Thalidomide and its analogs, lenalidomide (CC-5013, Revlimid®, Celgene, NJ, USA) and pomalidomide (CC4047, Actimid™, Celgene, NJ, USA), belong to the family of IMiDs. Both lenalidomide and pomalidomide are more potent inhibitors of TNF-α and have better tolerability profile than thalidomide. Lenalidomide is the only IMiD approved by the FDA at present. Phase III clinical trials have established a role for thalidomide and lenalidomide in the treatment of MM at all stages of its natural history: newly diagnosed, transplant-eligible and -ineligible patients, relapsed myeloma and post-transplant maintenance. Lenalidomide is generally well tolerated, with primary AEs being myelosuppression and thromboembolic complications, which are manageable with dose modifications, G-CSF use and thromboprophylaxis. Pomalidomide is currently not FDA approved, and no Phase III trials have been conducted, but Phase II data show exciting activity including in patients refractory to lenalidomide, bortezomib or both.
Expert Rev Hematol. 2013;6(1):69-82. © 2013 Expert Reviews Ltd.