPath, Irwindeep Sandhu, MD, Al-Ola Abdallah, MD, PhD, Youngil Koh, MD, Albert Oriol, MD, Hang Quach, MD, Katja Weisel, MD, PhD, Aránzazu Alonso Alonso, MD, Enrique M. Ocio, MD, PhD, Wojciech Janowski, MD, Chang-Ki Min, MD, Karthik Ramasamy, MD, Ricarda Garcia Sanchez, MD, Paula Rodriguez-Otero, MD, Chris Brawley, MSc, Jacqueline L. Egger, PhD, Morrys C. Kaisermann, MD, PhD, and Marek Hus, MD, PhD "Memorial Sloan Kettering Cancer Center, New York, NY, USA Publication No. 497 Presented at the 66th American Society of Hematology Annual Meeting and Exposition, San Diego, California, USA and Online I December 7-10, 2024 --- [Slide 2] OF HEMATOLOGY Pacific Ballroom Salons 18-19 Best corrected visual acuity Dose and schedule Extending the dosing interval between the 1.9 mg/kg or 1.4 mg/kg doses from Q3/4W to Q6/8W was associated 20/20 20/50f affected the time to, and resolution of, with longer time to BCVA decrease to 20/50 or worse* BCVA decreases Resolution of BCVA decreases was generally faster in cohorts with lower initial doses of belamaf First occurrence of decrease in BVCA score from baseline (20/25 or better) to 20/50 or worse Belamaf schedule Number of patients, n (%) Time to onset Median (range), days 1.9 mg/kg Q3/4W 6 (50) 76 (42-439) 1.9 mg/kg Q6/8W 6 (50) 246 (106-472) 1.4 mg/kg Q3/4W 3 (23) 128 (113-409) 1.4 mg/kg Q6/8W 6 (50) 264 (92-546) Time to resolution 1.9 mg/kg Q3/4W 163 (36-230) 1.9 mg/kg Q6/8W 135 (29-246) 1.4 mg/kg Q3/4W 36 (22-85) 1.4 mg/kg Q6/8W 70 (43-421) 0 100 200 300 400 500 600 Days "In the 4 cohorts shown, 2 patients had a BCVA change from 20/25 or better to 20/200 or worse These patients both had bilateral cataracts. Image adapted from Shi C, et al. bioRxiv 2018,doc doi.org/10 1101/328443 Copyright 2018 the Author belamaf, belantamab malodotin; BVCA, best corrected visual acuity: QxW, every X weeks --- [Slide 3] PALERICAN SOCIETY OF MEMATOLOGY Pacific Ballroom Salons 18-19 Conclusions Across all dosing schedules, belamaf + VRd delivered highly effective tumor responses and MRD negativity in patients with TI NDMM ORR was 71-100% across cohorts with 4 cohorts having 100% ORR. CR+ was 30-92% across cohorts MRD[-] was 0-75% across cohorts: MRD[-] continued to increase into the Maintenance phase Higher starting doses of belamaf were generally associated with higher and faster rates of MRD[-] across dosing intervals MRD[-] was 75% in 1.9 mg/kg Q3/4W and 67% in 1.9 mg/kg Q6/8W cohorts In cohorts with comparable follow-up durations, longer dosing intervals were associated with increased time to onset of clinically meaningful BCVA changes Ocular events were effectively managed with dose modification, including extending the dosing interval or dose reduction, while maintaining patients on treatment across all cohorts. These data are consistent with prior clinical studies of belamaf in the relapsed/refractory MM setting¹⁻⁴ A phase 3, randomized, study of belamaf + Rd (BRd) versus daratumumab + Rd (DRd) in patients with TI NDMM (NCT06679101, DREAMM-10) is planned⁵ belamaf, belantamab mafodotin; BVCA, best corrected visual aculty, MM, multiple myeloma; MRD, minimal residual disease; ND, newly diagnosed; TL, transplant-ineligible; VRd, bortezomb, lenalidomide, and dexamethasone 1 Nooka AK of at Cancer 2023,129:3746-60; 2. Dimopoulos MA, at at Lancet Haematol 2023;10:e801-12;3 Hungria P. et at N Engl Med. 2024,391:393-407; 4. Dimopoulos MA, of al. N Engl J Med. 2024,391:408-21.

