Emerging data have shown that pomalidomide can be effective in patients experiencing relapse on lenalidomide treatment with good activity, but that is not the whole story. Major side effects associated with most treatments for MM include pancytopenias, thromboembolic events, peripheral neuropathy, and infections, according to Ivan Borrello, MD, of the Johns Hopkins Kimmel Cancer Center in Baltimore, Maryland. “One major benefit of pomalidomide is that its hepatic metabolism limits excessive toxicity in patients with renal failure,” Dr Borrello told Hematology Advisor. “However, a side effect that needs to be [kept in mind] is the incidence of pneumonia compared with other therapies that does not appear to be dose dependent.”

Gary Schiller, MD, professor of hematology and oncology at the University of California at Los Angeles’ Jonsson Comprehensive Cancer Center, agreed that pomalidomide is well tolerated. However, he noted the starting dose can be high for some patients. “Many patients have been heavily pretreated and are at risk for neutropenia, and this is mildly suppressive. It seems to be better to dose low and titrate up,” Dr Schiller said in an interview with Hematology Advisor. He added that relapse is inevitable with MM, and it would be interesting to study pomalidomide as upfront management. “It hasn’t been studied there and it needs to be.”

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Dr Richter said that in many ways, the treatment landscape for MM is changing significantly because of pomalidomide and other emerging novel agents. “With lenalidomide-based regimens representing the current standard of care in the United States, pomalidomide-based regimens represent ideal salvage options given the extensive study of this drug in lenalidomide-refractory patients,” he said. “Exciting triplet combinations with drugs such as elotuzumab, daratumumab, and isatuximab offer many new and highly effective options. Many recent trials have evaluated the role of lenalidomide in the salvage space [but] these trials did not allow for lenalidomide-refractory patients. Pomalidomide offers proven activity in doublet and triplet [therapies] in lenalidomide-refractory patients.”

Disclosures: Some authors have declared affiliations with the pharmaceutical industry. Please refer to the original study for a full list of disclosures.

References

  1. Gay F, Mina R. Redefining the treatment paradigm for multiple myeloma [published online May 13, 2019]. Lancet Oncol. doi:10.1016/S1470-2045(19)30295-5
  2. Celgene receives CHMP positive opinions for both REVLIMID® (lenalidomide and IMNOVID® (pomalidomide)-based triplet combination regimens for patients with multiple myeloma [news release]. Summit, NJ: Celgene Corporation; March 29, 2019. https://ir.celgene.com/press-releases/press-release-details/2019/Celgene-Receives-CHMP-Positive-Opinions-for-Both-REVLIMID-lenalidomide-and-IMNOVID-pomalidomide-Based-Triplet-Combination-Regimens-for-Patients-with-Multiple-Myeloma/default.aspx. Accessed June 7, 2019.
  3. Richardson PG, Oriol A, Meral B, et al. Pomalidomide, bortezomib, and dexamethasone for patients with relapsed or refractory multiple myeloma previously treated with lenalidomide (OPTIMISMM): a randomised, open-label, phase 3 trial [published online May 13, 2019]. Lancet Oncol. doi:10.1016/S1470-2045(19)30152-4

This article originally appeared on Hematology Advisor