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lenalidomide (Revlimid)

Trademark: Revlimid, FDA approved 2005 Indications: - myelodysplastic syndrome with 5q deletion - multiple myeloma - mantle cell lymphoma [8] Contraindications: - chronic lymphocytic leukemia [6] Dosage: - lenalidomide (25 mg/day for 21 days) & dexamethasone (20 mg on days 1-4 & 12-15 in 28 day cycles - after stem-cell transplantation: start 5-15 mg/day [3] Adverse effects: - venous thromboembolism* - neutrophilic dermatosis - pyoderma gangrenosum, Sweet syndrome [10] * prophylaxis for deep vein thrombosis Mechanism of action: - thalidomide analog, angiogenesis inhibitor Notes: - cost > $160,000/year (2012) [3] - Manufacturer: Bayer/Onyx - one of 2 drugs accounting for 26% of total Medicare drug spending but just 1% of claims [9]

General

antineoplastic immunomodulator pharmaceutical angiogenesis inhibitor (angiostatic agent)

Database Correlations

PUBCHEM cid=216326

References

  1. Prescriber's Letter 13(2): 2006 Detail-Document#: 220215 (subscription needed) http://www.prescribersletter.com
  2. UpToDate 14.1 http://www.utdol.com
  3. Palumbo A et al Continuous Lenalidomide Treatment for Newly Diagnosed Multiple Myeloma N Engl J Med 2012; 366:1759-1769 PMID: 22571200 http://www.nejm.org/doi/full/10.1056/NEJMoa1112704 - McCarthy PL et al Lenalidomide after Stem-Cell Transplantation for Multiple Myeloma N Engl J Med 2012; 366:1770-1781 PMID: 22571201 http://www.nejm.org/doi/full/10.1056/NEJMoa1114083 - Attal M et al Lenalidomide Maintenance after Stem-Cell Transplantation for Multiple Myeloma N Engl J Med 2012; 366:1782-1791 PMID: 22571202 http://www.nejm.org/doi/full/10.1056/NEJMoa1114138 - Badros AF Lenalidomide in Myeloma - A High-Maintenance Friend N Engl J Med 2012; 366:1836-1838 PMID: 22571206 http://www.nejm.org/doi/full/10.1056/NEJMe1202819
  4. Palumbo A et al Prevention of thalidomide- and lenalidomide-associated thrombosis in myeloma. Leukemia. 2008 Feb;22(2):414-23. PMID: 18094721
  5. List A, Dewald G, Bennett J, Giagounidis A et al Lenalidomide in the myelodysplastic syndrome with chromosome 5q deletion. N Engl J Med. 2006 Oct 5;355(14):1456-65. PMID: 17021321
  6. Celgene Will Discontinue Phase III ORIGIN Trial in Previously Untreated Elderly Patients with B-Cell Chronic Lymphocytic Leukemia. July 18, 2013 http://newsroom.celgene.com/press-release/corporate/celgene-will-discontinue-phase-iii-origin-trial-previously-untreated-elderly - Ferrajoli A et al. Lenalidomide induces complete and partial remissions in patients with relapsed and refractory chronic lymphocytic leukemia. Blood 2008 Jun 1; 111:5291 PMID: 18334676 http://bloodjournal.hematologylibrary.org/content/111/11/5291?ijkey=1f2236d3737b4f81c0700e651c5a72fc5ed0ffa9&keytype2=tf_ipsecsha
  7. Weber DM, Chen C, Niesvizky R et al Lenalidomide plus dexamethasone for relapsed multiple myeloma in North America. N Engl J Med. 2007 Nov 22;357(21):2133-42. PMID: 18032763
  8. Deprecated Reference
  9. Walker J Small Number of Drugs Drive Big Medicare Bill The Wall Street Journal. April 20, 2015 http://www.msn.com/en-us/money/insurance/small-number-of-drugs-drive-big-medicare-bill/ar-BBiZz23
  10. Medical Knowledge Self Assessment Program (MKSAP) 17, 18, American College of Physicians, Philadelphia 2015, 2018.