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Systemic Anti-Cancer Therapy Regimen Library

Home > PCN MM - lenalidomide and dexamethasone

PCN MM - lenalidomide and dexamethasone

Treatment Overview

Cycle 1 (and all further cycles) - 28 days

Cycle length:
28

dexamethasone: Consider dose reduction of dexamethasone to 20 mg orally ONCE a week in older or frail patients.

Cycle details

Cycle 1 (and all further cycles) - 28 days

Medication Dose Route Days Max Duration
dexamethasone * 40 mg flat dosing oral administration 1, 8, 15,
22
lenalidomide 25 mg Once daily oral administration 1 to 21

dexamethasone: Consider dose reduction of dexamethasone to 20 mg orally ONCE a week in older or frail patients.

Full details

Cycle 1 (and all further cycles) - 28 days

Day: 1

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Consider dose reduction to 20 mg in older or frail patients.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 2

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 3

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 4

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 5

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 6

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 7

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 8

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Consider dose reduction to 20 mg in older or frail patients.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 9

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 10

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 11

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 12

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 13

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 14

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 15

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Consider dose reduction to 20 mg in older or frail patients.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 16

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 17

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 18

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 19

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 20

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 21

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 22

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Consider dose reduction to 20 mg in older or frail patients.

Additional details

Section 1: Teratogenic effects

All patients must fulfil the requirements of the pregnancy prevention risk management programme to ensure pregnant women are not exposed to lenalidomide.

Supportive Care Factors

Factor Value
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis may be considered
Emetogenicity: Minimal to low
Gastroprotection: Gastroprotection may be considered
Pneumocystis jirovecii pneumonia (PJP) prophylaxis: Routine antibiotic prophylaxis recommended
Thromboprophylaxis: Thromboprophylaxis is recommended
Tumour lysis syndrome prophylaxis: Tumour lysis syndrome prophylaxis may be considered

Antiviral prophylaxis for hepatitis B virus: Guidance is limited to high-risk anti-cancer medicines. Clinicians will need to assess individual patient risk for other anti-cancer medicines.

References

Rajkumar SV, Jacobus S, Callander NS et al. 2010 " Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial."Lancet Oncol. 2010 Jan;11(1):29-37., PMID: 19853510

Benboubker, L., M. A. Dimopoulos, A. Dispenzieri, et al. 2014. "Lenalidomide and dexamethasone in transplant-ineligible patients with myeloma." N Engl J Med 371(10):906-917., PMID: 25184863

Weber, D. M., C. Chen, R. Niesvizky, et al. 2007. "Lenalidomide plus dexamethasone for relapsed multiple myeloma in North America." N Engl J Med 357(21):2133-2142., PMID: 18032763

Dimopoulos, M., A. Spencer, M. Attal, et al. 2007. "Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma." N Engl J Med 357(21):2123-2132., PMID: 18032762

Dimopoulos, M. A., C. Chen, A. Spencer et al. 2009. "Long-term follow-up on overall survival from the MM-009 and MM-010 phase III trials of lenalidomide plus dexamethasone in patients with relapsed or refractory multiple myeloma." Leukemia 23(11):2147-2152., PMID: 19626046

Celgene Pty Ltd. Revlimid New Zealand Datasheet 27 January 2022. "Lenalidomide Clinical Efficacy data" https://www.medsafe.govt.nz/profs/datasheet/r/revlimidcap.pdf (Accessed 28/3/2023)

Chanan-Khan, A. A., S. Lonial, D. Weber, et al. 2012. "Lenalidomide in combination with dexamethasone improves survival and time-to-progression in patients >/=65 years old with relapsed or refractory multiple myeloma." Int J Hematol 96(2):254-262., PMID: 22752567

Touzeau, C., N. Blin, A. Clavert et al. 2012. “Efficacy of lenalidomide plus dexamethasone in patients older than 75 years with relapsed multiple myeloma.” Leukemia & Lymphoma 53(7):1318-20., PMID: 22211836

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.