A Case of Secondary Primary Malignancy after Lenalidomide Therapy for Multiple Myeloma
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Lenalidomide, an orally administered immune-modulating drug, has several mechanisms of action against multiple myeloma (MM).However, the mechanisms of action of immune-modulating drugs are not understood completely.Lenalidomide maintenance therapy prolongs the time to progression and increases the overall survival in patients with MM.However, secondary primary malignancy (SPM) has been noted as a serious adverse event in patients with MM treated with lenalidomide.Lenalidomide treatment is not covered by insurance.Consequently, physicians have little experience with the adverse events of lenalidomide treatment in patients with MM.Here, we describe a case of breast cancer after lenalidomide treatment for MM.To our knowledge, this is the first report of a lenalidomide-associated SPM in Korea.The risk factors associated with lenalidomide-associated SPM should be considered carefully when implementing chemotherapy regimens in patients with MM. (The field of multiple myeloma therapeutics has been an active one for many years, but perhaps no more so than in the past decade. The introduction of thalidomide, lenalidomide and bortezomib in the treatment of this disease highlights clinical advances made during this period. While these agents were initially utilized in the setting of relapsed and refactory disease, they are now part of the therapeutic armamentarium for transplant-eligible and transplant-ineligible patients with newly diagnosed multiple myeloma. The principles of management applied in the care of newly diagnosed multiple myeloma are reviewed in this article, along with the clinical studies supporting the use of thalidomide, lenalidomide and bortezomib in newly diagnosed multiple myeloma. Management of treatment-related side effects is also discussed, since it constitutes a critical element in the successful management of patients with this disease. Combination regimens utilizing thalidomide, lenalidomide and bortezomib are also highlighted, as these regimens are likely to play an increasingly important role in myeloma therapy in the future.
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Immunomodulatory drug lenalidomide is a synthetic compound derived by modifying the chemical structure of thalidomide to improve its potency and reduce its side effects. Lenalidomide is a 4-amino-glutamyl analogue of thalidomide that has emerged as a drug with activity against various hematological and solid malignancies. It is approved by FDA in USA for clinical use in myelodysplastic syndromes with deletion of chromosome 5q and multiple myeloma. Studies have shown that lenalidomide exert anti-tumor activity probably by various mechanisms in hematologic malignancies, such as immunomodulation, anti-angiogenesis and effects on signal transduction. In this article, the progresses of study on these problems are reviewed.
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Thalidomide, lenalidomide and pomalidomide are synthetic immunomodulatory drugs (IMiDs) that have recently drawn attention in both clinics and basic research. Thalidomide was synthesized from glutamic acid and was banned due to its teratogenicity in pregnant women [1]. Lenalidomide is a 4-amino-glutamyl analogue of thalidomide and is approved for the treatment of certain hematologic malignancies. Lenalidomide is used for the treatment of lower-risk red blood cell (RBC) transfusiondependent myelodysplastic syndromes (MDS) with deletion of chromosome 5q (del(5q)) with or without additional cytogenetic abnormalities
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Lenalidomide is an immunomodulatory drug that was developed by modification of the first-generation immunomodulatory drug thalidomide in a drug discovery program. Lenalidomide more potently regulates cellular immune and cytokine responses, while lacking the side-effect profile of thalidomide. The promising activity seen in multiple myeloma and myelodysplastic syndrome has led to its approval by the U.S. Food and Drug Administration in these conditions. The clinical results that we have seen so far, which demonstrate significant efficacy with a tolerable toxicity profile, provide a strong basis for the use of lenalidomide in other malignancies. Combination therapy with lenalidomide could enhance this agent's antineoplastic role; this is likely the position it will occupy in the armamentarium against cancer.
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Lenalidomide is a synthetic derivative of thalidomide that acts as an immunomodulatory drug (iMiD) and is a treatment option for myelodysplastic syndrome and multiple myeloma, with a developing rol...
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Thalidomide is effective in the treatment of multiple myeloma. The immunomodulatory drug and thalidomide analogue lenalidomide is currently in late stage clinical development for MDS and multiple myeloma. This minireview highlights the course of initial and ongoing lenalidomide clinical development in oncology with reference to earlier thalidomide studies.
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