Blenrep
Blenrep (belantamab or belantamab mafodotin-blmf) is an antibody-drug conjugate (ADC) used to treat a certain type of blood cancer called multiple myeloma. Blenrep (belantamab) is given as an intravenous (IV) infusion at a doctor’s office or infusion center. Some side effects of Blenrep (belantamab) can be mild, such as nausea and diarrhea. But this medication can also cause serious eye problems that require special monitoring.
Please note: Blenrep (belantamab) is no longer FDA-approved in the United States and can only be accessed from the manufacturer through a special request process.
What is Blenrep (belantamab)?
What is Blenrep (belantamab) used for?
- Advanced multiple myeloma that have previously been treated with at least 4 prior therapies
How Blenrep (belantamab) works
Blenrep (belantamab) is an antibody-drug conjugate (ADC). It's made up of two main parts that work together to kill cancer cells:
- A monoclonal antibody part that finds and binds to cancer cells. In the case of multiple myeloma, the monoclonal antibody binds to proteins called BMCA and goes inside the cancer cells.
- Once Blenrep (belantamab) is inside the tumor cells, the chemotherapy part of this medication kills the tumor cells.
Drug facts
Side effects of Blenrep (belantamab)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Changes in the cornea (keratopathy) (up to 71%)
- Low platelet levels (62%)
- Higher liver enzyme levels in blood (up to 57%)
- Worse vision (53%)
- Low blood cell counts (up to 49%)
- Changes in protein and electrolytes levels in blood (up to 43%)
- High blood sugar levels (38%)
- Nausea (24%)
- Blurry vision (22%)
- Fever (22%)
- Chills, diarrhea, nausea, and other infusion-related reaction (21%)
- Tiredness (20%)
Less Common Side Effects
- Dry eyes
- Joint pain
- Back pain
- Lower appetite
- Diarrhea
- Constipation
Blenrep (belantamab) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious bleeds: bruising, nose bleeds, blood in urine, blood in stool, sudden and severe headache
The following Blenrep (belantamab) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Dryness or irritation of the eyes, eye pain, change in vision, sensitivity to light
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Infusion reactions—chest pain, shortness of breath or trouble breathing, feeling faint or lightheaded
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Low red blood cell level—unusual weakness or fatigue, dizziness, headache, trouble breathing
- New or worsening eye pain, redness, irritation, or discharge
- Unusual bruising or bleeding
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
Pros and cons of Blenrep (belantamab)
Pros
- Because it’s an antibody drug conjugate, it uses a more targeted, specific approach to get chemotherapy to cancer cells
- Each infusion only takes 30 minutes and is given every 3 weeks, so more convenient
- Doesn’t typically cause hair loss, a common side effect of many anticancer medications
Cons
- Commonly causes eye problems, which can be serious
- Only available through a special request program (not currently approved in the United States)
- Might cause infusion-related reactions, such as chills, fever, and nausea
Pharmacist tips for Blenrep (belantamab)
- You should use preservatives-free lubricant eye drops at least 4 times a day while you’re taking Blenrep (belantamab). This helps prevent dry eyes. Ask your provider which eye drop they recommend.
- Some people taking Blenrep (belantamab) experienced an infusion related reaction during treatment. If you have any symptoms such as itching, feeling hot, trouble breathing, or chest pain tell your nurse right away. They might need to pause your treatment or slow down the infusion. You might also need certain medications, such as diphenhydramine (Benadryl) or acetaminophen (Tylenol), before your next dose.
- Some Blenrep (belantamab) side effects, such as liver enzyme and electrolyte changes in your blood, are monitored with lab tests. It’s important you keep all appointments to get labs drawn as your provider recommends, so they can monitor for these side effects.
- Not all clinics or infusion centers are able to administer Blenrep (belantamab). Part of the REMS program requires the clinic to enroll in the program before they can give the medication. Your provider might need to refer you to a specific treatment center that’s registered to give Blenrep (belantamab).
- Females who are taking Blenrep (belantamab) shouldn’t breastfeed. We don’t know if Blenrep (belantamab) passes into human milk. But because of the risk of harm to the nursing infant, it’s best to avoid nursing if you’re taking Blenrep (belantamab) and for 3 months after the last dose.
Common questions about Blenrep (belantamab)
Not exactly. Blenrep (belantamab) is an antibody-drug conjugate, which means it’s a combination of a targeted therapy and chemotherapy. Unlike traditional chemotherapy medications, Blenrep (belantamab) doesn’t attack just any cell that’s growing quickly. Instead, the antibody part of Blenrep (belantamab) targets and binds to cells that have a specific protein called BMCA, like multiple myeloma cancer cells. Then, once the medication is bound to the specific cell, the chemotherapy can attack that cell.
