Pomalidomide is an immunomodulatory agent primarily used for the treatment of multiple myeloma, with dual anti-tumor and immunomodulatory effects. The drug interactions involve multiple metabolic enzymes and transporters, and special attention should be paid to safety adjustments when using combination therapy.

1. Effect of action

(1) Antitumor effect: By inhibiting the proliferation of myeloma cells and inducing apoptosis, significantly reducing M protein levels, and prolonging progression free survival.

(2) Immune regulation: enhances the activity of T cells and NK cells, regulates cytokine secretion, and improves the immunosuppressive state of the tumor microenvironment.

(3) Angiogenesis inhibition: Downregulate the expression of pro angiogenic factors such as VEGF and block tumor blood supply.

2. Drug interactions

(1) CYP1A2/CYP3A4 substrates: Pomalidomide is metabolized by these enzymes, and potent inhibitors (such as fluconazole) may increase its blood drug concentration, requiring toxicity monitoring.

(2) P-gp inhibitors, such as cyclosporine, may increase the absorption of pomalidomide. It is recommended to adjust the dosage when used in combination.

(3) Hematopoietic inhibitors: Combined use with lenalidomide and other drugs may exacerbate bone marrow suppression, and close monitoring of blood routine is necessary.

(4) Renal toxic drugs: Combined use with nonsteroidal anti-inflammatory drugs may increase the risk of kidney injury, and long-term use should be avoided.

(5) Vaccine: Live vaccines may cause serious infections and should not be administered during the medication period or within 4 weeks after discontinuation.