Immunomodulators work by blocking the growth signal for cancer cells and by stimulating the body’s immune system to attack the cancer cells.
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.
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Immunomodulators are most often given in combination with a steroid and a chemotherapy drug. They are taken as tablets, usually every day. Because these drugs increase the risk of blood clots, most people also take a blood thinner.
Some possible side effects of immunomodulators include drowsiness, constipation, nausea, diarrhoea, rashes, blood clots, low blood count and a weakened immune system.
Thalidomide or lenalidomide may also cause pain, numbness, tingling and muscle weakness in the hands and feet. This is known as peripheral neuropathy. Peripheral neuropathy is not a typical side effect of pomalidomide.
Women taking immunomodulators should not become pregnant as the fetus would develop abnormalities. Sperm is also affected – men should not conceive and should not donate sperm.
Dr Jane Estell, Senior Staff Specialist, Haematology Department, Concord Cancer Centre, and Senior Clinical Lecturer, The University of Sydney; Brenda Clasquin, 13 11 20 Consultant, Cancer Council NSW; Jacqui Keogh, Senior Myeloma Support Nurse, Myeloma Australia; Dr Silvia Ling, Haematologist, Liverpool Hospital and Sydney Adventist Hospital; and John Miller, Consumer.
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