Ledomide

Indications

Lenalidomide is a cancer medicine used mainly to treat multiple myeloma (a cancer of plasma cells in the bone marrow), both as initial treatment and as maintenance after a stem cell transplant. It is also used for certain myelodysplastic syndromes (bone marrow disorders) with a specific chromosome change, and for some lymphomas such as mantle cell and follicular lymphoma.

How It Works

Lenalidomide is an immunomodulatory medicine related to Thalidomide. It acts on a protein called cereblon inside cells, which leads to the breakdown of proteins that cancer cells need to survive. It also boosts the activity of immune cells (T cells and natural killer cells) that attack cancer, and reduces the growth of new blood vessels that feed tumours.

Dosage and Administration

Lenalidomide must be taken exactly as prescribed by a cancer specialist. It is usually taken as capsules once a day for a set number of days in repeated cycles (for example 21 days of a 28 day cycle), often together with Dexamethasone or other medicines. The dose depends on the illness, blood counts and kidney function. Swallow capsules whole with water at about the same time each day; do not open, break or chew them. Wash your hands after handling capsules.

Interactions

• Digoxin levels may rise; monitoring may be needed.
• Medicines that increase blood clot risk, such as Erythropoietin and hormonal contraceptives or hormone therapy, add to the risk of clots.
• Statins may increase the risk of muscle problems.
• Tell your doctor about all medicines, vaccines and herbal products; live vaccines should be avoided.

Contraindications

• Pregnancy, and women who could become pregnant unless all pregnancy prevention requirements are strictly followed.
• Allergy to Lenalidomide or Thalidomide related medicines.

Side Effects

Common side effects include low white cells, platelets and red cells (raising the risk of infection, bleeding and anaemia), tiredness, diarrhoea or constipation, muscle cramps, skin rash, swelling of the legs, and nerve tingling. It increases the risk of blood clots in the legs and lungs, especially with Dexamethasone. Rarely, serious skin reactions, liver problems, thyroid changes and new cancers can occur.

Get urgent medical help if you have fever, chills or other signs of infection; unusual bleeding or bruising; pain, swelling or redness in a leg; sudden chest pain or breathlessness; a severe skin rash with blistering or peeling; or yellowing of the skin or eyes.

Pregnancy and Lactation

Lenalidomide is expected to cause severe birth defects or death of an unborn baby. It must not be used in pregnancy. Women who can become pregnant must use effective contraception for at least 4 weeks before, during and for 4 weeks after treatment, with regular pregnancy tests. Men must use condoms during treatment and for at least 1 week after, as the medicine is present in semen, and must not donate sperm. Do not breastfeed during treatment.

Precautions and Warnings

• Regular blood counts, kidney and liver tests are needed.
• Your doctor may give a blood thinner to prevent clots.
• Do not donate blood during treatment and for 1 week after.
• Return unused capsules to the pharmacy; never share them.
• Tiredness and dizziness may affect driving.

Overdose

Overdose may cause severe falls in blood counts. Seek emergency medical help straight away. Treatment is supportive with close monitoring.

Therapeutic Class

Anticancer medicine; immunomodulatory agent.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children. Keep in the original pack.