Targeting BCMA in Early Relapsed/Refractory Myeloma: What Oncology Pharmacists Need to Know Now and in the Near Future : Pre-test

1.

For those who practice in academic or community settings, please indicate your practice setting:

A. Academic
B. Community
C. Not applicable

2.

How many people with multiple myeloma do you provide care for in a typical month?

A. 1-4
B. 5-10
C. 11-15
D. 16-20
E. >20
F. Not applicable

3.

Which of the following best explains the rationale for targeting BCMA to improve outcomes in patients with early R/R MM?

A. BCMA is primarily expressed on juvenile B-cells and targeting it reduces treatment complexity
B. BCMA is highly expressed on MM cells and is associated with disease burden
C. Soluble BCMA decreases with disease progression, making early targeting more effective
D. Soluble BCMA primarily increases on MM cells in patients with renal impairment

4.

Patient Case: 66-Yr-Old Patient With R/R MM

66-yr-old woman was diagnosed with IgG kappa MM with t(14;16)

She was initially treated with lenalidomide, bortezomib, dexamethasone (RVd) → autologous stem cell transplant and lenalidomide maintenance

She experienced biochemical relapse after 5 yr of maintenance therapy, and received daratumumab, pomalidomide, dexamethasone (DPd) for 1 yr

Over the past several mo, her M-spike has been slowly increasing and has now risen to >0.5 g/dL, indicating disease relapse

She is not interested in undergoing intensive treatment, including a second autologous stem cell transplant or CAR T-cell therapy

In your discussion with this patient, which of the following would you tell her is the most appropriate third-line treatment option for her disease?

A. Belantamab mafodotin + bortezomib + dexamethasone
B. Selinexor + dexamethasone
C. Talquetamab monotherapy
D. Venetoclax + dexamethasone ± daratumumab

5.

Patient Case (cont’d): 66-Yr-Old Patient With R/R MM

66-yr-old woman was diagnosed with IgG kappa MM with t(14;16)

She was initially treated with RVd → ASCT → lenalidomide maintenance

She experienced biochemical relapse after 5 yr of maintenance therapy and received DPd for 1 yr

Over the past several mo, her M-spike slowly increased and now at >0.5 g/dL, indicating disease relapse

Due to her lack of interest in receiving intensive treatment, she received belantamab mafodotin, bortezomib, dexamethasone

Before receiving the third dose, she presents to her community ophthalmologist for the required eye assessment

Slit-lamp exam shows grade 3 keratopathy (diffuse central microcyst-like deposits with central subepithelial haze)

Visual acuity has declined from 20/20 to 20/80 in the worse eye

Clinical findings: severe superficial punctate keratopathy, diffuse central corneal microcyst-like deposits, central subepithelial haze; new central stromal opacity

Ophthalmologist completes the REMS Eye Care Professional Consult Request Form, communicating a grade 3 keratopathy to the oncologist

Which of the following is the most appropriate approach for the management of belantamab mafodotin (BM)–associated grade 3 ocular toxicity?

A. Begin steroid eye drops with current BM dose
B. Continue at the same BM dose but extend the dosing interval
C. Hold BM until symptom resolution to grade ≤1 and then reduce by 1 dose level
D. Hold BM until symptom resolution to grade ≤2 and resume BM at same dose with extended dosing interval
E. Permanently discontinue BM

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Targeting BCMA in Early Relapsed/Refractory Myeloma: What Oncology Pharmacists Need to Know Now and in the Near Future

Donald Moore, PharmD, BCPS, BCOP, DPLA, FCCP, FASHP

Anthony Perissinotti, PharmD, BCOP

Pretest

Please answer the questions below.

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