Common brand names

• Revlimid

How it is administered

Lenalidomide is taken by mouth as a capsule. It comes in several strengths, including 2.5 mg, 5 mg, 10 mg, 15 mg, 20 mg, and 25 mg. For mantle cell lymphoma (MCL), the typical dose is 25 mg once daily on Days 1 to 21 of a repeated 28-day cycle. The capsules should be swallowed whole with water, and should not be opened, broken, or chewed. Lenalidomide can be taken with or without food. Always follow your doctor’s instructions regarding dosing and timing.

How it works

Lenalidomide is an immunomodulatory medicine, meaning it helps regulate the immune system. It is a thalidomide analogue with anti-cancer, anti-inflammatory, and anti-angiogenic (prevents new blood vessels from forming) properties. Lenalidomide works by targeting a protein called cereblon, which is part of a complex that helps degrade certain proteins in cells. When lenalidomide binds to cereblon, it leads to the destruction of proteins that cancer cells need to survive and grow.

In mantle cell lymphoma and other blood cancers, lenalidomide can directly kill cancer cells, slow their growth, and help the immune system recognize and attack these cells more effectively. It increases the activity of T cells and natural killer (NK) cells, which are important for fighting cancer. It also reduces the production of substances that promote inflammation and tumor growth. This multi-faceted approach helps control the disease and can lead to tumor shrinkage or stabilization.

Who should take it

Lenalidomide is indicated for adults with mantle cell lymphoma (MCL) whose disease has relapsed or progressed after at least two prior therapies, one of which included bortezomib. It is also used for other blood cancers such as multiple myeloma (in combination with dexamethasone), as maintenance therapy after stem cell transplant in multiple myeloma, and for certain types of myelodysplastic syndromes (MDS) with a specific genetic change.

For MCL, lenalidomide is typically considered when other treatments have not been successful or the disease has returned. Your doctor will determine if lenalidomide is appropriate for you based on your treatment history, overall health, and specific characteristics of your lymphoma.

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 known severe allergic reaction to lenalidomide (such as angioedema, Stevens-Johnson syndrome, or toxic epidermal necrolysis).

Caution is needed in people with severe liver or kidney problems, and the dose may need to be adjusted. Lenalidomide is not recommended for patients with chronic lymphocytic leukemia (CLL) outside of clinical trials due to increased risk of death. Always discuss your full medical history with your doctor before starting lenalidomide.

Commonly used with

For mantle cell lymphoma, lenalidomide is often used as a single agent after other treatments have failed. In other blood cancers, it may be used with dexamethasone (a steroid), or with rituximab (an antibody) in certain types of lymphoma. Your doctor may also prescribe medications to prevent blood clots or infections while you are on lenalidomide.

Commonly tested with

Lenalidomide has been tested in combination with:

• Bortezomib (a proteasome inhibitor)
• Rituximab (an antibody)
• Dexamethasone (a steroid)
• Other chemotherapy agents in clinical trials

For mantle cell lymphoma, its approval is specifically for patients who have already received bortezomib and at least one other therapy. In clinical studies, lenalidomide is often compared with other standard treatments or used in combination with other drugs to evaluate its effectiveness and safety.