Orally administered lenalidomide, a second-generation antimyeloma thalidomide analog, is a workhorse in contemporary management of multiple myeloma: it is approved by the US Food and Drug Administration (FDA) for the posttransplantation treatment of newly diagnosed multiple myeloma and for postinduction maintenance therapy for patients who are not eligible for autologous stem cell transplantation (ASCT).1,2 Recently, reported findings from the randomized phase 3 Myeloma XI clinical trial bolster the case for lenalidomide’s central role in the management of multiple myeloma.1

“Lenalidomide was proven beneficial and has taken the slot as an indispensable agent in the initial antimyeloma regimens,” noted Ajay Nooka, MD, MPH, FACP, associate professor, hematology and medical oncology, the Emory University School of Medicine, and the Winship Cancer Institute of Emory University, Atlanta, Georgia. “It has more potent antimyeloma activity and a more favorable toxicity profile, relative to its parent compound.”

The FDA-approved continuous-therapy dose of lenalidomide is 10 mg, with increased doses of up to 15 mg.2 Not receiving maintenance therapy is associated with a worse prognosis, Dr Nooka emphasized.

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“This is a modifiable risk factor that potentially can be altered, which can result in improved outcomes for myeloma patients,” he said. “Results from 2 phase 3 trials showed the efficacy and safety of lenalidomide combinations among transplant-ineligible patients.”

The previously reported FIRST trial showed that continuous lenalidomide and dexamethasone (Rd) yields better progression-free survival (PFS) times than fixed-duration therapy.3 The Southwest Oncology Group (SWOG) trial demonstrated superiority for lenalidomide, bortezomib, and dexamethasone (RVd) over Rd for overall survival.4