Lenalidomide is a distinct second-generation immunomodulatory drug with
multiple anticancer and immunomodulatory effects against hematologic
malignancies, in particular multiple myeloma (MM). Dexamethasone
synergistically enhances the anticancer effects of lenalidomide, and the
combination of lenalidomide and dexamethasone (Len/Dex) is approved for
the treatment of patients with relapsed and/or refractory MM. Results
from pivotal phase III trials in this setting have demonstrated that
Len/Dex extends overall survival compared with dexamethasone alone.
Optimal clinical benefits are seen when Len/Dex is initiated at first
relapse and continued, beyond best treatment response, until disease
progression. Lenalidomide based regimens are also effective as induction
therapy in patients with newly diagnosed MM. Importantly, lenalidomide
has a predictable and manageable tolerability profile, with minimal
neurotoxicity, allowing long-term administration. As the paradigm of
myeloma disease continues to change, future studies will determine the
efficacy of lenalidomide in novel combinations with potentially
complimentary agents. (C) 2013 Elsevier Ireland Ltd. All rights
reserved