How it is administered

Lenalidomide is available as oral capsules in various strengths (2.5 mg, 5 mg, 10 mg, 15 mg, 20 mg, and 25 mg). It is taken by mouth, usually once daily, at about the same time each day. The capsules should be swallowed whole with water and should not be opened, broken, or chewed. Lenalidomide can be taken with or without food.

The specific dosing schedule depends on the condition being treated and the patient's kidney function. For blood cancers, such as certain lymphomas, the medication is often taken for 21 days of a 28-day cycle, but your doctor will give you exact instructions.

How it works

Lenalidomide is an immunomodulatory agent, which means it helps regulate the immune system. It is a thalidomide analogue with antiangiogenic (prevents the growth of new blood vessels that tumors need to grow) and antineoplastic (anti-cancer) properties. Lenalidomide works by targeting a protein called cereblon, which is part of a complex that marks certain proteins for destruction within cells.

When lenalidomide binds to cereblon, it leads to the breakdown of specific proteins that are important for the survival of cancer cells, especially certain blood cancers. This results in direct killing of cancer cells and also boosts the immune system’s ability to attack these cells. Lenalidomide increases the number and activity of T cells and natural killer (NK) cells, which can help the body fight cancer. It also reduces the production of substances that promote inflammation and cancer growth, such as TNF-alpha and IL-6.

In combination with other drugs, such as dexamethasone or rituximab, lenalidomide can have a stronger effect against cancer cells.

Who Should take it

Lenalidomide is used to treat several types of blood cancers. For adults, it is indicated for:

• Multiple myeloma, in combination with dexamethasone, or as maintenance therapy after stem cell transplantation.
• Transfusion-dependent anemia due to certain types of myelodysplastic syndromes (MDS) with a specific genetic abnormality (deletion 5q).
• Mantle cell lymphoma (MCL) that has relapsed or progressed after at least two prior therapies, one of which included bortezomib.
• Previously treated follicular lymphoma (FL) or marginal zone lymphoma (MZL), in combination with rituximab.

While lenalidomide is not specifically approved for Adult T-cell Leukemia/Lymphoma (ATLL), it is used in other similar blood cancers and may be considered in certain cases, based on a doctor’s judgment and clinical trial data. Always follow your doctor’s recommendations for your specific diagnosis.

Who should not take it

Lenalidomide should NOT be taken by:

• Women who are pregnant or may become pregnant, as it can cause severe birth defects or death to an unborn baby. Strict pregnancy prevention measures must be followed.
• Patients with a history of severe allergic reactions (such as angioedema, Stevens-Johnson syndrome, or toxic epidermal necrolysis) to lenalidomide.

People with severe kidney impairment may need dose adjustments. Lenalidomide is not recommended for patients with chronic lymphocytic leukemia (CLL) outside of clinical trials due to increased risk of death. Always inform your healthcare provider of your full medical history before starting lenalidomide.

Commonly used with

Lenalidomide is often used in combination with other medications to enhance its effectiveness. For blood cancers, it is commonly combined with:

• Dexamethasone (a steroid)
• Rituximab (an antibody therapy, especially for follicular lymphoma or marginal zone lymphoma)
• Other chemotherapy agents, depending on the specific type of cancer

Your doctor will determine the best combination for your condition.

Commonly tested with

Lenalidomide has been tested in clinical trials with several other medications, including:

• Dexamethasone (for multiple myeloma)
• Rituximab (for follicular lymphoma and marginal zone lymphoma)
• Bortezomib (for mantle cell lymphoma)
• Pembrolizumab (not recommended due to increased risk of death in multiple myeloma)

It is important to follow your doctor’s instructions and not combine lenalidomide with other treatments unless directed.