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. The capsules should be swallowed whole with water, at about the same time each day, and can be taken with or without food. The capsules should not be opened, broken, or chewed.

How it works

Lenalidomide is a thalidomide analogue with immunomodulatory, antiangiogenic, and antineoplastic properties. It works by targeting a protein called cereblon, which is part of an enzyme complex in cells. When lenalidomide binds to cereblon, it causes the breakdown of specific proteins that are important for the survival of certain cancer cells. This leads to the death of these cancer cells (apoptosis) and stops them from multiplying.

Lenalidomide also boosts the immune system by increasing the number and activity of T cells and natural killer (NK) cells, which help the body attack cancer cells. It can also reduce the production of inflammatory substances in the body. In multiple myeloma, lenalidomide is often combined with dexamethasone to enhance its effects. In some lymphomas, it is used with rituximab to improve outcomes.

Who Should take it

Lenalidomide is used for adults with certain blood cancers:

• Multiple myeloma (MM), in combination with dexamethasone, or as maintenance therapy after autologous stem cell transplant.
• Transfusion-dependent anemia due to low- or intermediate-1-risk myelodysplastic syndromes (MDS) with a deletion 5q abnormality.
• Mantle cell lymphoma (MCL) that has relapsed or progressed after at least two prior therapies (one including bortezomib).
• Previously treated follicular lymphoma (FL) or marginal zone lymphoma (MZL), in combination with rituximab.

Your doctor will determine if lenalidomide is appropriate for you based on your specific diagnosis and prior treatments.

Who should not take it

Lenalidomide should NOT be taken by:

• Women who are pregnant, as it can cause severe birth defects or death to an unborn baby.
• People with a history of severe allergic reactions to lenalidomide (such as angioedema, Stevens-Johnson syndrome, or toxic epidermal necrolysis).

Special precautions and a Risk Evaluation and Mitigation Strategy (REMS) program are in place to prevent fetal exposure. Women of childbearing potential must use two forms of contraception and have regular pregnancy tests. Men taking lenalidomide must use condoms during sexual contact with women who can become pregnant and must not donate sperm.

Commonly used with

Lenalidomide is commonly used with:

• Dexamethasone (for multiple myeloma)
• Rituximab (for follicular lymphoma and marginal zone lymphoma)

In some cases, it may also be used after autologous stem cell transplantation as a single agent for maintenance therapy. Your doctor may prescribe other supportive medications to reduce the risk of blood clots or infections.

Commonly tested with

Lenalidomide has been tested in combination with:

• Dexamethasone (especially in multiple myeloma)
• Rituximab (in follicular lymphoma and marginal zone lymphoma)
• Bortezomib (in mantle cell lymphoma, as a prior therapy)

It has also been studied with other agents in clinical trials for various blood cancers. Your treatment plan may include additional medications based on your specific condition and response to therapy.