Pomalidomide is a thalidomide analog classified as an immunomodulator. It is indicated for the treatment of multiple myeloma (MM) and Kaposi sarcoma (KS). Its use must strictly adhere to the principle of individualization, and attention should be paid to contraindications such as embryotoxicity and thromboembolic risk.
How to Use Pomalidomide
Indications and Administration Timing
Multiple Myeloma (MM): It should be used in combination with dexamethasone, and is indicated for adult patients whose disease has progressed after receiving at least two prior lines of treatment (including lenalidomide and a proteasome inhibitor).
Kaposi Sarcoma (KS): It is used for HIV-positive patients who have failed highly active antiretroviral therapy (HAART), or for the treatment of HIV-negative patients.
Dosage and Administration Regimen
Recommended Dosage for MM: 4 mg orally once daily, administered on Days 1 to 21 of each 28-day cycle, until disease progression. It must be combined with dexamethasone (40 mg/20 mg, adjusted according to age).
Recommended Dosage for KS: 5 mg orally once daily, administered on Days 1 to 21 of each 28-day cycle, until disease progression or unacceptable toxicity.
Administration Precautions
Swallow Whole: Capsules must not be broken, chewed, or crushed.
With or Without Food: Food does not affect absorption, but a high-fat meal may delay the time to reach peak plasma concentration.
Dialysis Patients: The medication should be taken after the completion of dialysis.
Dosage Adjustment of Pomalidomide
Neutropenia
MM Patients: Discontinue treatment if the absolute neutrophil count (ANC) is < 500/μL or febrile neutropenia occurs; resume treatment at a reduced dose of 1 mg after recovery.
KS Patients: Discontinue treatment if ANC is < 1000/μL; resume treatment at the original dose after recovery. If neutropenia recurs, reduce the dose by 1 mg.
Thrombocytopenia
MM Patients: Discontinue treatment if platelets are < 25,000/μL; resume treatment at a reduced dose of 1 mg after recovery.
Adjustment for Non-Hematologic Toxicities
Severe Skin Reactions: Such as Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN) require permanent discontinuation of pomalidomide.
Hepatotoxicity: Discontinue treatment if elevated liver enzymes or signs of liver failure occur; consider dose reduction when resuming treatment after recovery.
Adjustment for Drug Interactions
Strong CYP1A2 Inhibitors (e.g., fluvoxamine): Avoid concurrent use. If co-administration is unavoidable, reduce the dose of pomalidomide to 2 mg.
Pomalidomide Use in Special Populations
Patients with Renal Impairment
MM Patients: Reduce the dose to 3 mg per day, and administer the medication after dialysis.
KS Patients: Reduce the dose to 4 mg per day.
Patients with Hepatic Impairment
MM Patients: For mild to moderate hepatic impairment (Child-Pugh A/B), reduce the dose to 3 mg per day; for severe hepatic impairment (Child-Pugh C), reduce the dose to 2 mg per day.
KS Patients: For all degrees of hepatic impairment, reduce the dose to 3 mg per day.
Pregnancy and Lactation
Contraindication in Pregnancy: Pomalidomide can cause severe fetal malformations or fetal death. Two negative pregnancy tests are required before initiating treatment, and two forms of contraception must be used during treatment.
Lactation: Breastfeeding is prohibited during pomalidomide treatment.
