Pomalidomide for Treatment of Relapsed and Refractory Multiple Myeloma

Pomalidomide is a third-generation immunomodulatory drug recommended for patients with multiple myeloma refractory to lenalidomide and bortezomib. The safety profile is optimized for application in patients with intensive and continuous anti-tumor treatment. Pomalidomide was approved by the Food and Drug Administration (FDA) and by the European Medicines Agency (EMA) in 2013 for use in patients with relapsed and refractory MM who have received at least two prior therapies, including lenalidomide and bortezomib, and have demonstrated disease progression on their last therapy or within 60 days after completion of the last therapy. Registration of pomalidomide for similar indications in Russia is pending in 2015. Pomalidomide has a similar mechanism of action with the other immunomodulators. The drug produces a direct cytostatic effect and causes an indirect effect by affecting the bone marrow microenvironment and T/NK-cells immunity. The recommended starting dose of pomalidomide is 4 mg daily (1–21/28) combined with low-dose dexamethasone 40 mg weekly for young patients or 20 mg for patients older than 75 years. The treatment should be performed till disease progression or unacceptable toxicity. This review summarizes current recommendations for dose adjustment depending on tolerance and prevention of thrombotic complications. The article presents author’s own clinical experience of successful application of pomalidomide for the management of a patient at high cytogenetic risk with «double» refractoriness to lenalidomide and bortezomib and preceding intensive anti-tumor treatment. The life expectancy was about 16 months after initiation of pomalidomide; this fact is consistent with literature data.