2013年2月8日，美国食品药品管理局FDA批准Pomalyst(pomalidomide)用于其它癌症药物治疗后病情仍有进展的多发性骨髓瘤患者的治疗。 多发性骨髓瘤起因于骨髓中的浆细胞，属血癌的一种，主要影响老年人有。根据美国国家癌症研究所提供的信息，每年大约有21700名美国人被诊断为多发性骨髓瘤，并且会有10710人死于该种疾病。 Pomalyst 泊马度胺 通过调节人体免疫系统破坏癌细胞，抑制癌细胞的生长。该药物用于先前至少接受过包括来那度胺和硼替佐米在内的两种药物治疗的患者，患者已对药物没有响应，并在60天的治疗期内病情仍有发展（复发和难以治疗）。 “Pomalyst 泊马度胺 是包括来那度胺和沙利度胺在内的第三个免疫调节剂类药物， 也是过去一年来第二个被批准用于治疗多发性骨髓瘤的药物，”FDA药物评价和研究中心血液和肿瘤产品办公室主任Richard Pazdur医学博士说。“对于多发性骨髓瘤的治疗要通过调整以满足个体患者的要求，今天Pomalyst 泊马度胺 的获批给对其它药物不起响应的患者提供了另一种治疗选择。” Pomalyst泊马度胺 的安全性和有效性通过221名复发或难治性多发性骨髓瘤患者参与的临床试验进行评价。临床试验的目的是检测使用该药物治疗之后（目标反应率，或ORR），癌症完全或部分消失的患者数量。 结果显示，单纯使用Pomalyst 泊马度胺 治疗的患者目标反应率为7.4%。但患者对该药物的持续响应时间仍未达到中位值。Pomalyst泊马度胺加低剂量地塞米松治疗的患者目标反应率为29.2%，平均响应时间为7.4个月。 Pomalyst泊马度胺有一个黑框警告，提醒患者和医护专业人员该药不能用于孕妇，因为该药物能引起严重致命性的出生缺陷，另外该药物还能引起血血栓。 由于Pomalyst泊马度胺的胚胎-胎儿风险，该药物只能通过Pomalyst泊马度胺风险评估与控制策略(REMS)程序才能使用。该药物处方必须进行登记并符合风险评估与控制策略的要求，并通过Pomalyst泊马度胺 REMS鉴定。患者必须签有医患协议并遵守REMS的要求。特别指出的是没有怀孕但能成为孕妇的女性患者必须进行妊娠检查并采取避孕措施，男性必须遵守避孕要求。药房必须通过Pomalyst 泊马度胺 REMS程序认证，必须把药物配发给获得授权可以使用该药物的患者，必须遵守REMS要求。来那度胺和沙利度胺也有类似的REMS。 该药物常见的副作用包括能使抗击感染的白细胞减少（嗜中性粒细胞减少症）、疲劳和虚弱、红细胞计数降低（贫血）、便秘、腹泻、血小板计数降低（血小板减少症）、上呼吸道感染、背部疼痛和发烧。 作用机制 Pomalidomide，一种沙利度胺类似物，也是一种有抗肿瘤活性.免疫调节剂。 在体外细胞学试验，pomalidomide抑制造血肿瘤细胞增殖和诱导凋亡。此外，pomalidomide 抑制来那度胺-耐药多发性骨髓瘤细胞株的增殖和在来那度胺-敏感和来那度胺-耐药细胞株与地塞米松协同诱导肿瘤细胞凋亡。Pomalidomide增强T细胞-和天然杀伤(NK)细胞介导的免疫和抑制单核细胞促炎性细胞因子的生成(如，TNF-α和IL-6)。在小鼠肿瘤模型和和体外脐带模型中Pomalidomide显示抗血管生成活性。 适应证和用途 POMALYST是一种沙利度胺类似物适用为有多发性骨髓瘤患者曾接受至少两种既往治疗包括来那度胺[lenalidomide]和硼替佐米[bortezomib]和已证实疾病进展或末次治疗完成60天内。批准是根据反应率。尚未证明临床获益，例如改善活存或症状。 剂量和给药方法 重复28天疗程在第1-21天每天口服4mg直至疾病进展。 不良反应： 白细胞(中性粒细胞)减少、疲劳和虚弱、红细胞计数降低(贫血)、便秘、腹泻、血小板减少下降(血小板减少症)、上呼吸道感染、背部疼痛和发烧。 POMALYST(pomalidomide capsules) General Information Pomalyst(pomalidomide) is an immunomodulatory antineoplastic agent. It inhibits proliferation and induces apoptosis of hematopoietic tumor cells, enhances T cell- and natural killer cell-mediated immunity and inhibits production of pro-inflammatory cytokines by monocytes. Pomalyst is specifically indicated for patients with multiple myeloma who have received at least two prior therapies including lenalidomide and bortezomib and have demonstrated disease progression on or within 60 days of completion of the last therapy. Pomalyst is supplied as a capsule for oral administration. The recommended starting dose is 4 mg once daily orally on Days 1-21 of repeated 28-day cycles until disease progression. It should be taken without food (at least 2 hours before or 2 hours after a meal). Pomalyst may be given in combination with dexamethasone POMALYST Leukemias, lymphomas, and other hematologic cancers  Only 4 drugs may be compared at once Generic Name and Formulations: Pomalidomide 1mg, 2mg, 3mg, 4mg; caps. Company: Celgene Corp Indications for POMALYST: In combination with dexamethasone for multiple myeloma, in patients who have received at least two prior therapies (including lenalidomide and a proteasome inhibitor), and have shown disease progression on or within 60 days of completion of the last therapy. Adult: Swallow whole; may be taken with water (with or without food). 4mg once daily on Days 1–21 of repeated 28-day cycles until disease progression; give with dexamethasone. Concomitant strong CYP1A2 inhibitors: consider alternatives, if necessary, reduce Pomalyst dose by 50%. Severe renal impairment requiring dialysis: initially 3mg daily; give dose after dialysis session on hemodialysis days. Hepatic impairment (mild or moderate): initially 3mg daily; (severe): 2mg daily. Dose modification for hematologic and other Grade 3/4 toxicities: see full labeling. Children: <18yrs: not established. Contraindications: Pregnancy (Cat.X): avoid during and for at least 4 weeks after