Yvonne Riley-Poku, PharmD

In September 2021, the FDA granted accelerated approval to mobocertinib (Exkivity; Takeda Pharmaceutical Company Limited) for the treatment of adults with locally advanced or metastatic 

 (NSCLC)
with EGFR exon 20 insertion mutations who have disease progression on or
after platinum-based chemotherapy. However, continued approval for this indication of the drug may be contingent on verification and description of clinical benefit in confirmatory trials.

Lung cancer is the second most common cancer in both men and women.

 The American Cancer Society estimates that 236,740 new cases of lung cancer will be diagnosed in the United States in 2022; NSCLC is the most common form, accounting for approximately 84% of all lung cancers.

 Further, patients with NSCLC with EGFR exon 20 insertion mutations account for approximately 1% to 2% of NSCLC cases.

Oncologists select patients for treatment with mobocertinib based on the presence of EGFR exon 20 insertion mutations detected using Oncomine Dx Target Test (Thermo Fisher Scientific), a companion diagnostic device that was also approved by the FDA.

The FDA approval of this indication of mobocertinib was based on results from an international, nonrandomized, open-label, multicohort clinical trial (NCT02716116).1,4 The trial included 114 patients with NSCLC with EGFR exon 20 insertion mutations who had previously received platinum-based chemotherapy.

During the trial, the patients were treated at a 160-mg dose of mobocertinib.

 Efficacy measures for the trial were overall response rate (ORR) and duration of response (DOR); the ORR during the trial was 28%, and the median DOR was 17.5 months.

Based on the trial results, the FDA granted the application priority review, breakthrough therapy designation, and orphan drug designation.

Mobocertinib is indicated for the treatment of adult patients with locally advanced or metastatic NSCLC with EGFR exon 20 insertion mutations, as detected by an FDA-approved test, who have disease progression on or after platinum-based chemotherapy.

Mobocertinib is a tyrosine kinase inhibitor that selectively targets and inhibits EGFR exon 20 insertion mutations.

The recommended mobocertinib dose is 160 mg orally once daily until disease progression or unacceptable toxicity. Patients may take mobocertinib with or without food at the same time each day.

Depending on the severity of the following clinically significant adverse effects (AEs), providers may withhold, dose reduce, or permanently discontinue mobocertinib

Heart rate–corrected QT (QTc) interval prolongation, including torsade de pointes, can be fatal.

Cardiac toxicity, including decreased ejection fraction, cardiomyopathy, and congestive heart failure, can be fatal.

Severe diarrhea, which can lead to dehydration or electrolyte imbalance, with or without renal impairment

Common AEs of mobocertinib that are generally less serious include diarrhea, rash, nausea, stomatitis, vomiting, decreased appetite, paronychia, fatigue, dry skin, and musculoskeletal pain.

Certain medications are known to affect mobocertinib’s efficacy and safety. For this reason, patients should avoid concomitant use of mobocertinib when taking the following medications

Strong or moderate cytochrome P450 (CYP) 3A inhibitors—These medications increase mobocertinib plasma concentrations, which can raise the risk of adverse reactions. If concomitant use of moderate CYP3A inhibitors cannot be avoided, providers must reduce the mobocertinib dose and frequently monitor the QTc interval.

Strong or moderate CYP3A inducers—These medications decrease mobocertinib plasma concentrations, reducing the efficacy of mobocertinib’s antitumor activity.

Pharmacists should be sure to counsel patients taking mobocertinib on the following points

Since mobocertinib can cause QTc interval prolongation and torsade de pointes, before taking the drug, patients should inform their health care provider of all medical conditions including cardiac problems and long QTc syndrome. Patients must avoid use of concomitant drugs that are known to prolong the QTc interval and should report the occurrence of symptoms including dizziness, light-headedness, and syncope, which may be indicative of significant QTc prolongation. Mobocertinib labeling has a boxed warning for this condition.

The drug can cause severe lung problems that can be fatal. Patients must contact their providers right away to report new or worsening respiratory symptoms, such as cough, shortness of breath, or chest pain.

Mobocertinib can cause heart problems that can be fatal. Providers must monitor cardiac function before initiating and during therapy with mobocertinib. Patients must contact their providers immediately if they experience signs or symptoms of heart failure, such as palpitations, shortness of breath, chest pain, and syncope.

The agent can cause severe diarrhea, which should be treated promptly. When diarrhea occurs, patients must immediately call their providers, who may advise them to take antidiarrheal medicine and increase oral fluids and electrolyte intake.

