All about pomalidomide. So pomalidomide is sold under the trade name pomalist in the United States. It's a drug that is given orally in multiple myeloma patients. The dose is four milligrams daily. It is one through 21 of 28 day cycle, which means you get it for three days and then you get a week break. Sometimes the dose of pomalist may need to be adjusted due to renal impairment or other side effects. Work with your health care provider to select a dose that is right for you. It is important to take pomalist at about the same time each day. Swallow the capsule whole. Do not open, break apart or chew your capsules. Pomalist may be taken with or without food. If you miss a dose, take it as soon as you remember it. If it has been less than 12 hours since your regularly scheduled time. If it has been more than 12 hours, then skip the missed dose. Never take two doses at the same time. If you take too much pomalist, call your doctor right away. What kind of drug is pomalist? It's an imid molecule, which means it's an immune modulating drug. The mechanism of action of this drug is very much similar to linoleumide, although this drug is more potent. It is more active. So it enhances the ability of immune system to identify cancer cells and also activates pathways within the malignant cells and leads to the cell death. It also causes anti-angiogenesis effects, which means it decreases the blood supply of tumor, eventually leading to cell death. Pomalidomide was first approved in the United States in 2013 in combination with dexamethasone. When is pomalist used? So currently this is used in patients who have relapsed refractory multiple myeloma. Pomalidomide can be used with dexamethasone alone as a two-drug combination regimen, and it is active in patients who are refractory to linoleumide. In relapsed and refractory patients, it is again combined with some other active anti-myeloma agents and it has a synergistic activity. It can be combined with daratumumab and dexamethasone. So this combination, which is called darapomdex, is very effective. It can be combined with another immunotherapy drug, which is elotuzumab. So combination elotuzumab, pomalidomide, and dexamethasone is also very effective. It is combined with proteasome inhibitors like carfilizumib and exazumib as well. And it is effective and used in combination with alkylating chemotherapy drug, which is called cyclophosphamide. So combination, which is cytokine, pomalidomide, and dexamethasone is also very effective. According to the NCCN guidelines, Velcade, pomdex, nenlaro pomdex, and newly approved sarcleza pomdex are preferred regimes in the relapsed and refractory setting. Darzalex pomdex, implicitly pomdex, pomcytoxin dex, and pomkyprolis dex are other recommended regimes. Additionally, selenexor pomdex may be useful in certain circumstances. In terms of side effect profile, the most common side effect that patients experience is fatigue and feeling tired. Dose modification is done if needed. Additionally, suggestions for managing fatigue and other side effects discussed in this video can be found in the patient solutions tool of Health Tree Cure Hub. Search on a specific side effect to find solutions that others have found helpful. These solutions have been provided by patients just like you. You can also filter side effects by an individual drug or combination of drugs. When filtering on a combination of drugs, keep in mind it might not always be clear which drug is creating which side effect. It can cause diarrhea. Diarrhea can affect the quality of life, so it's very important to address that as soon as possible. Patients can use over-the-counter antidiarrheal medications like Imodium to control the diarrhea. Pormalidomide also probably interferes with bile acid malabsorption in the intestine, and this is one of the mechanisms through which it causes diarrhea. So using bile acid sequestrants like cholesterolamine can help some patients as well. Always hydrate yourself to make sure that you're not getting dehydrated. One of the most common side effects of Imodium is rash and itching. So this is a side effect that can scare the patients. Rash appears as reddish spots. It can start from your body or it can start on your arms or legs. It can spread. There can be itching associated with rash. It has something to do with the immunomodulating action of IMIDs. In my patients, I never give up on IMIDs because of rash. If the patient has mild rash, which means that you have some spots on your arms and your body, then I add antihistamine drugs like citrazine during the daytime or banadryl at night and able to control the rash. If the rash is severe, which means that it involves most of your body and is itching a lot, then I hold IMID drug for a week or so until the rash improves and add citrazine or banadryl at night as well as steroids like shark course of prednisone. Once the rash improves, I