Lenalidomide (Revlimid)

Lenalidomide (pronounced len-a-lid-oh-mide) is a type of biological therapy drug. It affects how the immune system works and is called an immunomodulatory agent. It is also known by its brand name, Revlimid.

Researchers are still finding out how lenalidomide works. It affects all sorts of cell processes, including how cells divide and grow. We know that it interferes with chemicals that cells use to signal to each other to grow.

To develop, all cancers need a blood supply. Lenalidomide stops tumours making their own blood vessels. It is a type of anti angiogenic drug.

Lenalidomide is a treatment for myeloma for people who have already had at least one other treatment.

You may also have it as part of a trial for other types of cancer.

You take lenalidomide as a tablet with a glass of water. You need to swallow it whole. Don’t break or chew it. You should take it at the same time every day.

You take it every day for 3 weeks and then have a break for 1 week. This is one cycle of treatment. You then start the next cycle. You will also need to take a steroid.

It is very important that you take tablets according to the instructions your doctor or pharmacist gave you. Whether you have a full or empty stomach, for example, can affect how much of a drug gets into your bloodstream. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.

Lenalidomide can cause birth defects in children. So you must not become pregnant or father a child while taking this drug. Your doctor will talk to you about contraception before you have the treatment. Some people worry about taking lenalidomide but it doesn’t cause physical defects in adults.

Because lenalidomide causes birth defects, your doctor will talk to you and make sure that you understand the risks of taking lenalidomide and agree to use contraception

• For 4 weeks before you start treatment
• During treatment
• For 4 weeks after you finish treatment

Women also need to have pregnancy tests every 4 weeks while having treatment.

Men should use a condom while having treatment and for a week after finishing treatment.

Pregnant women should not touch or handle lenalidomide. You must store it in a place where pregnant women or children cannot reach it.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• Increased risk of getting an infection from a drop in white blood cells – chest infections called pneumonia are most common. It is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor or chemotherapy nurse if you have any of these effects. You will have blood tests regularly to see how well your bone marrow is working.

Other common side effects include

• Tiredness and lack of energy in just under 1 in 3 people (30%) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Difficulty sleeping
• Constipation in 1 in 4 people (25%) – drink at least 2 to 3 litres of fluid a day and eat a diet high in fibre. Your doctor or nurse can give you a laxative if you need one
• Muscle cramps and pain in 1 out of 5 people (20%) – you may also have swollen joints
• Blood clots in just under 1 out of 5 people (20%) – if this happens you will have treatment to thin your blood, dissolve any clots, and stop more developing. If you are at higher than normal risk of developing blood clots, your doctor will give you aspirin when you start lenalidomide treatment
• Diarrhoea in just over 1 in 10 people (10%) – drink plenty of fluid and tell your doctor if diarrhoea becomes severe, or continues for more than 3 days
• Skin reaction – you may have a rash and your skin may be dry, red and itchy
• Dizziness
• Shaky hands (tremor) caused by nerve damage
• Numbness or tingling in fingers and toes often causes difficulty with fiddly things such as doing up buttons – it starts within a few days or weeks and usually goes within a few months of finishing treatment
• Headaches
• Blurred vision and more rarely clouding of the eye (cataract)
• Feeling or being sick, which is usually well controlled with anti sickness drugs
• Changes in the levels of potassium, sodium and calcium in your blood – you may not have any symptoms from this but you will have regular blood tests to check the levels
• Loss of fertility – we don’t know exactly how this drug affects fertility, so do talk with your doctor before starting treatment if having a baby is important to you

Between 1 and 10 in every 100 people have one or more of these.

• A sore mouth
• Changes in your heart rhythm and blood pressure – your nurse or doctor will check your blood pressure and you will have ECGs if you need them
• Breathlessness due to changes in lung tissue
• Kidney changes that are mild and unlikely to cause symptoms – you will have regular blood tests to check how well your kidneys are working
• A drop in the level of thyroid hormones (hypothyroidism) – you will have regular blood tests to check your hormone levels
• Loss of appetite
• Liver changes – you are unlikely to notice any symptoms and your liver function will usually go back to normal when treatment ends. But you will have regular blood tests to check how well your liver is working
• Some hearing loss and ringing in the ears (tinnitus)
• Flu like symptoms such as chills and fever
• Urine infections
• Swelling of the ankles and legs due to a build up of fluid (oedema), which is usually mild

Fewer than 1 in 100 people have these.

• There is a small increase in the risk of developing a basal cell skin cancer after lenalidomide
• Allergic reaction while you have the treatment, causing fever, chills, shivering (rigors), a headache and feeling sick. A few people have a more severe reaction, with wheezing, an itchy rash and a drop in blood pressure. Your nurse will give you medicines before treatment to try to prevent a reaction
• Lower interest in having sex (libido) and in men difficulty getting an erection

You may only have 1 or 2 or a few of these side effects and some may be very mild. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

• How many times you've had a drug before
• Your general health
• How much of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.

Lenalidomide is a relatively new drug in cancer treatment. This means that the information about side effects is based on only a few trials. And there is no information available at the moment about possible longer term effects that it may cause. Tell your doctor if you notice anything that is not normal for you.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.