Mobocertinib can cause fetal harm. Female patients of reproductive potential must use effective nonhormonal contraception during treatment with mobocertinib and for 1 month after the last dose. Additionally, mobocertinib may render hormonal contraceptives ineffective. Men with female partners of reproductive potential must also use effective contraception during treatment with mobocertinib and for 1 week after the last dose.

Women must not breastfeed during treatment with mobocertinib and for 1 week after the last dose because it is currently unknown whether the drug can be passed through breast milk and what its effect may be on breastfed children.

Patients who miss a dose of mobocertinib by more than 6 hours or experience vomiting occurs should skip the dose or not take an additional dose and then take the next dose as prescribed the following day.

Patients taking mobocertinib must avoid grapefruit or grapefruit juice, which may increase the amount of mobocertinib in the blood.

Mobocertinib may impair fertility in men and women of reproductive potential, which is something patients should be aware of when taking the drug.

, is a registered pharmacist based in Connecticut.

FDA grants accelerated approval to mobocertinib for metastatic non-small cell lung cancer with EGFR exon 20 insertion mutations. FDA. Updated September 16, 2021. Accessed October 26, 2021. 

https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-mobocertinib-metastatic-non-small-cell-lung-cancer-egfr-exon-20

Key statistics for lung cancer. American Cancer Society. Updated January 12, 2022. Accessed January 14, 2022. 

https://www.cancer.org/cancer/lung-cancer/about/key-statistics.html

Takeda’s Exkivity (mobocertinib) approved by the U.S. FDA as the first oral therapy specifically designed for patients with EGFR exon 20 insertion+ NSCLC. News release. September 15, 2021. Accessed October 26, 2021. 

https://www.takeda.com/newsroom/newsreleases/2021/takeda-exkivity-mobocertinib-approved-by-us-fda/

Exkivity. Prescribing information. Takeda Pharmaceuticals USA Inc; 2021. Accessed October 26, 2021. 

https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/215310s000lbl.pdf

Articles

The agent is the first oral therapy for this indication.

Using Mobocertinib to Treat Advanced NSCLC With EGFR Exon 20 Insertion Mutations

An estimated 20 million Americans have some form of thyroid disorder, and more than 12% of the US population will develop a thyroid condition, according to the American Thyroid Association.

 Although thyroid disease can affect anyone, women are 5 to 8 times more likely to experience problems, and 1 in 8 will develop a thyroid disorder.

Thyroid disease is often chronic, and pharmacists are in a unique position—in collaboration with providers—to educate patients about symptom identification, treatment, and appropriate medication use.

The thyroid gland—a small, butterfly-shaped organ—sits at the base of the neck and releases and controls 2 main thyroid hormones, thyroxine and triiodothyronine.

 Thyroid hormones regulate the body’s metabolism, affecting critical functions such as digestion, energy level, growth, heart rate, and heat production.

In hypothyroid disease, the thyroid gland releases inadequate amounts of thyroid hormone. Hashimoto thyroiditis is the most common cause of hypothyroidism; however, there are others.

In hyperthyroid disease, the thyroid gland produces excess thyroid hormone. Graves disease accounts for most cases of hyperthyroidism; however, other causes exist.

 Other thyroid-related health issues include goiter, thyroid cancer, thyroid eye disease, thyroiditis, and thyroid nodules.

Thyroid disease can affect anyone, but certain factors increase the risk.

 These include being female, older than aged 60 years, or taking medications that affect thyroid functions, as well as having a family history of thyroid disease or a history of treatments such as radiation or thyroidectomy.

Undiagnosed and untreated thyroid disease has consequences, putting patients at risk of conditions such as cardiovascular and fertility problems and osteoporosis.

 Thyroid disease symptoms may be similar to those of other conditions. Pharmacists can educate patients concerning identification of symptoms and referral to a physician. Doctors make a conclusive diagnosis based on blood levels of thyroid stimulating hormone (TSH) and free thyroxine.

 outlines thyroid conditions with associated symptoms and treatments.

Pharmacologic treatment of thyroid disease is largely effective and safe. Pharmacists can counsel patients about proper medication usage, educate them on existing and new medications, and encourage adherence to medication therapy.

 For instance, pharmacists should advise patients that certain foods and medications, including dietary supplements and vitamins, can affect levothyroxine absorption. Patients must take levothyroxine on an empty stomach with a full glass of water, 30 minutes to 1 hour before breakfast and 4 hours before or after other medications.

