Dr. Siegel on Pomalidomide in Lenalidomide-Refractory Patients With Myeloma

David M. Siegel, MD, PhD, chief of myeloma, John Theurer Cancer Center, professor of medicine, Hackensack Meridian Health, discusses the feasibility of using pomalidomide (Pomalyst) to treat patients with myeloma who have become refractory to lenalidomide (Revlimid).

When treating patients with myeloma, there is a traditional belief that once they become refractory to a drug, oncologists need to completely change classes of drugs for the next line of therapy—for example, going from an immunomodulatory agent to a proteasome inhibitor. A study presented at the 2018 ASH Annual Meeting challenged this dogma by assessing the efficacy of pomalidomide in patients who progressed on a lenalidomide-based regimen.

The trial suggested there was no detriment in doing this, and Siegel says the next steps are taking these patients and treating them with the commonly used regimen comprised of pomalidomide, corticosteroids, and daratumumab (Darzalex). Siegel adds that although these are early data in patients who have progressed on 1 or 2 prior lines of treatment, this is still potentially practice-changing.