A Risk Evaluation and Mitigation Strategy (REMS) program is a special prescribing program created by the FDA for medications that might cause serious side effects. Blenrep (belantamab) had a REMS program because it can cause serious eye problems. The REMS program included patient education and requires eye exams with an ophthalmologist before every dose. Keep in mind that the official Blenrep (belantamab) REMS program is no longer active because this medication has been discontinued in the United States. But if you are still receiving it through the compassionate use program, your provider will provide the same patient education and work with you closely to monitor for side effects.
People taking Blenrep (belantamab) might develop several types of eye problems. The most common is called keratopathy, or changes to the clear layer at the front of your eye (the cornea). Keratopathy can cause eye damage and blurry vision, though not everyone notice symptoms. Blenrep (belantamab) might also cause dry eyes, so your provider will recommend that you use a lubricant eye drop regularly during treatment. They might also recommend that you avoid wearing contacts during this time to prevent further eye damage or irritation. If you take Blenrep (belantamab), your provider will let you know about proper eye care and how often you need to come in for eye exams and check ups.
Yes, most people taking Blenrep (belantamab) had lower platelet levels in their blood, which can raise your risk for serious bleeds. Your provider will monitor your platelets while you’re taking Blenrep (belantamab). If they see a low platelet level on your lab results, you might need to pause Blenrep (belantamab) or start taking a lower dose. If you have any signs of low platelets, such as bruising, nose bleeds, or blood in your urine or stool, contact your provider right away.
No, Blenrep (belantamab) isn’t safe to take during pregnancy. It can cause harm to an unborn baby. Females who can have children should use effective birth control while taking Blenrep (belantamab) and for 4 months after the last dose. Males who are sexually active with a female who can have children should also use birth control such as condoms while taking Blenrep (belantamab) and for 6 months after the last dose.
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Risks and warnings for Blenrep (belantamab)
Blenrep (belantamab) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Serious eye problems
People taking Blenrep (belantamab) commonly develop eye problems, typically within the first 2 treatment cycles. The most common eye problem is called keratopathy, which results in changes to the thin clear layer at the front of your eye (the cornea). Sometimes this condition doesn’t cause symptoms, but sometimes it can cause serious vision changes where you can’t see as well and blurred vision. Blenrep (belantamab) might also cause dry eyes and a sensation that something is in your eye. You’ll need to see an ophthalmologist before each dose so they can check for vision changes even if you don’t have symptoms. Your provider will recommend that you use preservatives-free eye drops 4 times a day throughout treatment. Avoid wearing contact lenses, unless your ophthalmologist says it's safe to do so. Depending on how this medication affects your eyesight, you might not be able to drive. If you do experience eye problems, you might need to pause Blenrep (belantamab), take it at a lower dose, or stop taking it altogether.
REMS program
Because Blenrep (belantamab) can cause serious eye problems, it used to only be available through a special program called a Risk Evaluation and Mitigation Strategy (REMS). But since this medication has been withdrawn from the US market, this program is no longer available. If you’re receiving Blenrep (belantamab), your provider will give you more information about current safety programs.
Risk of bleeds (from low platelet levels)
Some people who receive Blenrep (belantamab) can develop low platelet counts in their body, typically within the first month of treatment. Platelets are the cells in your blood that form blood clots and prevent bleeding. So, when they’re low, your body can’t stop bleeding as well. Your provider will monitor your blood cell counts while you’re taking Blenrep (belantamab). If you have signs of low platelets such as bruising, nose bleeds, or blood in stool or urine, contact your provider right away. Your provider might need to stop, pause, or lower your dose of Blenrep (belantamab).
Infusion-related reactions
Some people receiving Blenrep (belantamab) developed an infusion reaction during their treatment. Symptoms of an infusion reaction might include itching, chills, chest pain or tightness, trouble breathing, and changes in blood pressure. Your nurse will monitor you during your infusion. If you have a reaction, your infusion might need to be paused, slowed down, or completely stopped depending on how severe your symptoms are. In addition, your provider will give you premedications for all future infusions to lower your risk of these reactions.
Harm to unborn baby
Blenrep (belantamab) hasn’t been studied in human pregnancy, but based on the way the medication works it can cause harm to an unborn baby or pregnancy loss (miscarriage). Your provider might require a negative pregnancy test before you start taking Blenrep (belantamab). Females who can get pregnant should use effective birth control while taking Blenrep (belantamab) and for 4 months after the last dose. Males who are sexually active with a female who can get pregnancy should use condoms while taking Blenrep (belantamab) and for 6 months after the last dose.
Blenrep (belantamab) dosage
Typical dosage for Blenrep (belantamab)
Your provider will determine your dose of Blenrep (belantamab) based on your body weight. The typical dose is 2.5 mg/kg given through the vein (intravenously) once every 3 weeks.
