Treatment of Keratopathy Associated with Belantamab Mafodotin

Sagar Lonial, MD, FACP: Dr Klugo, I want to come back to some of the belantamab [mafodotin]-associated keratopathy. You mentioned the KVA [Keratopathy and Visual Acuity] scale as a way to measure severity. Are there any data on how to treat belamaf [belantamab mafodotin]-associated keratopathy? There were trials looking at corticosteroids, and there are doctors who still use corticosteroids for different reasons. Do you mind touching on that a little?

Karen L. Klugo, MD: Sure. My understanding is that corticosteroids don’t halt any type of progression or occurrence of the epithelial microcyst. In the first few patients in whom I saw them, I tried the steroid, and after a treatment or 2, they came back and had progression. There are other risks associated with steroids. They can increase cataracts and cause elevated intraocular pressure. Because all of the data and evidence that I saw related to the study showed no benefit, I had them discontinue the medication.

There’s definitely benefit to aggressive lubrication. These patients should use tears. I’m a very big stickler on the type of tears. I tell patients to avoid Visine products. It’s the first thing they reach for. Visine has all kinds of additives that can cause more irritation. My recommendation is to use a preservative-free artificial tear—the kind that comes packaged in individual vials—and to use them for a day and toss them out. Because there are no preservatives, they can get secondarily contaminated. Aggressive lubrication can mean as much as hourly for patients who are experiencing symptoms. Usually, I’ll start with 3 or 4 times a day. I usually say mealtime and bedtime—breakfast, lunch, dinner, and bedtime. Keep things lubricated and make sure the eyes are comfortable, and that’ll help any surface issues as well as with visual acuity to keep the tear film more regular.

Your relationship with the ophthalmologist, patient, and oncologist is extremely important in following the keratopathy and giving recommendations. What I do with any other patient is a slit lamp evaluation. I didn’t see any eye pressure issues and I don’t think any of the studies showed any problems, but I always check their eye pressure. At the baseline examination, I’ll do a complete dilated exam to rule out any other type of ocular abnormalities.

In a study, I had a patient who had visually significant cataracts. The patients who go on this therapy need to understand that cataract surgery is not a possibility in the time that they’re going through their treatment—at least not reasonably—because these epithelial microcysts can affect their measurements for cataract surgery and can change their corneal surface. I had a patient who ended up discontinuing therapy because of her significant keratopathy. It has subsequently resolved, and now she’s going to undergo cataract surgery that’s unrelated to her treatment. She just happened to have cataracts beforehand. Doing cataract surgery would be a significant challenge while on the treatment if they end up with these corneal findings.

Sagar Lonial, MD, FACP: What about patients who have had corneal transplants or wear contact lenses? What are your recommendations for those issues?

Karen L. Klugo, MD: Regarding contact lenses, that’s a good question. I would say they need to discontinue their contact lens wear during treatment. I haven’t run into that situation much. None of the studies included information on patients with prior corneal disease. Corneal transplants aren’t something that happen very regularly, but that would be a contraindication for a patient who has significant corneal disease to use this treatment.

Transcript edited for clarity.