DREAMM-9 Top Tweets

Top tweets by impressions — click to view on X

Aaron Goodman - “Papa Heme”
Aaron Goodman - “Papa Heme”@AaronGoodman33

DREAMM-9 results are in!

Would anyone (other than an ophthamologist) consider using belantamab-VRd as an induction for patients with multiple myeloma not eligible for ASCT?

I have said this…

👁 2.6K ♡ 1 ↻ 0 Dec 8, 2024
Rahul Banerjee, MD, FACP
Rahul Banerjee, MD, FACP@RahulBanerjeeMD

#ASH24 excellent presentation by @szusmani of Bela-VRd in frontline ASCT-ineligible #MMsm.

Trick is to space out the dose frequency as keratopathy develops - pretty nice rates of MRD…

👁 601 ♡ 5 ↻ 2 Dec 8, 2024
Robin Tuohy
Robin Tuohy@IMFsupport

Great Presentation, thank you @szusmani - Abstract #497 looking forward to "Bela is Back" #ASH24 #IMFASH24 #MMsm
Phase I Study of Belantamab Mafodotin in Combo with Standard of Care in…

👁 558 ♡ 4 ↻ 3 Dec 8, 2024
Robin Tuohy
Robin Tuohy@IMFsupport

Abstract 497: Phase 1 Bela in combo with SOC transplant ineligible NDMM-Dreamm-9 Updated Interim Analysis ⁦@szusmani⁩ ⁦@TerryGlassman#ASH24 #IMFASH24 #MMsm https://t.co/hBJsBFQzlt

👁 407 ♡ 7 ↻ 7 Dec 9, 2024
Rafael Fonseca MD
Rafael Fonseca MD@Rfonsi1

Frontline bela for ND TIE MM? Courageous study but interesting results. With bela dose adjustmemts rate of dfiscontinuation low and responses are deep. A new fight is brewing between QUADs (PN!),…

👁 351 ♡ 6 ↻ 2 Dec 8, 2024
Rahul Banerjee, MD, FACP
Rahul Banerjee, MD, FACP@RahulBanerjeeMD

#ASH24 and the most important slide of DREAMM-9 by @szusmani with Bela-VRd in frontline myeloma #MMsm.

MRD rates improve over time, even in patients where belantamab is held for toxicities! Maybe…

👁 282 ♡ 2 ↻ 2 Dec 8, 2024
Rakesh Popat
Rakesh Popat@DrRakeshPopat

DREAMM-9: Belamaf - VRd for 1st line TNE myeloma. Very interesting data on spacing out frequency of Belamaf to reduce ocular toxicity but achieving high responses and gradual MRD negativity rates.…

👁 240 ♡ 10 ↻ 4 Dec 8, 2024
International Myeloma Foundation
International Myeloma Foundation@IMFmyeloma

🧵The DREAMM-9 study tests belantamab mafodotin + VRd in newly diagnosed myeloma patients ineligible for ASCT. Higher doses boost MRD negativity, with a favorable safety profile despite ocular events.…

👁 227 ♡ 2 ↻ 1 Feb 23, 2025
Samer Al Hadidi, MD,MS,FACP
Samer Al Hadidi, MD,MS,FACP@HadidiSamer

#ASH24 #mmsm @ASH_hematology

Oral myeloma: Dreamm-9

Higher doses of Blenrep better responses and worse AEs (eye issues and thrombocytopenia)

