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. For transplant ineligible patients at first line, lenalidomide is accepted for restricted use in combination with dexamethasone for those patients who are intolerant or contraindicated to thalidomide. Most recently in 2023, it has also been approved in combination with daratumumab and dexamethasone.
Efficacy
Evidence for the safety and efficacy of lenalidomide comes from a number of Phase III trials, including the FIRST trial (MM-020) which showed that progression free survival (PFS) was significantly longer in patients receiving continuous lenalidomide and dexamethasone (25.5 months) compared to those receiving MPT (21.2 months). Median overall survival (OS) was 59 months versus 48 months respectively and patients in the lenalidomide arm had a 25% reduction in the risk of death compared to patients in the MPT arm.
Administration
Lenalidomide is taken as a single oral dose. Individual treatment plans vary and the dose can be altered if toxicity is significant, for example in cases of renal impairment. Often the starting dose is lower in older, frailer patients. Lenalidomide is normally taken for 21 days followed by a 7-day rest period. This forms one 28-day (4 week) cycle.