How it is administered

Lenalidomide is taken by mouth as a capsule. It is available in several strengths, including 2.5 mg, 5 mg, 10 mg, 15 mg, 20 mg, and 25 mg capsules. The capsules should be swallowed whole with water, at about the same time each day, with or without food. They should not be opened, broken, or chewed.

For blood cancers, the dosing schedule and strength may vary depending on the specific disease and treatment plan. Your doctor will provide detailed instructions on how and when to take lenalidomide.

How it works

Lenalidomide is a type of medication known as an immunomodulatory agent. It works in several ways to help control blood cancers:

• It affects the immune system by increasing the number and activity of certain white blood cells (T cells and natural killer cells), which can help the body attack cancer cells.
• It blocks the growth of new blood vessels (antiangiogenic effect) that tumors need to grow.
• It directly targets cancer cells, causing them to die (apoptosis) and stopping their growth (antineoplastic effect).

Lenalidomide acts through a protein called cereblon, which is part of a complex that helps break down other proteins in cells. By binding to cereblon, lenalidomide changes how certain proteins are handled in the cell, leading to the destruction of proteins that cancer cells need to survive. This multi-faceted approach helps slow down or stop the progression of certain blood cancers.

Who Should take it

Lenalidomide is approved for use in adults with several blood cancers, including:

• Multiple myeloma (in combination with dexamethasone, or as maintenance therapy after stem cell transplant)
• 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 two prior therapies, including bortezomib
• Previously treated follicular lymphoma or marginal zone lymphoma (in combination with a rituximab product)

Important note: Lenalidomide is NOT recommended for the treatment of chronic lymphocytic leukemia (CLL) outside of controlled clinical trials, due to increased risk of serious side effects and death in this population.

Your doctor will determine if lenalidomide is right for you based on your diagnosis, previous treatments, and overall health.

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. Women of childbearing potential must use two forms of birth control and have regular pregnancy tests.
• Anyone with a history of severe hypersensitivity reactions to lenalidomide, such as angioedema, Stevens-Johnson syndrome, or toxic epidermal necrolysis.

If you become pregnant while taking lenalidomide, stop the medication immediately and contact your doctor. Males taking lenalidomide must also use condoms during sexual contact with women of childbearing potential and must not donate sperm during and for 4 weeks after treatment.

Lenalidomide is only available through a special program called the Lenalidomide REMS program, which ensures strict safety measures are followed to prevent fetal exposure.

Commonly used with

Lenalidomide is often used with other medications, depending on the type of blood cancer:

• With dexamethasone for multiple myeloma
• With rituximab for follicular lymphoma or marginal zone lymphoma
• Sometimes with other supportive medications, such as blood thinners to reduce the risk of blood clots, or antibiotics to prevent infections

Your doctor will tailor your treatment plan to your specific needs.

Commonly tested with

Lenalidomide has been tested in combination with:

• Dexamethasone (for multiple myeloma)
• Rituximab (for follicular lymphoma and marginal zone lymphoma)
• Bortezomib (for mantle cell lymphoma)
• Melphalan and prednisone (in some multiple myeloma regimens)

It has also been studied with other agents in clinical trials, but the above combinations are the most common and supported by FDA approval for specific blood cancers.