Lenalidomide (Revlimid)

What is Lenalidomide?

Lenalidomide is a type of immunomodulating drug. This means is affects the way the immune system works by helping the bone marrow to produce normal blood cells and by killing abnormal cells in the bone marrow. It is given in combination with the steroid dexamethasone.
Generally, this drug is only available in specialist cancer treatment centers where research trials are taking place. It is currently most commonly given to patients with multiple myeloma, who have received at least one other previous treatment. Lenalidomide is also being researched as a possible treatment for other cancers.

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How does it work ?

How Lenalidomide works in the treatment of cancer is not fully understood. Cancer needs to produce a network of new blood vessels in order to grow. Researchers hope that Lenalidomide can stop cancers from developing new blood vessels and therefore will cause the tumour to shrink or stop the cancer growing.

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What does it look like ?

Lenalidomide is a capsule, available in 5mg, 10mg, 15mg and 25mg.

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How is it given?

Lenalidomide is given by mouth, once a day. Swallow each capsule whole, do not chew or open them. The dosage is based on your body size and is determined by your doctor or pharmacist, who will instruct you, as to how many capsules to take daily.
Your doctor may need to interrupt your treatment or reduce your dose if you experience certain side effects. Be sure to tell your doctor how you are feeling during your treatment with lenalidomide.
If you miss a dose, take the missed dose as soon as you remember it. If you do not remember the missed dose until the next day, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

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Side effects

Each person's reaction to a cancer drug is different. Some people have very few side effects, while others may experience more. The most common side effects are outlined; however, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects that you think may be due to the drug but which are not listed here, please discuss them with your doctor or nurse.

Birth defects: You must not become pregnant or father a child while taking Lenalidomide, as it causes severe abnormalities in developing babies. Women will be asked to have a pregnancy test, to check that they are not pregnant. They will also be advised to use a highly effective form of contraception (such as implanted or injected contraception) as well as a barrier method (such as a condom or cap).
Men taking Lenalidomide are advised to use a condom during sexual intercourse even if they have had a vasectomy. Both men and women may be asked to use contraception for four weeks before starting treatment and for four weeks after treatment has finished.

Temporary reduction in the production of blood cells by the bone marrow: This can result in anaemia, risk of bruising or bleeding and infection. Lenalidomide has only a slight effect on bone marrow. However, it can often be given in combination with chemotherapy drugs. The extent to which your bone marrow is affected depends on which chemotherapy drugs, if any, are given in combination with the Lenalidomide. Your blood will be checked regularly to see how well your bone marrow is working.
If your temperature goes above 38°C (100.5°F), if you develop any unexplained bruising or bleeding, or you suddenly feel unwell, even if you have a normal temperature, contact your doctor or the hospital straight away.

Risk of blood clots: Lenalidomide may increase your risk of developing blood clots. These can be either a deep vein thrombosis (DVT), or a pulmonary embolism (PE), which is a clot in the lung. While taking Lenalidomide you may also be given warfarin (an anticoagulant) that will thin your blood and help to prevent any clots forming. Let your hospital doctor know if you develop any pain, swelling or redness in one of your calves (a possible DVT), or if you develop any breathlessness or chest pain (a possible PE).

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Less common side effects

Lethargy, sleepiness and loss of balance: It is not unusual for people to feel sleepy when taking Lenalidomide. It is important to tell your doctor if you have these side effects. However, tolerance to day time drowsiness improves, over a number of weeks, as you continue to take the drug. If you are sleepy, it is important not to drive or operate machinery. Taking your medication in the evening minimizes daytime drowsiness.

Constipation: This can usually be relieved by drinking plenty of fluids (2–3 litres a day), eating a high-fibre diet and taking gentle exercise. Sometimes a mild laxative may be recommended.

Rashes: Lenalidomide can cause a rash, which may be itchy. It may occur 2 -3 days after starting the medication. Do not take another dose of the drug until the rash has been evaluated by your doctor, who can then, prescribe treatment to help reduce this.

Nausea (feeling sick) and vomiting: Most people have little or no nausea. You will probably be given anti-sickness (anti-emetic) medicines to take, but tell your doctor if the nausea becomes a problem.

Loss of appetite: A dietician or specialist nurse at your hospital can give advice about loss of appetite.

Numbness or tingling in hands or feet: This effect is uncommon if you have standard doses of the drug, but it may happen if you have very high-dose treatment or prolonged use. This is due to the effect of Lenalidomide on the nerves and is known as peripheral neuropathy. You may also notice that you have difficulty in tasks, for example, buttoning your shirt. Tell your doctor if you notice any of these side effects. They usually improve slowly a few months after the treatment ends. Avoid wearing tight-fitting shoes and socks. Keep feet loosely covered or uncovered while in bed to avoid friction and overheating. Maintain moderate activity as tolerated, such as walking. Gently massaging affected areas may improve circulation and reduce pain. Soaking affected areas in cool water also may be helpful. For more information on peripheral neuropathy, please see our factsheet.

Headache: Let your doctor know if you have headaches while having treatment with Lenalidomide.

Dizziness on standing: Lenalidomide may cause a drop in blood pressure (orthostatic hypotension), if you stand up quickly. You may feel dizzy and are at risk of falling, this is caused by a temporary fall in blood pressure. Move slowly from lying to sitting and then sitting to standing. Tell your doctor if you have ever had any blood pressure problems and about any medicines you are taking.

Swelling and fluid retention: You may find that your ankles swell, particularly if you have been standing still or sitting down for a time. Try to remember to keep your feet up if you are sitting still. Talk to your doctor about medicines that may help. If the swelling is uncomfortable, your doctor may be able to prescribe elastic stockings to keep it under control.

Lenalidomide may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

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