completing therapy. Warnings/Precautions: Females of reproductive potential must commit either to abstain from heterosexual sex or to use two methods of reliable contraception, beginning 4 weeks prior to initiating, during therapy, dose interruptions and for 4 weeks after discontinuation. Obtain two negative pregnancy tests prior to initiating therapy: perform first test within 10–14 days, and second test within 24hrs prior to prescribing, and then weekly during first month, then monthly thereafter in women with regular menstrual cycles or every 2 weeks if irregular cycles. Males: must use latex or synthetic condom during therapy and up to 28 days after discontinuing, even after successful vasectomy; do not donate sperm. Patients must not donate blood during therapy and for 1 month after discontinuation. Venous and arterial thromboembolism; consider anticoagulation prophylaxis. Monitor for hematologic toxicities (esp. neutropenia); obtain CBCs weekly for first 8 weeks and monthly thereafter; may need dose interruption and/or modification. Hepatic or severe renal impairment on hemodialysis: adjust doses (see Adults). Monitor LFTs monthly; discontinue and evaluate if elevated liver enzymes occur; consider using lower dose when restarting. Risk of second primary malignancies. High tumor burden (monitor). Discontinue if angioedema, skin exfoliation, bullae, or other severe dermatologic reactions occur; do not restart. Nursing mothers: not recommended. Interactions: Potentiated by strong CYP1A2 (eg, ciprofloxacin, fluvoxamine), CYP3A or P-gp inhibitors (eg, ketoconazole); avoid. May be antagonized by strong CYP1A2 or CYP3A (eg, carbamazepine) inducers. Smoking may reduce efficacy. Pharmacological Class: Immunomodulator. Adverse Reactions: Fatigue, asthenia, neutropenia, anemia, constipation, nausea, diarrhea, dyspnea, upper-respiratory tract infections, back pain, pyrexia; thromboembolism, dizziness, confusion, neuropathy, pneumonia, thrombocytopenia, tumor lysis syndrome. Note: Available only through Pomalyst REMS program. REMS: YES Generic Availability: NO How Supplied: Caps—21, 100 POMALYST® (pomalidomide) is indicated for patients with multiple myeloma whohave received at least two prior therapies including lenalidomide and bortezomib and have demonstrated disease progression on or within 60 days of completion of the last therapy. Approval is based on response rate. Clinical benefit, such as improvement in survival or symptoms, has not been verified. Important Safety Information WARNING: EMBRYO-FETAL TOXICITY and VENOUS THROMBOEMBOLISM Embryo-Fetal Toxicity •POMALYST is contraindicated in pregnancy. POMALYST is a thalidomide analogue. Thalidomide is a known human teratogen that causes severe birth defects or embryo-fetal death. In females of reproductive potential, obtain 2 negative pregnancy tests before starting POMALYST treatment •Females of reproductive potential must use 2 forms of contraception or continuously abstain from heterosexual sex during and for 4 weeks after stopping POMALYST treatment POMALYST is only available through a restricted distribution program called POMALYST REMS™. Venous Thromboembolism •Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE) occur in patients with multiple myeloma treated with POMALYST. Prophylactic anti-thrombotic measures were employed in the clinical trial. Consider prophylactic measures after assessing an individual patient’s underlying risk factors  CONTRAINDICATIONS: Pregnancy •POMALYST can cause fetal harm and is contraindicated in females who are pregnant. If this drug is used during pregnancy or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to a fetus •Pomalidomide