Lenalidomide (Revlimid)

General information

Class/mechanism: Second-generation immunomodulatory drug (IMiD) similar to Thalidomide (Thalomid); mechanism not fully understood. Lenalidomide's mechanism may involve immunomodulatory, antiinflammatory, and antiangiogenic effects and suppression of tumor necrosis factor-alpha (TNF-α) from peripheral blood mononuclear cells. It has been observed to inhibit cells with the 5q deletion in myelodysplastic syndromes. It has also been seen in vitro to inhibit cyclooxygenase-2 (COX-2) expression, but not COX-1.
Route: PO
Extravasation: n/a

• Use of Lenalidomide (Revlimid) requires participation the Revlimid REMS program.

For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, Lexicomp, UpToDate (courtesy of Lexicomp), or the prescribing information.

Diseases for which it is used

• Aggressive Non-Hodgkin lymphoma
• Chronic lymphocytic leukemia (CLL) and Small lymphocytic lymphoma (SLL)
• Follicular lymphoma
• Light-chain (AL) amyloidosis
• Mantle cell lymphoma
• Marginal zone lymphoma
• Multiple myeloma
• Myelodysplastic syndrome
• Myelofibrosis
• T-cell lymphoma

Patient drug information

• Lenalidomide (Revlimid) package insert PDF pages 28-33
• Lenalidomide (Revlimid) patient medication guide
• Lenalidomide (Revlimid) patient drug information (Chemocare)
• Lenalidomide (Revlimid) patient drug information (UpToDate)

History of changes in FDA indication

• 12/28/2005: FDA approved for patients with "transfusion-dependent anemia due to low- or intermediate-1-risk myelodysplastic syndromes (MDS) associated with a deletion 5q abnormality with or without additional cytogenetic abnormalities."
• 6/29/2006: FDA approved for treatment of patients with "multiple myeloma (MM), in combination with dexamethasone, in patients who have received at least one prior therapy.]
• 6/5/2013: FDA approved for patients with "mantle cell lymphoma (MCL) whose disease has relapsed or progressed after two prior therapies, one of which included bortezomib."