Pomalidomide. A last-line treatment option for multiple myeloma

Treatment options for multiple myeloma dwindle with each relapse. There is no standard treatment for patients who relapse. Pomalidomide, an analogue of thalidomide and lenalidomide, has been authorised in the EU for the treatment of relapsed and refractory multiple myeloma after at least two previous lines of treatment including lenalidomide and bortezomib. Clinical evaluation of pomalidomide in this setting is based on an unblinded controlled trial in 455 patients who had already received several treatments, including lenalidomide. Nearly one-third of the patients were refractory to thalidomide.The patients were assigned to either high-dose dexamethasone or pomalidomide + low-dose dexamethasone. Pomalidomide prolonged median survival by at least 3 months. It has not been compared to thalidomide. The known adverse effects of pomalidomide include peripheral neuropathy, venous thrombosis, cutaneous disorders and neutropenia. Few cardiac disorders have been reported. Some drug-drug interactions can result in pomalidomide overdose. Pomalidomide is teratogenic. In practice, despite its adverse effects, third-line treatment with pomalidomide is an option for some patients who want to prolong survival by a few weeks: when myeloma is refractory to lenalidomide and thalidomide and their adverse effects were acceptable.