Lenalidomide

Lenalidomide

Clinical data
Pronunciation	/ˌlɛnəˈlɪdoʊmaɪd/
Trade names	Revlimid
AHFS/Drugs.com	Monograph
MedlinePlus	a608001
Pregnancy category	AU: X (High risk) US: X (Contraindicated)
Routes of administration	Oral (capsules)
ATC code	L04AX04 (WHO)
Legal status
Legal status	UK: POM (Prescription only) US: ℞-only
Pharmacokinetic data
Bioavailability	Undetermined
Protein binding	30%
Metabolism	Undetermined
Biological half-life	3 hours
Excretion	Renal (67% unchanged)
Identifiers
IUPAC name (RS)-3-(4-Amino-1-oxo-1,3-dihydro-2H-isoindol-2-yl)piperidine-2,6-dione
CAS Number	191732-72-6 Y
PubChem (CID)	216326
IUPHAR/BPS	7331
DrugBank	DB00480 Y
ChemSpider	187515 Y
UNII	F0P408N6V4 Y
KEGG	D04687 Y
ChEMBL	CHEMBL848 Y
ECHA InfoCard	100.218.924
Chemical and physical data
Formula	C13H13N3O3
Molar mass	259.261 g/mol
3D model (Jmol)	Interactive image
Chirality	Racemic mixture
SMILES O=C1NC(=O)CCC1N3C(=O)c2cccc(c2C3)N
InChI InChI=1S/C13H13N3O3/c14-9-3-1-2-7-8(9)6-16(13(7)19)10-4-5-11(17)15-12(10)18/h1-3,10H,4-6,14H2,(H,15,17,18) Y Key:GOTYRUGSSMKFNF-UHFFFAOYSA-N Y

Lenalidomide (trade name Revlimid) is a derivative of thalidomide introduced in 2004.

It was initially intended as a treatment for multiple myeloma, for which thalidomide is an accepted therapeutic treatment. Lenalidomide has also shown efficacy in the class of hematological disorders known as myelodysplastic syndromes (MDS). Along with several other drugs developed in recent years, lenalidomide has significantly improved overall survival in myeloma (which formerly carried a poor prognosis), although toxicity remains an issue for users. It costs $163,381 per year for the average patient.

Multiple myeloma is a cancer of the blood, characterized by accumulation of a plasma cell clone in the bone marrow. Lenalidomide is one of the novel drug agents used to treat multiple myeloma. It is a more potent molecular analog of thalidomide, which inhibits tumor angiogenesis, tumor secreted cytokines and tumor proliferation through the induction of apoptosis.

Compared to placebo, lenalidomide is effective at inducing a complete or "very good partial" response as well as improving progression-free survival. Adverse events more common in people receiving lenalidomide for myeloma were neutropenia (a decrease in the white blood cell count), deep vein thrombosis, infections, and an increased risk of other hematological malignancies. The risk of second primary hematological malignancies does not outweigh the benefit of using lenalidomide in relapsed or refractory multiple myeloma. It may be more difficult to mobilize stem cells for autograft in people who have received lenalidomide.

On 29 June 2006, lenalidomide received U.S. Food and Drug Administration (FDA) clearance for use in combination with dexamethasone in patients with multiple myeloma who have received at least one prior therapy.

On 23 April 2009, The National Institute for Health and Clinical Excellence (NICE) issued a Final Appraisal Determination (FAD) approving lenalidomide, in combination with dexamethasone, as an option to treat patients who suffer from multiple myeloma who have received two or more prior therapies in England and Wales.