In multiple myeloma, defective plasma cells divide uncontrollably in the bone marrow, crowding out normal disease-fighting cells. This leads to a weakened immune system and damage in the bones and kidneys. Revlimid, which is manufactured by Celgene, is a new immunomodulatory drug used to treat multiple myeloma. It is structurally similar to thalidomide but has been modified by scientists to have fewer side effects and higher potency. According to the Mayo Clinic, many physicians are choosing it over thalidomide to treat patients with relapsed myeloma. The generic name for Revlimid is lenalidomide.
Mechanism of Action
As an Immunomodulatory drug, Revlimid takes many actions against faulty immune functioning, according to the International Myeloma Foundation. It enhances the activity of specialized white blood cells to help kill cancer cells. It induces an overall immune response and inhibits inflammation. Revlimid is also a growth factor inhibitor. It programs myeloma cells to die and inhibits growth of new blood vessels they rely on. It also limits the ability of the myeloma cells to adhere to other cells in the bone marrow.
Revlimid is approved for use in people with multiple myeloma who have already had another therapy. According to the Mayo Clinic, physicians often use Revlimid for people with newly diagnosed disease as well. For patients with relapsed myeloma, it is prescribed with dexamethasone, a chemotherapy, as research has shown that the two agents together are more effective than either agent alone.
How Revlimid is Taken
Revlimid is taken orally, as a pill. Patients take it once a day for 21 days, then rest on days 22 to 28. After that, they begin the treatment cycle again. Depending on side effects, the doctor may modify the dosage for the next month. Patients who may become pregnant are advised not to take Revlimid, as it potentially causes birth defects. Also, because researchers don't know whether Revlimid passes into semen, men are advised to use protection while taking it until 4 weeks after treatment ends.
According to the American Cancer Society, the most common side effects of Revlimid are low blood counts of platelets, which is called thrombocytopenia, and of white blood cells, which is called neutropenia. Neuropathy, painful nerve damage, may also occur. Patients taking Revlimid have a higher risk for blood clots in veins and the lungs. Shortness of breath, chest pain, and redness or swelling in the arm or leg are signs of blood clots and warrant immediate medical attention. Because it is chemically similar to thalidomide, which is linked to birth defects, Revlimid is available only from doctors and pharmacists registered with a special distribution program. Women taking Revlimid are advised to avoid becoming pregnant.
Many oncologists now prescribe Revlimid with dexamethasone given only once a week at a lower dosage. According to the International Myeloma Foundation, studies show that combining Revlimid with low-dose chemotherapy may be even more effective than the old approach. Also, researchers are looking into using Revlimid by itself in certain patients.