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How Does Thalomid, Revlimid or Pomalidomide Work?

Posted on December 11 2009 by Pat Killingsworth | 1,492 views

I wanted to follow-up my previous post for those of you who are more scientifically and technically minded with a summary conclusion from an even more complicated study
I found this afternoon:

Mechanism of action of immunomodulatory drugs (IMiDS) in multiple myeloma.
Quach H, Ritchie D, Stewart AK, Neeson P, Harrison S, Smyth MJ, Prince HM.

[1] Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Victoria, Australia [2] Department of Medicine, University of Melbourne, Victoria, Australia [3] Haematology Immunology Translational Research Laboratory, Peter MacCallum Cancer Centre, Victoria, Australia.

Immunomodulatory drugs (IMiDs) are thalidomide analogues, which possess pleiotropic anti-myeloma properties including immune-modulation, anti-angiogenic, anti-inflammatory and anti-proliferative effects. Their development was facilitated by an improved understanding in myeloma (MM) biology and initiated a profound shift in the therapeutic approach towards MM. Despite the diverse effects of IMiDs in vitro, the relative contribution of each effect towards their ultimate anti-MM activity is still unclear. Based on in vitro data, it appears that anti-proliferative effects and downregulation of crucial cytokines are their most important anti-MM attributes. Although the co-stimulatory effects on T and NK cells have been heralded as a unique and important property of IMiDs towards enhancing anti-MM immune activity, these in vitro effects have yet to be firmly corroborated in vivo. Much is yet to be elucidated regarding the complex interplay of immunomodulatory cytokines that occurs in vivo, which ultimately dictates the net effects of IMiDs in MM-the understanding of which is necessary to facilitate optimal manipulation of these drugs in future MM management.Leukemia advance online publication, 12 November 2009; doi:10.1038/leu.2009.236.

PMID: 19907437 [PubMed – as supplied by publisher]

What is your conclusion when you read this? I’m clearly not a research scientist. But my interpretation is this: Myeloma researchers don’t really know how Thalomid, Revlimid or pomalidomide work!
I understand these drugs don’t work well for all myeloma patients. But all I can add is–thank God they work for most of us! 31 Revlimid cycles and still working for me!

Feel good and keep smiling! Pat

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