Current Treatment Strategies with Lenalidomide in Multiple Myeloma and Future Perspectives

Abstract

Lenalidomide is an immunomodulatory drug derived from thalidomide, developed to maximize its anti-inflammatory and antineoplastic properties while reducing toxicity. Lenalidomide administered orally at 25 mg/d on days 1–21 of 28-day cycles plus dexamethasone is indicated for the treatment of relapsed/refractory multiple myeloma patients, who received at least one prior therapy. In the pivotal MM-009 and MM-010 Phase III registration trials, lenalidomide–dexamethasone, when compared with placebo–dexamethasone, significantly improved response rate (60 vs 20%, respectively), time-to-progression and survival. The most common adverse events included hematologic toxicity and venous thromboembolism. The drug is currently being investigated for the treatment of newly diagnosed myeloma and, in association with chemotherapy drugs (cyclophosphamide and melphalan) or novel agents (bortezomib, carfilzomib and elotuzumab), for the development of highly active combination regimens.

Keywords:

• immunomodulatory drug
• lenalidomide
• multiple myeloma
• newly diagnosed patients
• refractory
• relapsed

Financial & competing interests disclosure

A Larocca has received honoraria from Celgene and Janssen–Cilag; F Cavallo has received honoraria from Celgene and Janssen–Cilag, and served on the advisory committee for Celgene; M Boccadoro has received research funding from and served on the scientific advisory board for Celgene and Janssen–Cilag; A Palumbo has received honoraria from Celgene, Janssen–Cilag, Bristol–Myers Squibb, Millennium, Merck and Onyx, and served on the advisory board for Celgene and Janssen–Cilag.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Acknowledgements

The authors thank the editorial assistant Giorgio Schirripa.

Additional information

Funding

A Larocca has received honoraria from Celgene and Janssen–Cilag; F Cavallo has received honoraria from Celgene and Janssen–Cilag, and served on the advisory committee for Celgene; M Boccadoro has received research funding from and served on the scientific advisory board for Celgene and Janssen–Cilag; A Palumbo has received honoraria from Celgene, Janssen–Cilag, Bristol–Myers Squibb, Millennium, Merck and Onyx, and served on the advisory board for Celgene and Janssen–Cilag.