How it is administered

Lenalidomide is taken by mouth as a capsule. It is available in various strengths, including 2.5 mg, 5 mg, 10 mg, 15 mg, 20 mg, and 25 mg. The capsules should be swallowed whole with water, at about the same time each day, and may be taken with or without food. Do not open, break, or chew the capsules. The usual dose for follicular lymphoma is 20 mg once daily on days 1 to 21 of each 28-day cycle, in combination with a rituximab product, for up to 12 cycles. Your doctor will adjust your dose based on your response and any side effects.

How it works

Lenalidomide is an immunomodulatory medication, meaning it helps regulate the immune system. It is a thalidomide analogue with anti-cancer (antineoplastic) and anti-angiogenic (prevents new blood vessel formation) properties. Lenalidomide works by targeting a protein called cereblon, which is part of a complex that tags certain proteins for destruction within cells. This leads to the breakdown of proteins that help cancer cells survive, ultimately causing cancer cell death.

In follicular lymphoma and other blood cancers, lenalidomide helps to slow or stop the growth of cancer cells. It also boosts the activity of immune cells, such as T cells and natural killer (NK) cells, making them more effective at attacking cancer cells. When combined with rituximab, lenalidomide enhances the immune system’s ability to kill lymphoma cells through a process called antibody-dependent cell-mediated cytotoxicity (ADCC).

Who Should take it

Lenalidomide is indicated for adults with previously treated follicular lymphoma, in combination with a rituximab product. It is also used for other blood cancers, such as multiple myeloma, certain myelodysplastic syndromes, mantle cell lymphoma, and marginal zone lymphoma. For follicular lymphoma, it is typically prescribed after at least one prior treatment.

Your doctor may recommend lenalidomide if your follicular lymphoma has returned (relapsed) or did not respond to previous treatments (refractory). It is usually given with rituximab to improve effectiveness. Your healthcare team will determine if lenalidomide is right for you based on your health, prior treatments, and specific type of lymphoma.

Who should not take it

Lenalidomide should NOT be taken by:

• Pregnant women or women who may become pregnant, as it can cause severe birth defects or fetal death.
• Patients with a known severe hypersensitivity (allergic reaction) to lenalidomide (such as angioedema, Stevens-Johnson syndrome, or toxic epidermal necrolysis).

If you are of childbearing potential, you must use two effective forms of contraception and have regular pregnancy testing before, during, and after treatment. Lenalidomide is only available through a special program (Lenalidomide REMS) to prevent fetal exposure. If you have a history of severe allergic reactions to thalidomide, you should not take lenalidomide. Always inform your doctor of all allergies and medical conditions before starting this medication.

Commonly used with

For follicular lymphoma, lenalidomide is most commonly used in combination with rituximab, a monoclonal antibody that targets lymphoma cells. This combination is sometimes called "R2" therapy. In other blood cancers, lenalidomide may be combined with dexamethasone or other chemotherapy agents, depending on the specific disease and treatment plan.

Commonly tested with

Lenalidomide has been tested in combination with rituximab for follicular lymphoma in clinical trials such as AUGMENT and MAGNIFY. It has also been studied with other agents such as dexamethasone for multiple myeloma, and with bortezomib or other chemotherapy drugs for mantle cell lymphoma. In follicular lymphoma, the combination with rituximab is the most well-studied and widely used.