Lenalidomide (Revlimid®), a derivative of thalidomide, is the first oral drug that was developed as treatment for myeloma. It is an immumomodulatory drug (IMiD) and exerts multiple actions including anti-myeloma, anti-inflammatory and anti-angiogenic (inhibiting new blood vessel formation) activities.
Its use as a first line treatment is only allowed in Wales and Scotland, where it is accepted for restricted use in combination with dexamethasone for newly diagnosed transplant-ineligible patients who are intolerant or contraindicated to thalidomide.
Evidence for the safety and efficacy of Revlimid come from a number of Phase III trials, including the FIRST trial (MM-020) which showed that PFS was significantly longer in patients receiving continuous Revlimid and dexamethasone (25.5 months) compared to those receiving MPT (21.2 months). Median overall survival was 59 month versus 48 months respectively and patients in the Revlimid arm had a 25% reduction in the risk of death compared to patients in the MPT arm.
Lenalidomide is taken as a single oral dose. The dose can be altered if toxicity is significant and it is worth starting at a lower dose in older frailer patients. The dose needs adjusting in cases of renal impairment.