Evidence For Pomalidomide In 2nd Line Treatment Of Relapse Refractory Multiple Myeloma

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Multiple myeloma (MM) is the second most common hematologic malignancy in the United States (US). MM is an uncurable disease and current treatments are meant to delay progression and extend patient’s lives. Pomalidomide is used to treat patients with relapsed or refractory (RR) MM that have failed two prior therapies including lenalidomide and bortezomib. The goal of this paper is to critically summarize the available evidence on the use of pomalidomide in 2nd line treatment of RRMM. 2 studies were identified that explored the use of pomalidomide in the 2nd line setting. One study used Flatiron electronic health record (EHR) data from January 1, 2011 to March 31, 2018 comparing the use of pomalidomide regimens following lenalidomide treatment vs non-pomalidomide regimens following lenalidomide treatment in RRMM patients. The Flatiron EHR study measured baseline characteristics, persistence, and time to discontinuation. A second study used case report forms (CRFs) collected from community oncology centers across the US and compared 2nd line of therapy (LOT) pomalidomide use following lenalidomide induction vs 2nd LOT non-pomalidomide use following lenalidomide induction in RRMM patients. The Flatiron EHR study showed that 36% of pomalidomide use was in 3rd LOT or greater while only 22% of non-pomalidomide use was in 3rd LOT or greater. Flatiron EHR also showed pomalidomide patients had better persistence compared to non-pomalidomide (222 days vs 161 days; p<0.0001). The CRF study showed that pomalidomide patients had better response (≥ very good partial response) to therapy than non-pomalidomide (78.6% vs 51.7%;P<0.0001). These studies suggest that pomalidomide use is associated with better clinical outcomes for patients. However, these studies failed to consider the economic and quality of life implications associated with pomalidomide use and further research into these topics is needed before pomalidomide should be suggested over non-pomalidomide in 2nd LOT treatment.



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