Pomalidomide vs Lenalidomide: Differences and Effectiveness Explained!

With multiple myeloma, choosing between Pomalidomide and Lenalidomide is a big deal. That’s why the importance of understanding the differences between these two meds can’t be overstated.

Knowing what sets them apart can help you choose the one that fits your needs and lifestyle best. It could impact how effective your treatment is and how you feel day-to-day. Let’s explore what each one offers so you can make an informed decision.

What are Pomalidomide and Lenalidomide?

Here’s a basic overview of both drugs, to make things clear before we start comparing them.

Pomalidomide

Pomalidomide is a medication used to treat multiple myeloma, a type of blood cancer. It’s in a group of drugs that help the immune system fight cancer. Pomalidomide is sold under the name Pomalyst and is typically used when other treatments no longer work.

Uses and Indications

Pomalidomide is mainly prescribed for multiple myeloma patients who have tried at least two other treatments, including lenalidomide, and whose cancer is still growing. It’s often given with dexamethasone, a steroid that reduces inflammation.

How Pomalidomide Works

Pomalidomide fights cancer by:

• Boosting the Immune System: It helps immune cells attack cancer cells and reduces substances in the body that help tumors grow.
• Cutting Off Blood Supply to Tumors: It stops tumors from making new blood vessels, which they need to grow.
• Directly Killing Cancer Cells: Pomalidomide triggers cancer cells to die by disrupting key proteins.

Lenalidomide

Lenalidomide is a drug similar to pomalidomide, designed to be more effective and less harmful than thalidomide. It’s sold under the brand name Revlimid and is widely used to treat multiple myeloma and other blood disorders.

Uses and Indications

Lenalidomide is a drug also used for multiple myeloma. It’s used on patients who are newly diagnosed or whose cancer has come back. It’s also used for other blood disorders to reduce the need for blood transfusions and for certain types of lymphomas when other treatments haven’t worked. 

How Lenalidomide Works

Lenalidomide is similar to Pomalidomide in some ways, but its formula has different effects. It fights cancer by:

• Stimulating the Immune System: It boosts immune cells to help them destroy cancer cells.
• Stopping Tumor Blood Supply: Lenalidomide prevents tumors from growing the blood vessels they need.
• Directly Killing Cancer Cells: It causes cancer cells to die by interfering with crucial proteins.
• Balancing Substances in the Body: This is the unique part. Lenalidomide adjusts substances (such as Cytokine) to fight cancer growth, favoring those that support the immune system.

Pomalidomide Vs Lenalidomide: Key Differences

Now, let’s talk about the biggest thing that sets them apart.

Effectiveness in Treating Multiple Myeloma

Lenalidomide is often the first choice for treating multiple myeloma because it’s very effective, especially for new or relapsed cases. Pomalidomide comes into play when lenalidomide and other treatments haven’t worked. It’s great for tougher situations but is typically used as a follow-up option.

Survival Rates

Lenalidomide significantly improves survival rates. In the Myeloma XI trial, people taking lenalidomide had a 3-year survival rate of 78.6% and a 5-year rate of 61.3%. Those not on the drug had lower rates: 75.8% at 3 years and 56.6% at 5 years. This shows that lenalidomide boosts both short-term and long-term survival. Pomalidomide can also improve survival, but it’s usually used after lenalidomide.

Cost and Availability

Lenalidomide cost isn’t too high and it’s easier to get. It’s well-covered by insurance and generally costs less, especially if you go for Generic Lenalidomide. Pomalidomide is pricier and less available. Although, you can still get a cheaper version of Pomalidomide over its official branding, called Pomalid.

Chances of Larger Risks

Both medications carry risks, but pomalidomide has a higher chance of severe problems, like serious infections and blood issues. It carries risks of birth defects, too. Lenalidomide also has risks, such as blood clots as well as birth defects, but they’re usually less severe. This makes lenalidomide a safer option overall. 

