IMNOVID (pomalidomide)

• Key points

Favourable opinion for maintenance of reimbursement in combination with dexamethasone in the treatment of adult patients with relapsed and refractory multiple myeloma who have received at least two prior treatment regimens, including both lenalidomide and bortezomib, and have demonstrated disease progression on the last therapy.

• What therapeutic improvement?

No clinical added value.

• Role in the care pathway?

There is no standard treatment for the relapse or progression of multiple myeloma. The therapeutic decision depends on age, previous treatments, the duration of the first remission, the circumstances of the relapse, the availability of peripheral blood stem cells, the general health status of patients and their comorbidities. Recently, new medicinal products have been added to the therapeutic arsenal for second-line treatment, such as daratumumab (DARZALEX), ixazomib (NINLARO) or carfilzomib (KYPROLIS), combined with bortezomib (VELCADE) or lenalidomide (REVLIMID) and dexamethasone.

From the second relapse, in patients already treated with bortezomib and lenalidomide, FARYDAK (panobinostat), combined with bortezomib and dexamethasone, represents a last resort treatment option for patients with relapsed and/or refractory myeloma, who have received at least two prior treatment regimens, including bortezomib and an immunomodulatory agent. DARZALEX (daratumumab) is also an option in patients with relapsed and refractory multiple myeloma, whose prior therapy included a proteasome inhibitor and an immunomodulatory agent; however, its earlier use in the context of combinations with a proteasome inhibitor (PI) or an IMiD, substantially reduces the benefit of this monotherapy in subsequent treatment lines.

Role of the medicinal product in the care pathway

Given the evolution of the care pathway in multiple myeloma, with new medicinal products having been added to the therapeutic arsenal in earlier treatment lines, the role of IMNOVID (pomalidomide) in combination with dexamethasone has become more limited.  In addition, earlier use of IMNOVID (pomalidomide) from the second line of treatment in combination with bortezomib and dexamethasone is likely to substantially reduce the benefit of pomalidomide-dexamethasone dual therapy in subsequent treatment lines. In the absence of any comparison with the other treatments now available as third-line treatment (DARZALEX (daratumumab) and FARYDAK (panobinostat)), the role of IMNOVID (pomalidomide) in combination with dexamethasone compared to these treatments is still to be defined.