re-challenge with the same drug. I re-challenge with linalidamide or pomalidamide and tell the patient that when you restart your IMID molecule drug, add citrazine or banadryl with it and take it together for a few weeks and then see what happens. Some patients develop rash again and I go through the same cycle again. But eventually patients develop tolerance and are able to take the drug without rash. It can also cause myelgia and joint aches and pains and muscle cramps. Hydrate yourself. Make sure that your electrolytes are properly replenished. That helps. Pomalidamide can cause myelosuppression, which means it can lower blood cell count. It can decrease white cell count. It can cause anemia as well as low platelet count. Patients if needed get a transfusion of platelets and blood products and growth factor injections can be used to improve the white cell count, platelet count as well as improve anemia. Use of pomalidamide is associated with increased risk of second malignancies. So make sure that you are getting your age appropriate cancer screening. This drug can cause embryonal and fetal toxicity. It is always distributed through a program which is called REMS in the United States. Patients, provider and pharmacy have to go through this program and make sure that a proper form of contraception is taken if the patient is in a fertility age group. This medication is relatively better tolerated in patients who have renal disease as compared to linalidamide. It is important to know that pomalist can cause fetal harm when administered to a pregnant woman and is contraindicated in pregnant females or females capable of becoming pregnant. To avoid embryo-fetal exposure, pomalist is only available under a restricted distribution program called Pomalist Risk Evaluation and Mitigation Strategy or Pomalist REMS program. There are special requirements for men and women in the program. Any prescribers and pharmacies certified by the Pomalist REMS program can prescribe and dispense pomalists to patients who are enrolled and meet all the conditions of the Pomalist REMS program. The goals of the Pomalist Risk Evaluation and Mitigation Strategy are as follows. To prevent the risk of embryo-fetal exposure to pomalists, to inform prescribers, patients and pharmacists on the serious risks and safe use conditions for pomalists, you can take your mandatory confidential patient survey at CellgeneRiskManagement.com. According to the Pomalist prescribing instructions found on Pomalist.com, patients with severe renal impairment requiring dialysis must go below the normally recommended dosage to 3 milligrams orally daily. These patients should take their dose of pomalist following hemodialysis on hemodialysis days. In patients who are elderly and fragile, I start with a lower dose, which is 2 milligrams, and if the patient tolerates okay, then I go up to 4 milligrams. Using pomalidomide can also increase the risk of having infections. The patient needs to be monitored very closely for signs and symptoms of infection. We can prevent infections by making sure that the patient has received appropriate vaccinations like flu shot and pneumonia shot. If the patient is getting recurrent bacterial infections and other severe infections, then we use intravenous immunoglobulins, which is a blood product containing antibodies and prevents infections in patients with hemolygnancies. And if the patient gets infection, they need to be treated with appropriate antibiotics to overcome the infection. Pomalidomide, especially when used in combination with dexamethasone and other anti-myeloma therapy, increases the risk of having blood clots. Blood clots can be both arterial or venous, and it can be life-threatening. Your doctor should talk to you about prophylaxis to prevent these blood clots. Prophylaxis can be with antiplatelet drugs like aspirin. Or in selected patients who are at high risk of having blood clots, they should receive anticoagulation with Luvinox or Alequis or other agents. What time of day should you take pomalist? Immits, lenalidomide or pomalidomide can make you feel fatigued and tired. So I always tell my patients, take it at night before you go to bed. If you are taking steroids with imits, you can take steroids during the daytime early morning because steroids can interfere with sleep. Cellgene patient support provides patients with information about the insurance approval process and the financial help that may be available. Programs that may be available to help with the cost of your Cellgene medicine differ by the type of insurance you have. Even if you don't have insurance or enough coverage to pay for your medicine, financial help may be available. Fast-track for first prescription may be available to help eligible patients receive their first prescription faster. You can call a Cellgene patient support specialist at 1-800-931-8691 or by visiting their website.