Differences in Dosages

Lenalidomide is taken daily, with a dose of either 10 mg or 25 mg, based on specific conditions. Pomalidomide is usually taken at 4 mg per day, with a 21-day cycle followed by 7 days off. Lenalidomide’s daily dosing is straightforward and effective, while pomalidomide’s schedule might be better for some patients.

More Differences Between Pomalidomide And Lenalidomide: Comparison Table

Factor	Pomalidomide	Lenalidomide
Brand Name	Pomalyst	Revlimid
Drug Class	Immunomodulatory Drug (IMiD)	Immunomodulatory Drug (IMiD)
Chemical Structure	Similar to thalidomide, with changes	Similar to thalidomide, with changes
Mechanism of Action	Boosts immune response; reduces cancer cell growth	Modulates immune system; kills cancer cells
Primary Indications	Multiple Myeloma (relapsed/refractory)	Multiple Myeloma, MDS, Mantle Cell Lymphoma
Administration	Oral capsule	Oral capsule
Dosage Forms	1 mg, 2 mg, 3 mg, 4 mg capsules	2.5 mg to 25 mg capsules
Dosing Frequency	Once daily in 28-day cycles	Once daily in 21- or 28-day cycles
Typical Dose	Starts at 4 mg daily (21 of 28 days)	Starts at 25 mg daily (21 of 28 days)
FDA Approval Year	2013	2005
Side Effects	Fatigue, anemia, infections, constipation	Fatigue, diarrhea, low blood counts, rash
Black Box Warning	Birth defects, blood clots, low blood counts	Birth defects, blood clots, serious skin reactions
Use in Pregnancy	Not safe (Category X)	Not safe (Category X)
Cost	More expensive, third-line therapy	Less expensive, used earlier
Metabolism	Liver (CYP1A2, CYP3A4)	Minimal liver; mainly kidney
Half-life	~7.5 hours	~3 hours
Drug Interactions	Affected by strong CYP3A4 drugs	Fewer interactions
Resistance	May develop with mutations in target proteins	Occurs due to changes in cancer cell biology
Best Stage To Use	Relapsed/refractory cases	Newly diagnosed and relapsed/refractory cases

Is Lenalidomide Better Than Pomalidomide?

Not exactly. Both drugs have their strengths, depending on the patient’s needs. Here’s a quick look at what each one brings to the table:

Pomalidomide’s Benefits Over Lenalidomide

• Works When Lenalidomide Doesn’t: Pomalidomide is effective for patients whose myeloma is resistant to lenalidomide.
• Better for Advanced Cases: It’s more effective for relapsed or harder-to-treat multiple myeloma.
• Fewer Side Effects: Pomalidomide often comes with fewer blood-related side effects.
• More Potency: It’s more potent, being stronger at stopping cancer growth and boosting the immune system.
• Simpler Dosing: Easier, less frequent dosing makes it more manageable for patients.
• Lower Long-Term Risks: Less chance of developing secondary cancers or other issues.

Lenalidomide’s Benefits Over Pomalidomide

• Proven First-Line Treatment: Lenalidomide is a trusted starting option for newly diagnosed patients.
• Great for Maintenance: It’s widely used to keep the disease in check after initial treatments.
• Combines Well with Other Drugs: Works effectively in combination therapies, offering treatment flexibility.
• Well-Studied: A lot of research supports its safety and effectiveness, making it a reliable choice.
• More Accessible: Easier to get and often more affordable than pomalidomide.
• Versatile: Fits into a variety of treatment plans and regimens.
• Helps with Anemia: Lenalidomide can improve anemia, enhancing overall quality of life.

Both drugs have their place in treating multiple myeloma, and the best choice depends on your or your patient’s situation.

Conclusion

Now that you know the differences between Pomalidomide and Lenalidomide, you can have a better conversation with your doctor about which one might work best for you. Remember, it’s all about finding what fits your needs. And you don’t have to navigate this alone—your doctors are there to help you make the best choice.