Update on the role of lenalidomide in patients with multiple myeloma

Abstract

Lenalidomide is a derivative of thalidomide and belongs to the class of drugs known as the immunomodulatory drugs (IMiDs). The IMiDs have played a large role in improving the survival outcomes of patients with multiple myeloma. In particular, lenalidomide is currently standard of care in the newly diagnosed setting, in the maintenance setting post-autologous stem cell transplant, as well as in the relapsed/refractory setting. While the combination of lenalidomide and various proteasome inhibitors has proven particularly effective, there are emerging data demonstrating the effectiveness of lenalidomide in combination with other important classes of drugs including the monoclonal antibodies. Recent studies have provided insight into the molecular target of lenalidomide and the other IMiDs, although there is still much to be learned regarding the mechanisms by which lenalidomide affects the myeloma cell and the immune system. Here we review the molecular mechanisms of action, side effects, and the results of the clinical trials which have led to the widespread incorporation of lenalidomide into the myeloma therapeutic armamentarium.

Keywords: immunomodulatory drug; lenalidomide; multiple myeloma.

Figure 1.

Timeline of key events in the development of lenalidomide for the treatment of myeloma. ASCT, autologous stem cell transplant; Car, carfilzomib; CRBN, cereblon; Dara, daratumumab; Dex, dexamethasone; Elo, elotuzumab; FDA, US Food and Drug Administration; IMiD, immunomodulatory drug; Ixa, ixazomib; Len, lenalidomide; MM, multiple myeloma; NDMM, newly diagnosed multiple myeloma; RRMM, relapsed/refractory multiple myeloma; Thal, thalidomide.