Lower doses of Blenrep lower responses and better AEs…

👁 161 ♡ 1 ↻ 0 Dec 8, 2024
Hamza Hashmi
Hamza Hashmi@hhashmi87

@szusmani on Belamaf in combo w RVD for TI NDMM, several dosing and frequency cohorts.
G3+ KVA 50%, Lower and less frequent dosing delays onset and improves recovery of KVA; deeper & faster MRD…

👁 152 ♡ 6 ↻ 2 Dec 8, 2024

About the DREAMM-9 Trial

DREAMM-9 provides dose/schedule optimization data for belantamab + VRd in TI NDMM. High response rates and MRD negativity are encouraging but Phase 1 design precludes practice-changing conclusions. Belantamab mafodotin returned to the U.S. market in RRMM combinations (DREAMM-7 FDA approval July 2025 — belamaf + BVd). Ocular toxicity (keratopathy) remains the defining class challenge; DREAMM-9 cohorts explore lower doses / longer intervals to mitigate.

Trial Methodology & Results

Dose-Limiting Toxicities and Adverse Events (Phase 1) — Primary Endpoints (Safety / Dose Optimization)

Phase 1 dose-optimization study (N=108) across 8 cohorts of belantamab mafodotin dose/schedule combined with VRd. Primary endpoints are DLTs and AEs — no PFS/OS comparison yet. Best response rates (ORR) ranged from 71-100% across cohorts. ≥VGPR rate was 100% in three cohorts, including lower-dose/less-frequent schedules. ≥CR rates in cohorts 1-4 ranged from 62-92% with responses deepening over time. Higher starting doses associated with deeper, faster MRD negativity; in Cohort 1, 100% of patients with CR achieved MRD negativity. No randomized comparator — response rates are single-arm.

✓ ORR 71-100% across cohorts; ≥CR 62-92% in C1-4

📄 Source: KOL commentary on X →

Overall Survival (OS)

OS not reported (Phase 1 design, early follow-up).


📄 Source →

Safety & Tolerability

Key AEs: thrombocytopenia (30% Grade 3/4), neutropenia (26% Grade 3/4), COVID-19 pneumonia (14% Grade 3/4), ocular / keratopathy (class effect of belantamab — specific rates not in published sources). Belantamab-related Grade 3/4 AEs in 33% of 105 safety-evaluable patients overall. Lower doses and longer intervals associated with lower Grade 3/4 AE rates. Most frequent non-ocular Grade 3/4 AEs: thrombocytopenia (30%), neutropenia (26%), COVID-19 pneumonia (14%). Ocular/keratopathy AEs (hallmark belantamab toxicity) not quantified in available summary sources. Discontinuation rates not reported.

⚠ 33% belamaf-related G3/4 AEs; keratopathy monitoring required

📄 Source →

Clinical Implications

🔬 Phase 1 dose optimization — investigational; not for clinical use in TI NDMM. DREAMM-9 provides dose/schedule optimization data for belantamab + VRd in TI NDMM. High response rates and MRD negativity are encouraging but Phase 1 design precludes practice-changing conclusions. Belantamab mafodotin returned to the U.S. market in RRMM combinations (DREAMM-7 FDA approval July 2025 — belamaf + BVd). Ocular toxicity (keratopathy) remains the defining class challenge; DREAMM-9 cohorts explore lower doses / longer intervals to mitigate.

