Pomalidomide is a thalidomide analog and belongs to the class of immunomodulators. It is indicated for the treatment of multiple myeloma (MM) and Kaposi's 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 Timing of Administration
Multiple Myeloma (MM): It must 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's 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 a 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 a 28-day cycle, until disease progression or intolerable toxicity.
Precautions for Administration
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: If the absolute neutrophil count (ANC) is < 500/μL or febrile neutropenia occurs, suspend treatment; resume treatment at a reduced dosage of 1 mg after recovery.
KS Patients: If the ANC is < 1000/μL, suspend treatment; resume treatment at the original dosage after recovery. If neutropenia recurs, reduce the dosage by 1 mg.
Thrombocytopenia
MM Patients: If the platelet count is < 25,000/μL, suspend treatment; resume treatment at a reduced dosage of 1 mg after recovery.
Adjustment for Non-Hematologic Toxicity
Severe Skin Reactions: Such as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN), permanent discontinuation of treatment is required.
Hepatotoxicity: If elevated liver enzymes or symptoms of liver failure occur, suspend treatment; consider dosage reduction after recovery.
Adjustment for Drug Interactions
Strong CYP1A2 Inhibitors (e.g., fluvoxamine): Concomitant use should be avoided. If co-administration is necessary, reduce the dosage of pomalidomide to 2 mg.
Pomalidomide Use in Special Populations
Patients with Renal Impairment
MM Patients: Reduce the dosage to 3 mg per day, and take the medication after dialysis.
KS Patients: Reduce the dosage to 4 mg per day.
Patients with Hepatic Impairment
MM Patients: For mild to moderate hepatic impairment (Child-Pugh A/B), reduce the dosage to 3 mg per day; for severe hepatic impairment (Child-Pugh C), reduce the dosage to 2 mg per day.
KS Patients: For all degrees of hepatic impairment, reduce the dosage to 3 mg per day.
Pregnancy and Lactation
Contraindicated in Pregnancy: Pomalidomide can cause severe fetal malformations or fetal death. Two negative pregnancy tests are required before treatment initiation, and two forms of contraception must be used during treatment.
Lactation: Breastfeeding is prohibited during treatment.
