Immunomodulator drugs work by blocking the growth signal for cancer cells and by stimulating the body’s immune system to attack the cancer cells.
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The most common immunomodulators used for myeloma are thalidomide, lenalidomide and pomalidomide.
Thalidomide is an old drug that has new uses. It was given to pregnant women in the 1950s as an anti-nausea drug but was banned because it caused severe birth defects. We now know that thalidomide has anti-cancer properties that can be effective for myeloma. Lenalidomide and pomalidomide are newer types of immunomodulators.
Immunomodulators are most often given in combination with a steroid and a chemotherapy drug. They are taken as tablets, usually every day or for a certain number of days each month. As some immunomodulator drugs increase the risk of blood clots, your doctor may advise you to take a blood thinner.
Possible side effects of immunomodulators include drowsiness, constipation, nausea, diarrhoea, rashes, blood clots, low blood count and a weakened immune system.
Thalidomide may cause pain, numbness, tingling and muscle weakness in the hands and feet. This is called peripheral neuropathy. It is not a typical side effect of lenalidomide or pomalidomide.
New drug therapies
New drug therapies are being developed all the time, including antibody drug conjugates, BCL2 inhibitors, and selective inhibitor of nuclear exports. At the time of publication (September 2022) the Pharmaceutical Benefits Scheme (PBS) does not cover the cost of some of these newer drugs for myeloma. If your doctor thinks they are a promising treatment for you, ask about clinical trials or compassionate access schemes that may help with the costs.
It is very important that you do not get pregnant if you are taking immunomodulators. The fetus would develop serious abnormalities. Sperm is also affected, so men should not conceive a child or donate sperm. If you want to have children, talk to your doctor about fertility options before treatment starts.
Podcast: Making Treatment Decisions
Dr Ian Bilmon, Haematologist, Westmead Hospital and The Sydney Adventist Hospital; Martin Boling, Consumer; Catherine Bowley, Myeloma Support Nurse, Myeloma Australia; Dr Samuel Dickson, Radiation Oncologist, Calvary Mater Newcastle; Rachelle Frith, Clinical Nurse Consultant, Haematology, Prince of Wales Hospital; Dr Wojt Janowski, Haematologist, Calvary Mater Newcastle; Yvonne King, 13 11 20 Consultant, Cancer Council NSW.
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