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Use of Generic Pomalidomide in India for Resistant Multiple Myeloma

By: Lauren Harrison, MS
Posted: Wednesday, April 7, 2021

The use of generic pomalidomide–based therapy has been effective and well tolerated among patients with relapsed or refractory multiple myeloma in India. These findings were published in JCO Global Oncology by Nevin Khattry, DM, of the Tata Memorial Hospital in Mumbai, India, and colleagues.

This group retrospectively analyzed 81 patients treated with generic pomalidomide for relapsed or refractory multiple myeloma at Tata Memorial Centre in Mumbai between May 2017 and March 2019. All patients included had completed at least one cycle of pomalidomide with subsequent follow-up response evaluation. Patients received a median of three prior lines of therapy and underwent a median of six pomalidomide cycles. Nearly all patients (96.3%) received prior bortezomib, and 82.7% received prior lenalidomide. However, 80.2% of patients were refractory to bortezomib, 76.5% were refractory to lenalidomide, and 59.3% were refractory to both agents.

The objective response rate among patients was 58.7%, with a median time to best response of 3 months. A complete response was seen in 6.7% of patients; a very good partial response, partial response, minimal response, stable disease, and progressive disease were seen in 17.3%, 34.7%, 5.3%, 5.3%, and 30.7% of patients, respectively. The median progression-free survival was 9.1 months, and overall survival was not reached. The median progression-free survival for patients who were refractory to lenalidomide and bortezomib was 5.5 months. In contrast, patients who were not refractory to these regimens had progression-free survival of 12.6 months.

The most common grade 3 or higher toxicities were hematologic, with 28.3% of patients experiencing anemia, 18.5% experiencing thrombocytopenia, and 16% experiencing neutropenia. Fatigue of any grade was seen in 27.2% of patients, and pneumonia was noted in 16% of patients. The leading causes of discontinuation of therapy were pulmonary embolism, grade 3 anemia, and worsening peripheral neuropathy. No patients died due to drug toxicity; however, three patients died within 1 month of pomalidomide initiation due to disease progression.

Disclosure: The authors reported no conflicts of interest.

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