is a thalidomide analogue and is teratogenic in both rats and rabbits when administered during the period of organogenesis WARNINGS AND PRECAUTIONS Embryo-Fetal Toxicity •Females of Reproductive Potential: Must avoid pregnancy while taking POMALYST and for at least 4 weeks after completing therapy. Must commit either to abstain continuously from heterosexual sexual intercourse or to use 2 methods of reliable birth control, beginning 4 weeks prior to initiating treatment with POMALYST, during therapy, during dose interruptions and continuing for 4 weeks following discontinuation of POMALYST therapy. Must obtain 2 negative pregnancy tests prior to initiating therapy •Males: Pomalidomide is present in the semen of patients receiving the drug. Males must always use a latex or synthetic condom during any sexual contact with females of reproductive potential while taking POMALYST and for up to 28 days after discontinuing POMALYST, even if they have undergone a successful vasectomy. Males must not donate sperm •Blood Donation: Patients must not donate blood during treatment with POMALYST and for 1 month following discontinuation of the drug because the blood might be given to a pregnant female patient whose fetus must not be exposed to POMALYST POMALYST REMS Program Because of the embryo-fetal risk, POMALYST is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called “POMALYST REMS.” Prescribers and pharmacists must be certified with the program; patients must sign an agreement form and comply with the requirements. Further information about the POMALYST REMS program is available at [celgeneriskmanagement.com] or by telephone at. Venous Thromboembolism: Patients receiving POMALYST have developed venous thromboembolic events reported as serious adverse reactions. In the trial, all patients were required to receive prophylaxis or antithrombotic treatment. The rate of DVT or PE was 3%. Consider anticoagulation prophylaxis after an assessment of each patient’s underlying risk factors. Hematologic Toxicity: Neutropenia of any grade was reported in 50% of patients and was the most frequently reported Grade 3/4 adverse event, followed by anemia and thrombocytopenia. Monitor patients for hematologic toxicities, especially neutropenia, with complete blood counts weekly for the first 8 weeks and monthly thereafter. Treatment is continued or modified for Grade 3 or 4 hematologic toxicities based upon clinical and laboratory findings. Dosing interruptions and/or modifications are recommended to manage neutropenia and thrombocytopenia. Hypersensitivity Reactions: Patients with a prior history of serious hypersensitivity associated with thalidomide or lenalidomide were excluded from studies and may be at higher risk of hypersensitivity. Dizziness and Confusional State: 18% of patients experienced dizziness and 12% of patients experienced a confusional state; 1% of patients experienced grade 3/4 dizziness, and 3% of patients experienced grade 3/4 confusional state. Instruct patients to avoid situations where dizziness or confusion may be a problem and not to take other medications that may cause dizziness or confusion without adequate medical advice. Neuropathy: 18% of patients experienced neuropathy (approximately 9% peripheral neuropathy). There were no cases of grade 3 or higher neuropathy adverse reactions reported. Risk of Second Primary Malignancies: Cases of acute myelogenous leukemia have been reported in patients receiving POMALYST as an investigational therapy outside of multiple myeloma. ADVERSE REACTIONS In the clinical trial of 219 patients who received POMALYST alone (n=107) or POMALYST + low-dose dexamethasone (low-dose dex) (n=112), all patients had at least one treatment-emergent adverse reaction. •In the POMALYST alone versus POMALYST + low dose dexamethasone arms, respectively, most common adverse reactions (≥30%) included fatigue and asthenia (55%, 63%), neutropenia (52%, 47%), anemia (38%, 39%), constipation (36%, 35%), nausea (36%, 22%), diarrhea (34%, 33%), dyspnea (34%, 45%), upper respiratory tract infection (32%, 25%), back pain (32%, 30%), and pyrexia (19%, 30%) •90% of patients treated with POMALYST alone and 88% of patients treated with POMALYST + low-dose dex had at least one treatment-emergent NCI CTC Grade 3 or 4 adverse reaction •In the POMALYST alone versus POMALYST + low dose dexamethasone arms, respectively, most common Grade 3/4 adverse reactions (≥15%) included neutropenia (47%, 38%), anemia (22%, 21%), thrombocytopenia (22%, 19%), and pneumonia (16%, 23%). For other Grade 3 or 4 toxicities besides neutropenia and thrombocytopenia, hold treatment and restart treatment at 1 mg less than the previous dose when toxicity has resolved to less than or equal to Grade 2 at the physician’s discretion •67% of patients treated with POMALYST and 62% of patients treated with POMALYST + low-dose dex had at least one treatment-emergent serious adverse reaction •In the POMALYST alone versus POMALYST + low dose dexamethasone arms, respectively, most common serious adverse reactions (≥5%) were pneumonia (14%, 19%), renal failure (8%, 6%), dyspnea (5%, 6%), sepsis (6%, 3%), pyrexia (3%, 5%), dehydration (5%, 3%), hypercalcemia (5%, 2%), urinary tract infection (0%, 5%), and febrile neutropenia (5%, 1%) DRUG INTERACTIONS No formal drug interaction studies have been conducted with POMALYST. Pomalidomide is primarily metabolized by CYP1A2 and CYP3A. Pomalidomide is also a substrate for P-glycoprotein (P-gp). Coadministration of POMALYST with drugs that are strong inhibitors or inducers of CYP1A2, CYP3A, or P-gp should be avoided. Cigarette smoking may reduce pomalidomide exposure due to CYP1A2 induction. Patients should be advised that smoking may reduce the efficacy of pomalidomide. USE IN SPECIFIC POPULATIONS Pregnancy: If pregnancy does occur during treatment, immediately discontinue the drug and refer patient to an obstetrician/gynecologist experienced in reproductive toxicity for further evaluation and counseling. Report any suspected fetal exposure to POMALYST to the FDA via the MedWatch program at  and also to Celgene Corporation at. Nursing Mothers: It is not known if pomalidomide is excreted in human milk. Pomalidomide was excreted in the milk of lactating rats. Because many drugs are excreted in human milk and because of the potential for adverse reactions in nursing infants from POMALYST, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. Pediatric Use: Safety and effectiveness of POMALYST in patients under the age of 18 have not been established. Geriatric Use: No dosage adjustment is required for POMALYST based on age. Patients greater than or equal to 65 years of age were more likely than patients less than or equal to 65 years of age to experience pneumonia. Renal and Hepatic Impairment: Pomalidomide is metabolized in the liver. Pomalidomide and its metabolites are primarily excreted by the kidneys. The influence of renal and hepatic impairment on the safety, efficacy, and pharmacokinetics of pomalidomide has not been evaluated. Avoid POMALYST in patients with a serum creatinine >3.0 mg/dL. Avoid POMALYST in patients with serum bilirubin >2.0 mg/dL and AST/ALT >3.0 x ULN. Please see full Prescribing Information, including Boxed WARNINGS, CONTRAINDICATIONS, WARNINGS AND PRECAUTIONS, and ADVERSE REACTIONS.