Immune Modulators (IMiDs)

Question 1

What drugs are in the Immune Modulators (IMiDs) class?

Answer 1

Drugs in this class are:
- Lenalidomide
- Pomalidomide
- Thalidomide

Question 2

What is the brand name of Lenalidomide?

Answer 2

The brand name of this generic drug is:
- Revlimid

Question 3

What is the brand name of Pomalidomide?

Answer 3

The brand name of this generic drug is:
- Pomalyst

Question 4

What is the brand name of Thalidomide?

Answer 4

The brand name of this generic drug is:
- Thalomid

Question 5

What is the generic of name of Revlimid?

Answer 5

The generic name of this brand name drug is:
- Lenalidomide

Question 6

What is the generic of name of Pomalyst?

Answer 6

The generic name of this brand name drug is:
- Pomalidomide

Question 7

What is the generic of name of Thalomid?

Answer 7

The generic name of this brand name drug is:
- Thalidomide

Question 8

What are the main indications for use of Lenalidomide?

Answer 8

The main indications of this drug are:
- Multiple Myeloma
- Non-Hodgkin Lymphoma
- Myelodysplastic Syndrome
- CLL

Question 9

What are the main indications for use of Pomalidomide?

Answer 9

The main indications of this drug are:
- Multiple Myeloma
- Pomalidomide
- Kaposi Sarcoma

Question 10

What are the main indications for use of Thalidomide?

Answer 10

The main indications of this drug are:
- Multiple Myeloma

Question 11

What are the main/common indications of the Immune Modulators (IMiDs) class?

Answer 11

The main/common indications of this drug class are:
- Multiple Myeloma

Question 12

What is the class and MOA of Lenalidomide?

Answer 12

This drug in the following class:
- Immune Modulators (IMiDs)

This drug’s MOA is as follows:
- The mechanism of action is still under investigation but it is believed to exert direct cytotoxic effects on the tumor cells causing apoptosis

Question 13

What is the class and MOA of Pomalidomide?

Answer 13

This drug in the following class:
- Immune Modulators (IMiDs)

This drug’s MOA is as follows:
- The mechanism of action is still under investigation but it is believed to exert direct cytotoxic effects on the tumor cells causing apoptosis

Question 14

What is the class and MOA of Thalidomide?

Answer 14

This drug in the following class:
- Immune Modulators (IMiDs)

This drug’s MOA is as follows:
- The mechanism of action is still under investigation but it is believed to exert direct cytotoxic effects on the tumor cells causing apoptosis

Question 15

What are the notable/common monitoring parameters for the Immune Modulators (IMiDs) class?

Answer 15

The notable/common monitoring parameters for this drug class are:
- Females of reproductive potential should receive a pregnancy test 10 to 14 days and 24 hours prior to initiating therapy, weekly during the first 4 weeks of treatment, then every 2 to 4 weeks through 4 weeks after therapy discontinued.

Question 16

Describe the emetic potential of the Immune Modulators (IMiDs) class.

Answer 16

The emetic potential of this drug class is:
- Minimal-Low

Question 17

Describe the extravasation risk and management strategies for the Immune Modulators (IMiDs) class.

Answer 17

The extravasation risk and management strategies for this drug class are as follows:
- None, N/A

Question 18

Describe the metabolism of the Immune Modulators (IMiDs) class.

Answer 18

The metabolism of this drug is as follows:
- Excreted primarily as unchanged drug in the urine (70-90%)

Question 19

What are the notable/common ADRs of the Immune Modulators (IMiDs) class?

Answer 19

The notable/common ADRs of this drug class are:
- Risk of birth defects (fetal death; limb (seal-like), eye, urinary tract, and heart problems).
- Thromboembolism

Question 20

Describe the strategy and rationale for management of birth defects caused by the Immune Modulator (IMiDs) class.

Answer 20

The strategy and rationale for management of this condition caused by drugs in this class are:
- Women of childbearing potential need to be on effective contraception for at least 4 weeks prior to starting therapy, during therapy, and for at least 4 weeks after discontinuing therapy.
- Pregnancy screening should be done prior to initiating therapy and pregnancy must be excluded by 2 negative pregnancy tests.
- During the first month of therapy patients are required to undergo weekly pregnancy tests, then monthly thereafter in women with regular menstrual cycles or every 2 weeks for women with irregular menstrual cycles while on treatment.
- If pregnancy does occur, therapy must be discontinued.
- Drug is present in semen so male patients are required to use condoms during any sexual contact with females of childbearing potential while on treatment and for up to 28 days after receiving therapy and must not donate sperm.

Question 21

Describe the strategy and rationale for management of thromboembolism caused by the Immune Modulator (IMiDs) class.

Answer 21

The strategy and rationale for management of this condition caused by drugs in this class are:
- All patients receiving these drugs need some sort of VTE prophylaxis.
- The SAVED score can estimate VTE risk and takes into account: recent surgeries, race, VTE history, age, and dexamethasone dosing to estimate VTE risk while taking these drugs.
- Patients at low risk for VTE (per the SAVED score) can receive aspirin 81 mg once daily.
- High risk patients should receive full dose warfarin (target INR 2-3), enoxaparin 40 mg daily, Dalteparin 5,000 units daily, or apixaban 2-5 mg every 12 hours.
- Patient can also receive full dose anticoagulation if indicated for another medical condition.

Question 22

What are the clinical pearls of the Immune Modulators (IMiDs) class?

Answer 22

The clinical pearls of this drug class are as follows:
- All of these drugs have a REMS program with restrictions for prescribing and dispensing due to the risk of fetal toxicity.
- If patients are deemed transplant eligible, collect stem cells within first 4 cycles of lenalidomide as this increases the likelihood of a successful collection.

Question 23

Describe the history of Thalidomide Babies.

Answer 23

The history of this is as follows:
- This drug was first marketed in 1957 in Europe as an over the counter medication. It was said to help with anxiety, trouble sleeping, and morning sickness.
- While it was initially thought to be safe in pregnancy, concerns regarding birth defects arose in 1961 and the medication was removed from the market.
- It is estimated that 10,000 embryos were affected by the use of thalidomide during pregnancy - of which 40% died at the time of birth. Those who survived had limb (seal-like), eye, urinary tract, and heart problems.
- This led to public support for stronger drug laws in the United States and the creation of the Kefauver-Harris drug amendment.