How it is administered

Pomalidomide is taken by mouth as a capsule. It comes in 1-mg, 2-mg, 3-mg, and 4-mg strengths for multiple myeloma, and a 5-mg dose is used for Kaposi sarcoma.

You should swallow the capsule whole with water, without breaking, chewing, or opening it. Pomalidomide can be taken with or without food, and it's usually taken once daily at about the same time each day. If you are on hemodialysis, take pomalidomide after your dialysis session on those days.

How it works

Pomalidomide is an immunomodulatory drug, closely related to thalidomide. It works by targeting a protein called cereblon, which is part of a complex that helps regulate the breakdown of certain proteins in cells. When pomalidomide binds to cereblon, it leads to the destruction of proteins that help cancer cells survive, such as Aiolos and Ikaros.

This action results in several effects: it directly kills cancer cells (especially in blood cancers like multiple myeloma), enhances the immune system's ability to attack cancer (by boosting T cell and natural killer cell activity), and reduces the production of substances that promote inflammation and cancer growth. Pomalidomide also prevents the growth of new blood vessels that tumors need to grow (antiangiogenic effect). These combined effects make it effective for treating certain blood cancers, especially when other treatments have stopped working.

Who Should take it

Pomalidomide is mainly used to treat adults with multiple myeloma, a type of blood cancer, who have already tried at least two other therapies (including lenalidomide and a proteasome inhibitor) and whose disease has worsened. It is also approved for adults with Kaposi sarcoma, either related to AIDS (after failure of antiretroviral therapy) or in HIV-negative patients.

If you have multiple myeloma and your cancer has come back or stopped responding to other treatments, pomalidomide (usually combined with dexamethasone) may help slow disease progression and improve survival. For Kaposi sarcoma, pomalidomide is an option when standard treatments are not effective.

Who should not take it

You should not take pomalidomide if you are pregnant, as it can cause severe birth defects or death to an unborn baby. Women who are able to become pregnant must use strict birth control and have regular pregnancy tests before, during, and after treatment. Men taking pomalidomide must also use condoms during sex with women who could become pregnant, even if they have had a vasectomy, and must not donate sperm.

Pomalidomide is also contraindicated if you have had a severe allergic reaction (such as angioedema or anaphylaxis) to pomalidomide or any of its ingredients. If you have severe liver or kidney problems, your doctor may need to adjust your dose or monitor you more closely. Children should not take pomalidomide, as its safety and effectiveness have not been established in pediatric patients.

Commonly used with

In blood cancers, especially multiple myeloma, pomalidomide is most commonly used together with dexamethasone, a steroid that helps reduce inflammation and can also help fight cancer. Sometimes, it may be combined with other supportive medications, such as blood thinners to prevent clots, or antibiotics if you are at risk for infections.

Your doctor will decide on the best combination based on your individual situation and previous treatments.

Commonly tested with

Pomalidomide has been tested in combination with dexamethasone in clinical studies for multiple myeloma. It has also been studied with other agents, such as proteasome inhibitors (like bortezomib or carfilzomib), and sometimes with monoclonal antibodies in research settings. However, its main approved and tested combination for blood cancers is with dexamethasone.