In addition, pharmacists should be aware of the clinical and pharmacologic implications of levothyroxine substitution and maintain patients on the same brand of the medication. If a substitution is made, the pharmacy team must inform the prescriber, because patients will need to be reevaluated and sent for new laboratory work to assess serum TSH. Finally, pharmacists must advise patients that thyroid disease is often chronic, requiring lifelong therapy, and express the need for therapeutic drug monitoring.

is a registered pharmacist and recent graduate of the University of Connecticut School of Pharmacy's Medical Writing Certificate program.

1. General information/press room. American Thyroid Association. Accessed November 23, 2021. https://www.thyroid.org/media-main/press-room/

2. Thyroid disease. Cleveland Clinic. Updated April 19, 2020. Accessed November 23, 2021. https://my.clevelandclinic.org/health/diseases/8541-thyroid-disease

3. Hershman JM. Overview of the thyroid gland. Merck Manual Consumer Version. Updated October 2020. Accessed November 23, 2021. https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/thyroid-gland-disorders/overview-of-the-thyroid-gland

4. Hashimoto’s disease. Mayo Clinic. February 11, 2020. Accessed November 23, 2021. https://www.mayoclinic.org/diseases-conditions/hashimotos-disease/symptoms-causes/syc-20351855

5. Kravets I. Hyperthyroidism: diagnosis and treatment. Am Fam Physician. 2016;93(5):363-370.

6. Douglas RS, Kahaly GJ, Patel A. Teprotumumab for the treatment of active thyroid eye disease. N Engl J Med. 2020;382(4):341-352. doi:10.1056/NEJMoa1910434

7. Wilson SA, Stem LA, Bruehlman RD. Hypothyroidism: diagnosis and treatment. Am Fam Physician. 2021;103(10):605-613.

8. Thyroid eye disease. National Organization for Rare Disorders. Accessed November 23, 2021. https://rarediseases.org/rare-diseases/thyroid-eye-disease/

9. FDA approves first treatment for thyroid eye disease. News release. FDA. January 21, 2020. Accessed November 23, 2021. https://www.fda.gov/news-events/press-announcements/fda-approves-firsttreatment-thyroid-eye-disease

10. Benvenga S, Carlé A. Levothyroxine formulations: pharmacological and clinical implications of generic substitution. Adv Ther. 2019;36(suppl 2):59-71. doi:10.1007/s12325-019-01079-1

11. Levothyroxine (oral route). Mayo Clinic. Updated August 1, 2021. Accessed November 23, 2021. https://www.mayoclinic.org/drugs-supplements/levothyroxine-oral-route/proper-use/drg-20072133

Pharmacists can offer guidance on proper use of therapies and encourage adherence to regimens. 

Treatments for Thyroid Disease Are Generally Effective and Safe

In September 2021, the FDA granted accelerated approval to mobocertinib (Exkivity; Takeda Pharmaceuticals) for adults with locally advanced or metastatic non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (

) exon 20 insertion mutations. Eligible patients should have disease progression while on or after platinum-based chemotherapy. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials.

Lung cancer is the second most common form of the disease in both men and women.

The American Cancer Society estimates that physicians will diagnose 235,760 cases of lung cancer in the United States in 2021. NSCLC is the most common form of lung cancer, accounting for approximately 80%-85% of all cases.

 exon 20 insertion mutation NSCLC account for approximately 1%-2% of NSCLC cases.

 Oncologists select patients for treatment with mobocertinib based on the presence of 

 exon 20 insertion mutations detected using Oncomine Dx Target Test (Thermo Fisher Scientific), a companion diagnostic device also approved by the FDA.

The FDA approval for this indication was based on results from an international, non-randomized, open label, multicohort clinical trial (NCT02716116).

 exon 20 insertion mutation NSCLC who had previously received platinum-based chemotherapy.

The patients were treated at the 160 mg dose.

 The FDA granted the application priority review, breakthrough therapy designation, and orphan drug designation.

Efficacy measures for the trial were overall response rate (ORR) and duration of response (DoR). The ORR was 28% and a median DoR at 17.5 months.

Mobocertinib is indicated for the treatment of adult patients with locally advanced or metastatic NSCLC with 

 exon 20 insertion mutations as detected by an FDA-approved test, whose disease has progressed on or after platinum-based chemotherapy.