DREAMM-9 in the News

Key KOL Sentiments — DREAMM-9

DoctorSentimentComment
Rahul Banerjee, MD, FACP ● POSITIVE #ASH24 excellent presentation by @szusmani of Bela-VRd in frontline ASCT-ineligible #MMsm. Trick is to space out the dose frequency as keratopathy develops - pretty nice rates of MRD negativity! That being said, possibly maintaining full dose when dosed does ⬆️ efficacy… https://t.co/ulgexOsmYU
Robin Tuohy ● POSITIVE Great Presentation, thank you @szusmani - Abstract #497 looking forward to "Bela is Back" #ASH24 #IMFASH24 #MMsm Phase I Study of Belantamab Mafodotin in Combo with Standard of Care in Transplant-Ineligible Newly Diagnosed Multiple Myeloma: Dreamm-9 Updated Interim Analysis https://t.co/DI25nwB17H
Rafael Fonseca MD ● POSITIVE Frontline bela for ND TIE MM? Courageous study but interesting results. With bela dose adjustmemts rate of dfiscontinuation low and responses are deep. A new fight is brewing between QUADs (PN!), Bispecific combos (infections) and Bela (visual). We will see! #ASH24RF #MMSM https://t.co/KZpYydaJu9
Jim Omel ● POSITIVE Bela WILL be back and soon FDA-approved. It’s an ADC with a unique MOA, and is quite effective. Thanks for the live tweets @IMFsupport #ASH24 #IMFASH24 https://t.co/2OmrL3P07g
Aaron Goodman - “Papa Heme” ● NEUTRAL DREAMM-9 results are in! Would anyone (other than an ophthamologist) consider using belantamab-VRd as an induction for patients with multiple myeloma not eligible for ASCT? I have said this before, they need to develop belantamab for the treatment of eyeball cancer. #ASH24
Robin Tuohy ● NEUTRAL Abstract 497: Phase 1 Bela in combo with SOC transplant ineligible NDMM-Dreamm-9 Updated Interim Analysis ⁦@szusmani⁩ ⁦@TerryGlassman⁩ #ASH24 #IMFASH24 #MMsm https://t.co/hBJsBFQzlt
Rahul Banerjee, MD, FACP ● NEUTRAL #ASH24 and the most important slide of DREAMM-9 by @szusmani with Bela-VRd in frontline myeloma #MMsm. MRD rates improve over time, even in patients where belantamab is held for toxicities! Maybe the bela induces polyclonal immune responses to other myeloma cell antigens? https://t.co/5V7a2Wedl9 https://t.co/WLtTF4oD5m
Rakesh Popat ● NEUTRAL DREAMM-9: Belamaf - VRd for 1st line TNE myeloma. Very interesting data on spacing out frequency of Belamaf to reduce ocular toxicity but achieving high responses and gradual MRD negativity rates. #ASH24 #mmsm https://t.co/fydLVP18sV
International Myeloma Foundation ● NEUTRAL 🧵The DREAMM-9 study tests belantamab mafodotin + VRd in newly diagnosed myeloma patients ineligible for ASCT. Higher doses boost MRD negativity, with a favorable safety profile despite ocular events. Watch to learn more:https://t.co/WmmgEl1bmF #mmsm #IMFASH25 #ASH25 https://t.co/LeLfdsZuTR
Samer Al Hadidi, MD,MS,FACP ● NEUTRAL #ASH24 #mmsm @ASH_hematology Oral myeloma: Dreamm-9 Higher doses of Blenrep better responses and worse AEs (eye issues and thrombocytopenia) Lower doses of Blenrep lower responses and better AEs https://t.co/ugo45WqFdk
Hamza Hashmi ● NEUTRAL @szusmani on Belamaf in combo w RVD for TI NDMM, several dosing and frequency cohorts. G3+ KVA 50%, Lower and less frequent dosing delays onset and improves recovery of KVA; deeper & faster MRD w ⬆️ doses, option for non BsAb pts in community #mmsm #ash24 @MSKCancerCenter https://t.co/78XAfB0jBG
Hamza Hassan ● NEUTRAL #ASH24 DREAMM-9 presented by @szusmani with variable dosing in Transplant ineligible myeloma of Bela + VRd Lower dosing and frequency accompanies lower KVA & earlier resolution. Higher MRD achieved with possibly maintaining standard dose.👏 session @andrew02114 @JoshuaRichterMD https://t.co/g3mxEkIRY5
Becky Bosley ● NEUTRAL @szusmani presents Abstract #497 Phase 1 study of Belantamab Mafodotin in combo with SOC in TI-NDMM: DreaMM-9 updated interim analysis #IMFASH24 #ASH24 https://t.co/dKLoQkRocZ