Pomalidomide in Refractory Multiple Myeloma

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Pomalidomide is a third-generation immunomodulatory drug approved by the FDA for multiple myeloma, specifically for patients who experience disease progression after treatment with at least 2 prior therapies including lenalidomide or bortezomib. Noopur Raje, MD, Sagar Lonial, and Ann McNeill, RN, APN, state that pomalidomide is a relatively well tolerated drug. Also, pomalidomide is available as a pill formulation, which has advantages for patients in terms of convenience, comment Raje and Lonial.

McNeill remarks that an adverse event that occurs in most patients is fatigue, which can be either related to the disease or a medication-related adverse event, and can be brought on by anemia, dehydration, or depression. McNeill also notes that thrombocytopenia is commonly seen with proteasome inhibitors and neutropenia with immunomodulatory drugs. Other common adverse events include diarrhea, constipation, and peripheral neuropathy.

Compared with older agents, the newer immunomodulatory drugs seem to have an improved toxicity profile, remarks Raje. She explains that whereas with higher doses of thalidomide, many patients experienced neuropathy and constipation, lenalidomide is associated with less neuropathy and constipation, and pomalidomide is generally well tolerated. McNeill comments that discontinuation of pomalidomide is usually due not due to intolerable toxicity but rather due to disease progression.

Neutropenia seems to be the most common hematologic toxicity that occurs with pomalidomide, states McNeill; however, the neutropenia is manageable. Patients are monitored frequently for blood counts, and the dose of pomalidomide may be adjusted if neutropenia persists. Patients are also monitored for neuropathy. Lonial notes that thrombosis prophylaxis is another consideration for patients on pomalidomide therapy.