[Joe Courtney]

Dealing with nausea side effect of Revlimid and pomalidomide

by Joe Courtney on Mon May 02, 2011 2:28 pm

After SCT and 30 months remission without any maintenance treatment, my myeloma began to come back. We started with 10 mg Revlimid for 21 days with 20 mg dex on first day of each week and one week off for each cycle. After two cycles I began to feel great discomfort from nausea which we attributed to the Revlimid. We changed it to two weeks on and two weeks off and still the nausea returned. Finally lowered dose to 5 mg. for 3 weeks on and one week off. Same results. Now a year later and with m -spike going up to 2.7 and igg at 4300 I was accepted for compassionate care trial with pomalidomide [Pomalyst]. I take 2 mg every single day with 20 mg. dex on first day of the week. I am 5 weeks into this and starting to feel a similar, but not quite as extreame nausea. I notice that taking the dex gives me a repreive from the nausea, and I take half of it on two seperate days. I am worried what will happen when I reach maximum response from this and am no longer on the dex. I worry that the maintenance dose of pomalidomide without any dex will bring unbearable nausea. I take ondansetron 8mg one pill every 12 hours for nausea and cannot really tell if it helps. Does anyone have experience with this issue and any suggestions?

[Dr. Edward Libby]

Re: Dealing with nausea side effect of Revlimid and pomalido

by Dr. Edward Libby on Fri May 06, 2011 4:57 pm

Hi Joe !
This is an unusual side effect because severe nausea is rarely seen with Thalidomide, Revlimid, or pomalidomide. However, every patient is different and side effects like this are crippling. In addition, we need to deliver the therapy on time and on schedule (pomalidomide) so that hopefully you can benefit from this new drug.
Dexamethasone can help patients to prevent acute and delayed chemotherapy induced nausea. It is used routinely for this purpose. Of course dex has its own set of side effects but you are respondng to it so you should continue to use it. I think the frequency and/or dosage of the dexamethasone should be increased. Although the compassionate use trial may recommend that dexamethasone be minimized if possible ( this would be done to try and determine the "pure" effect of the pomalidomide) I suspect that the investigator (your oncologist) may be able to contact the company to explain the reasons for your use of steroids so that recommendation could be bypassed.
Other antinausea medicications should be tried alone or added to the ondansetron since the ondansetron does not seem to be helping. My first choice would be Emend (aprepitant).