Can pomalidomide improve multiple myeloma treatment?

This study looked at pomalidomide (Pomalyst) for patients with multiple myeloma (MM) which had returned after previous treatment. It found that adding pomalidomide to Vd (bortezomib, dexamethasone) led to better outcomes than Vd alone.

MM is a blood cancer in adults. Myeloma cells are cancerous versions of plasma cells, which create antibodies for the immune system. Patients with MM often have very high levels of antibodies, which can damage other organs including the kidneys. Myeloma cells can develop tumors in the bones, leading to pain and weakened bones. Myeloma cells also crowd out healthy blood cells from developing, which can increase the risk of infection.

There are a number of effective treatments for MM, which can greatly improve outcomes. A standard early treatment is lenalidomide (Revlimid). Lenalidomide works in multiple ways, including harming myeloma cells and reducing tumors’ supply of blood. Lenalidomide also aids the immune system in acting against myeloma cells.

However, MM is not currently curable, and the cancer eventually relapses (returns) for nearly all patients. Vd bortezomib, dexamethasone) is a treatment for relapsed MM. A previous study looked at whether adding pomalidomide (Pomalyst) to Vd can improve outcomes for relapsed MM. Pomalidomide is a relative of lenalidomide which may have stronger action against myeloma cells. Current research is promising that pomalidomide can improve outcomes for patients with relapsed MM.

Medications can have different results for patients in different countries. This may be due to genetic differences, differences in lifestyle, and different healthcare systems. It is not clear whether pomalidomide is equally effective in all regions.

This substudy included all patients enrolled in Japan, out of a larger trial conducted in multiple countries. The larger study included 566 patients. All of the patients had MM which had relapsed after at least one previous treatment. All patients had previously been treated with lenalidomide. Half of the patients received PVd (pomalidomide, bortezomib, dexamethasone). The other half received Vd without pomalidomide. The patients and their doctors knew which treatment was being used.

With 566 patients, the larger study found that pomalidomide lengthened the average time until the cancer relapsed from 7.1 to 11.2 months compared to Vd alone.

The current substudy included 17 patients from Japan. 12 patients received PVd, and 5 received Vd. Pomalidomide significantly lengthened the time until relapse for Japanese patients (17.6 vs. 4.4 months). All 12 Japanese patients treated with PVd responded to treatment. In comparison, 3 of the 5 patients treated with Vd responded to treatment.

Within the substudy, the most common serious side effect was low white blood cells (neutropenia). Half the patients treated with PVd had this side effect, while none of the Vd patients did. Other side effects included infection and tingling or numbness in the hands or feet.

This study found that pomalidomide improved outcomes for patients with relapsed MM, including patients from Japan.

The patients knew which treatment they received. This can influence how patients perceive their disease status. This study was funded by the manufacturer of pomalidomide.