Mobocertinib is a tyrosine kinase inhibitor that selectively targets and inhibits 

Depending on the severity of the following clinically significant AEs, providers may withhold, reduce the dose, or permanently discontinue mobocertinib:

QTc prolongation and torsades de pointes—mobocertinib can cause life threatening heart rate corrected QTc prolongation including torsades de pointes, which can be fatal.

Interstitial lung disease (ILD)/pneumonitis—mobocertinib can cause ILD/pneumonitis, which can be fatal.

Cardiac toxicity—mobocertinib can cause cardiac toxicity including decreased ejection fraction, cardiomyopathy, and congestive heart failure, which can be fatal.

Diarrhea—mobocertinib can cause severe diarrhea which can lead to dehydration or electrolyte imbalance, with or without renal impairment.

Common AEs include diarrhea, rash, nausea, stomatitis, vomiting, decreased appetite, paronychia, fatigue, dry skin, and musculoskeletal pain.

Certain medications have effects on mobocertinib. Patients must avoid concomitant use of mobocertinib with these medications:

Strong or moderate CYP3A inhibitors—these medications increase mobocertinib plasma concentrations, thus increasing the risk of AEs. If concomitant use of moderate CYP3A inhibitors cannot be avoided, providers must reduce the mobocertinib dose and frequently monitor the QTc interval.

Strong or moderate CYP3A inducers—these medications decrease mobocertinib plasma concentrations thus reducing mobocertinib anti-tumor activity.

Pharmacists need to counsel patients on several points:

Mobocertinib can cause QTc interval prolongation and torsades de pointes. Before taking mobocertinib, patients must inform their health care provider of all medical conditions, including cardiac problems and long QTc syndrome. Patients must avoid use of concomitant drugs that are known to prolong the QTc interval, and also report symptoms including dizziness, lightheadedness, and syncope, which may be indicative of significant QTC prolongation. Mobocertinib labeling has a boxed warning for this condition.

Mobocertinib can cause severe lung problems, which can be fatal. Patients must contact their providers right away to report new or worsening respiratory symptoms, such as cough, shortness of breath, or chest pain.

Mobocertinib can cause heart problems, which can be fatal. Providers must monitor cardiac function before initiating and during therapy with mobocertinib. Patients must contact their providers immediately if they experience any signs or symptoms of heart failure, such as palpitations, shortness of breath, chest pain, and syncope.

Mobocertinib can cause severe diarrhea and should be treated promptly. When diarrhea occurs, patients must call their providers right away, who may advise them to take antidiarrheal medicine and increase oral fluids and electrolyte intake.

Mobocertinib can cause fetal harm. Female patients of reproductive potential must use effective non-hormonal contraception during treatment with mobocertinib, and for 1 month after the last dose. Mobocertinib may render hormonal contraceptives ineffective. Males with female partners of reproductive potential must also use effective contraception during treatment with mobocertinib, and for 1 week after the last dose.

It is not known if mobocertinib passes into breastmilk and its effect on breastfed children. Women must not breastfeed during treatment with mobocertinib and for 1 week after the last dose.

When patients miss a dose of mobocertinib by more than 6 hours or when vomiting occurs, they must skip the dose or not take an additional dose, and take the next dose as prescribed the following day.

Patients must avoid grapefruit or grapefruit juice while taking mobocertinib. Grapefruit may increase the amount of mobocertinib in the blood.

Mobocertinib may impair fertility in males and females of reproductive potential.

U.S Food and Drug Administration. FDA grants accelerated approval to mobocertinib for metastatic non-small cell lung cancer with EGFR exon 20 insertion mutations. September 16, 2021. Accessed October 26, 2021. 

American Cancer Society. What is lung cancer? Accessed October 26, 2021. 

Takeda News Releases. Takeda’s Exkivity (mobocertinib) approved by the U.S. FDA as the first oral therapy specifically designed for patients with EGFR Exon 20 insertion+ NSCLC. September 15, 2021. Accessed October 26, 2021. 

Exkivity Prescribing Information. Takeda Pharmaceuticals U.S.A., Inc.; 2021. Accessed October 26, 2021. 

Patients with EGFR exon 20 insertion mutation NSCLC account for approximately 1%-2% of NSCLC cases.

Oncology Overview: Mobocertinib for Advanced Non-Small Cell Lung Cancer With EGFR Exon 20 Insertion Mutations

 (Truseltiq; QED Therapeutics) for the treatment of adults with previously treated, unresectable locally advanced or metastatic cholangiocarcinoma with a fibroblast growth factor 2 (FGFR2) fusion or other rearrangement.

