[Madge Manfred]

Pomalyst for patient with kidney failure

by Madge Manfred on Thu Apr 03, 2014 7:05 pm

Pomalyst is chemically similar to Revlimid, which I have been taking for several months. It is nor recommended for patients with kidney failure because it has not been studied in that population. However, if it is chemically similar, why can't I try it? I would prefer it to Kyprolis, which requires infusion twice a week. Any thoughts or suggestions?

[Joy]

Re: Pomalyst for patient with kidney failure

by Joy on Fri Apr 04, 2014 2:43 pm

Hi Madge,

I'm not familiar with all of the recommendations for Pomalyst but when I googled it, I saw that it's okay for kidney patients (it doesn't specify the level of functioning). Have you spoken with your doctor? I wonder what the manufacturer says about it.

Good luck and best wishes

[Multibilly]

Re: Pomalyst for patient with kidney failure

by Multibilly on Fri Apr 04, 2014 5:30 pm

See Dr. Valent's comments.

https://myelomabeacon.org/news/2013/02/22/pomalyst-pomalidomide-which-multiple-myeloma-patients-will-physicians-treat-with-it/

Also look at the renal and hipatic section here:

http://reference.medscape.com/drug/pomalyst-pomalidomide-999809

Like you said, I believe the basic issue is that the correct Pomalyst dosing for those with renal insufficiency hasn't been established yet (unless there is a new, recent study on this subject). So, I think doctors are proceeding cautiously with this segment of the population.

I agree with Joy that you should discuss this with your doc. With careful monitoring, maybe it would be OK to proceed? (obviously, a doc needs to make this call).

[Dr. Craig Hofmeister]

Re: Pomalyst for patient with kidney failure

by Dr. Craig Hofmeister on Sat Apr 05, 2014 12:17 am

I think you should go ahead and feel free to use pomalidomide [Pomalyst] in renal insufficiency (mildly bad kidneys) and renal failure (bad kidneys). I often start with 2 mg of pomalidomide as a starting dose in relapsed myeloma, extrapolating on Martha Lacy's presentation of her phase 2 study that 2 mg of pomalidomide had the same response rate as 4 mg of pomalidomide when given days 1-21 of a 28 day cycle. Remember that pomalidomide's renal excretion is less than Revlimid, so you won't need to dose reduce nearly as much as you would for Revlimid. Go for it.

[Runette]

Re: Pomalyst for patient with kidney failure

by Runette on Wed Apr 08, 2015 8:54 am

Would it be ok to try Pomalyst if creatinine level is 4.3? All other blood levels are normal.

He has exhausted all other chemo options.

Thank you for your insight.

[JimNY]

Re: Pomalyst for patient with kidney failure

by JimNY on Wed Apr 08, 2015 9:46 am

What does your husband's doctor say about the option of Pomalyst, given his creatinine levels?

Section 8.7 of the the prescribing information for Pomalyst,

http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/204026s003lbl.pdf

says:

"Avoid Pomalyst in patients with a serum creatinine greater than 3.0 mg/dL."

However, there also was a study presented at ASH last December that concluded

"pomalidomide is now a standard for patients with relapsed/refractory multiple myeloma, and dosing should not be limited by renal or hepatic dysfunction."

https://ash.confex.com/ash/2014/webprogram/Paper76373.html

So I would say that this is still a somewhat unsettled issue. However, given that your husband has limited treatment options at this point, it probably is worth trying Pomalyst, perhaps at a reduced dose initially, as Dr. Hofmeister suggested above.

Please let us know what you decided to do, why, and how it works out. That sort of information will be helpful to others here in the forum who may be looking for information on this topic.

[Dr. Jason Valent]

Re: Pomalyst for patient with kidney failure

by Dr. Jason Valent on Wed Apr 08, 2015 4:32 pm

I will have to revise my comments from February of 2013.

I do now use Pomalyst in patients with more severe kidney impairment. There were several abstracts at ASH that documented the relative safety of this. My own experience is that, even with patients on dialysis, there is limited toxicity on the healthy blood counts, and Pomalyst seems well tolerated and effective in patients with more advanced kidney failure.

This is, of course, an "off-label" use of this drug, and some physicians may not be as comfortable with this. But largely I agree with Dr. Hofmeister.

[Tracy J]

Re: Pomalyst for patient with kidney failure

by Tracy J on Wed Apr 08, 2015 4:47 pm

It seems that often patients are often placed on an agent from each of two classes : the "mibs" and the thalidomide derivatives. Pomalyst (pomalidomide) is a thalidomide derivative, whereas Velcade (bortezomib) and Krypolis (carfilzomib) are in the other class. So isn't it possible, even likely, that a doctor would recommend BOTH Pomalyst AND either Velcade or Krypolis?

[Runette]

Re: Pomalyst for patient with kidney failure

by Runette on Wed Apr 08, 2015 5:48 pm

Thank all for the comments.
My husbands doctor said that his creatinine level was 4.3 and studies were that to be safe the level should be no higher than 3.0. He had prescribed Pomalyst and we had the medicine and then got the creatinine level results.

[TerryH]

Re: Pomalyst for patient with kidney failure

by TerryH on Wed Apr 08, 2015 7:35 pm

Hi Runette,

You've gotten some very good feedback. I think it would be worth having your husband's doctor reconsider whether Pomalyst will be okay for your husband.

Also, Tracy makes a good point about Pomalyst often being combined these days with either Velcade or Kyprolis (and dex). Of those two, Velcade is the one that is generally considered for myeloma patients who have kidney issues. There also has been a research paper that suggests Kyprolis may be okay in cases of kidney impairment,

http://www.nature.com/leu/journal/v27/n8/abs/leu201329a.html

However, there was an article here in the Beacon about the study that raised some issues about it:

https://myelomabeacon.org/news/2013/02/18/kyprolis-carfilzomib-multiple-myeloma-kidney-damage/

Whether or not Velcade or Kyprolis make sense for your husband will also depend, of course, on whether he has been treated with them before, and how recently that was.

Is your husband being seen by a doctor who is a myeloma specialist? It could be particularly helpful to your husband at this point to be under the care of a myeloma specialist. A doctor who who is focused on researching and treating myeloma is likely to be particularly good at coming up with creative ways to treat your husband's relapsed myeloma. Also, a specialist may be able to help your husband enroll in a clinical trial, where he could be treated with one of the promising new myeloma therapies still being researched.

Good luck!