How it is administered

Pomalidomide is taken by mouth as a capsule. It is available in 1 mg, 2 mg, 3 mg, and 4 mg capsules. The medication should be swallowed whole with water and should not be opened, broken, or chewed. It can be taken with or without food, once daily at about the same time each day. If you are on hemodialysis, take pomalidomide after your dialysis session on dialysis days.

How it works

Pomalidomide is a thalidomide analogue with immunomodulatory, antiangiogenic, and antineoplastic properties. It works by targeting a protein called cereblon, which is part of a complex that tags certain proteins for destruction inside cells. By promoting the breakdown of specific proteins (like Aiolos and Ikaros), pomalidomide can directly kill cancer cells and also change how the immune system responds to cancer.

Pomalidomide can help stop the growth of abnormal blood cells and encourage the immune system to attack cancer cells. It also reduces the production of certain substances (cytokines) that promote inflammation and cancer cell survival. In clinical studies, pomalidomide has shown effectiveness in patients whose disease has stopped responding to other treatments.

Who Should take it

Pomalidomide is approved for adults with multiple myeloma who have received at least two prior therapies, including lenalidomide and a proteasome inhibitor, and whose disease has progressed during or shortly after their last treatment. It is also approved for adults with Kaposi sarcoma after failure of antiretroviral therapy or for those who are HIV-negative.

While not specifically approved for myelofibrosis, pomalidomide is sometimes studied or used off-label in blood cancers where other treatments have failed. Always discuss with your doctor if pomalidomide is right for your specific condition.

Who should not take it

Pomalidomide should NOT be taken by women who are pregnant, as it can cause severe birth defects or death to an unborn baby. Women of childbearing potential must use two reliable forms of contraception and have regular pregnancy tests before, during, and after treatment. Men taking pomalidomide must use condoms during sex with women of childbearing potential and must not donate sperm.

People who have had severe allergic reactions (such as angioedema or anaphylaxis) to pomalidomide or any of its ingredients should not take this medication. Blood donation is not allowed during and for 4 weeks after stopping treatment.

Commonly used with

Pomalidomide is most commonly used in combination with dexamethasone, a steroid, for the treatment of multiple myeloma. In clinical trials, this combination has shown improved outcomes compared to dexamethasone alone.

Other supportive medications, such as blood thinners, may be used to reduce the risk of blood clots, depending on your risk factors.

Commonly tested with

Pomalidomide has been tested with dexamethasone in clinical trials for multiple myeloma. It has also been studied in combination with other agents, but the main approved and studied combination is with dexamethasone.

It is not recommended to combine pomalidomide with certain immune checkpoint inhibitors (like pembrolizumab) for multiple myeloma outside of clinical trials, as this has been associated with increased risk of death.