 Continued approval of this indication may be contingent upon verification and description of clinical benefit in confirmatory trials.

The FDA granted the application priority review, fast-track designation, and orphan drug designation.

Cholangiocarcinoma is a rare bile duct cancer, with physicians diagnosing approximately 8000 cases each year.

 Physicians select patients for infigratinib treatment based on the presence of FGFR2 fusion or rearrangement detected using an FDA-approved companion diagnostic test, FoundationOne CDx.

The FDA approval was based on a multicenter, open-label, single-arm phase 2 trial. Study investigators enrolled 108 patients who had undergone a previous treatment for unresectable locally advanced or metastatic cholangiocarcinoma with an FGFR2 fusion or rearrangement as determined by local or central testing.

Patients received infigratinib 125 mg daily for 21 consecutive days, in 28-day cycles until disease progression or unacceptable toxicity.

The trial’s efficacy measures were overall response rate (ORR) and duration of response (DoR). The ORR was 23% (1 complete response and 24 partial responses), and the average DoR was 5 months. The median time to response was 3.6 months.

Infigratinib inhibits fibroblast growth factor receptor (FGFR) signaling and decreases cell proliferation in cancer cell lines with activating FGFR amplifications, mutations, or fusions.

The recommended infigratinib dose is 125 mg (one 100 mg capsule and one 25 mg capsule) orally once a day for 21 consecutive days followed by 7 days off therapy in 28-day cycles. Patients continue treatment until disease progression or unacceptable toxicity.

Before beginning therapy with infigratinib, female patients must tell their health care provider whether they are pregnant or plan to become pregnant. Infigratinib can cause fetal harm when taken by pregnant women.

 Serious adverse events (AEs) include ocular toxicity and hyperphosphatemia.

Common AEs include hyperphosphatemia, increased creatinine, nail toxicity, stomatitis, dry eye, fatigue, alopecia, palmar-plantar erythrodysesthesia syndrome, arthralgia, dysgeusia, constipation, abdominal pain, dry mouth, eyelash changes, diarrhea, dry skin, decreased appetite, blurred vision, and vomiting.

Certain medications have effects on infigratinib. Patients must avoid concomitant use of infigratinib with these medications:

Strong and moderate CYP3A inhibitors may increase infigratinib plasma concentrations, thus increasing the risk of AEs.

Strong and moderate CYP3A inducers may decrease infigratinib plasma concentrations, thus reducing infigratinib anti-tumor activity.

Gastric acid reducing agents (e.g., proton pump inhibitors, H2-antagonists, and locally acting antacids) may decrease infigratinib plasma concentrations thus reducing infigratinib anti-tumor activity. If coadministration cannot be avoided, providers must advise patients to stagger infigratinib administration from H2-antagonists and locally acting antacids at appropriate time intervals.

Infigratinib can cause fetal harm when taken by pregnant women. Females of reproductive potential must use effective contraception during treatment and for 1 month after the final dose. Males with female partners of reproductive potential must also use effective contraception during treatment with infigratinib and for 1 month after final dose.

Patients must not breastfeed during treatment and for 1 month after the final infigratinib dose.

Infigratinib can cause retinal pigment epithelial detachment, causing symptoms such as blurred vision. Providers must perform ophthalmic examinations including optical coherence tomography (OCT) before initiating infigratinib therapy, and then at 1 month, 3 months, and every 3 months thereafter for the duration of treatment. When ocular toxicity occurs, providers must continue ophthalmic evaluations, modify dose, or withhold medication appropriately.

Infigratinib can elevate phosphate levels, leading to soft tissue mineralization, cutaneous calcinosis, non-uremic calciphylaxis, vascular calcification, and myocardial calcification. Providers must monitor blood phosphate levels throughout treatment and withhold, reduce dose, or permanently discontinue infigratinib depending on duration and severity of hyperphosphatemia.

Patients must take infigratinib on an empty stomach at least 1 hour before or 2 hours after food. Patients must swallow capsules whole with a glass of water at approximately the same time each day. When patients miss a dose by 4 or more hours or if vomiting occurs, they must resume the regular daily dose schedule the next day.

Clinical Oncology News. FDA Watch. FDA approves Truseltiq for some advanced cholangiocarcinoma patients. June 4, 2021. Accessed July 19, 2021.

