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 strengths. The capsules should be swallowed whole with water, and should not be opened, broken, or chewed. Pomalidomide can be taken with or without food, and it is usually taken once daily at about the same time each day. For patients on hemodialysis, it should be taken after dialysis on dialysis days.

How it works

Pomalidomide is an immunomodulatory medication, meaning it helps regulate the immune system. It is a thalidomide analogue with several actions: it boosts the immune system’s ability to fight cancer, blocks the growth of new blood vessels that tumors need to grow (antiangiogenic effect), and directly kills cancer cells (antineoplastic effect).

Pomalidomide works by targeting a protein called cereblon, which is part of a complex that tags certain proteins for destruction. When pomalidomide binds to cereblon, it leads to the breakdown of proteins that help cancer cells survive and multiply. This results in cancer cell death and a reduction in tumor growth. It also enhances the activity of immune cells like T cells and natural killer (NK) cells and reduces the production of inflammatory substances that can help cancer cells grow.

In multiple myeloma, pomalidomide is especially useful for patients whose disease has stopped responding to other treatments, including lenalidomide and proteasome inhibitors.

Who Should take it

Pomalidomide is indicated for adults with multiple myeloma who have already received at least two prior therapies, including lenalidomide and a proteasome inhibitor, and whose disease has worsened during or soon after the last treatment. It is used in combination with dexamethasone.

This medication is intended for patients whose myeloma is considered relapsed and refractory, meaning it has returned after previous treatments and is not responding to standard therapies. Your doctor will decide if pomalidomide is appropriate for you based on your treatment history and current health status.

Who should not take it

Pomalidomide should NOT be taken by:

• Women who are pregnant or may become pregnant, as it can cause severe birth defects or fetal death. Strict pregnancy prevention measures must be followed for both men and women of reproductive potential.
• Patients who have had severe allergic reactions (such as angioedema or anaphylaxis) to pomalidomide or any of its ingredients.

If you are of childbearing potential, you must have negative pregnancy tests before starting treatment and use two reliable forms of contraception. Men taking pomalidomide must use condoms during sexual contact with women of childbearing potential and must not donate sperm.

Commonly used with

Pomalidomide is most commonly used with dexamethasone, a steroid that helps reduce inflammation and can enhance the effectiveness of pomalidomide against multiple myeloma. In some cases, your doctor may combine pomalidomide and dexamethasone with other medications, depending on your specific situation and prior treatments.

Commonly tested with

In clinical studies for multiple myeloma, pomalidomide has been tested in combination with dexamethasone. It has also been studied with other agents, such as proteasome inhibitors (like bortezomib), but its FDA-approved use is primarily with dexamethasone for patients who have tried other therapies.