Truseltiq. Prescribing information. QED Therapeutics;2021. Accessed July 19, 2021. 

https://www.truseltiq.com/pdfs/prescribing-information.pdf

U.S Food and Drug Administration. FDA grants accelerated approval to infigratinib for metastatic cholangiocarcinoma. May 28, 2021. Accessed July 18, 2021. 

https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-infigratinib-metastatic-cholangiocarcinoma

American Cancer Society. Bile duct cancer. Accessed July 19, 2021. 

https://www.cancer.org/cancer/bile-duct-cancer.html

Oncology Overview: Infigratinib for Advanced Cholangiocarcinoma

Multiple myeloma (MM) is a cancer that forms in plasma cells. Healthy plasma cells are an important part of the immune system and help fight infections. In MM, cancerous plasma cells producing abnormal proteins overwhelm healthy blood cells and cause complications including fatigue, anemia, and the inability to fight infections.

MM is rare, with fewer than 200,000 cases occurring annually in the United States.

 The American Cancer Society estimates that oncologists will diagnose about 34,920 new cases of MM in 2021 with about 12,410 deaths expected to occur.

Therapy for MM may include a combination of targeted therapy, immunotherapy, corticosteroids, chemotherapy, radiation therapy, and bone marrow transplants.

The thalidomide analogues lenalidomide (Revlimid; Bristol Myers Squibb) and pomalidomide (Pomalyst; Celegene) are immunomodulating drugs for the treatment of MM.

 Thalidomide, a known human teratogen, causes serious birth defects or embryo-fetal death. Since lenalidomide and pomalidomide are related to thalidomide, they have similar teratogenic adverse effects.

The FDA initially approved lenalidomide in 2005 for treatment of transfusion dependent myelodysplastic syndrome. In 2015, the FDA approved pomalidomide when its indication was expanded to include treatment of MM in combination with dexamethasone. Further, the FDA approved the first generic product lenalidomide in 2021.

Pomalidomide was initially approved by the FDA as an orphan drug in 2013 for patients with multiple myeloma. Pomalidomide is also available as a generic product with the FDA approving the first generic pomalidomide product in 2020.6 (see 

Patients must read and agree to all the instructions in the appropriate REMS programs before initiating therapy. Lenalidomide and pomalidomide may cause serious adverse effects including the following:

—Patients must not use lenalidomide or pomalidomide during pregnancy. These medications may cause birth defects or embryo-fetal death. Females of reproductive potential must prevent pregnancy before, during, and after treatment by using 2 reliable contraception methods. Male and female patients must comply with all contraceptive requirements in the REMS programs.

—Lenalidomide and pomalidomide can cause deep vein thrombosis, pulmonary embolism, myocardial infarction, and stroke. Thromboprophylaxis is recommended. Providers should base the choice of regimen on an assessment of the patient’s underlying risk factors.

—Lenalidomide can cause significant neutropenia and thrombocytopenia. Providers must monitor patients with neutropenia for signs of infection. Patients must watch for bleeding and bruising especially when they use other medication that may increase bleeding risk.

 is a non-credit lecturer for the Pharmacy Technician Certification Program at Housatonic Community College, Bridgeport, Connecticut.

Multiple Myeloma. Mayo Clinic. Updated June 16, 2021. Accessed July 14, 2021. 

https://www.mayoclinic.org/diseases-conditions/multiple-myeloma/symptoms-causes/syc-20353378

About Multiple Myeloma. American Cancer Society. Accessed July 14, 2021. 

https://www.cancer.org/cancer/multiple-myeloma/about.html

Revlimid. Prescribing information. Bristol Myers Squibb;2019. Accessed July 14, 2021. 

https://packageinserts.bms.com/pi/pi_revlimid.pdf

Pomalyst. Prescribing information. Bristol Myers Squibb;2020. Accessed July 14, 2021. 

https://packageinserts.bms.com/pi/pi_pomalyst.pdf

Revlimid FDA approval history. Drugs.com. Updated September 7, 2020. Accessed July 14, 2021. 

https://www.drugs.com/history/revlimid.html

Pomalyst FDA approval history. Drugs.com. Updated March 16, 2021. Accessed July 14, 2021. 

https://www.drugs.com/history/pomalyst.html

The American Cancer Society estimates that oncologists will diagnose about 34,920 new cases of multiple myeloma in 2021 with about 12,410 deaths expected to occur.