On June 29,
2006, the U.S. Food and Drug Administration
granted approval to lenalidomide oral capsules
(Revlimid, Celgene Corporation) for use in
combination with dexamethasone in patients
with multiple myeloma who have received one
prior therapy. Revlimid is available under a
special restricted distribution program,
called RevAssist (described below).
Efficacy and
safety were demonstrated in two randomized,
double-blind, multi-center, multi-national,
placebo-controlled studies comparing the
combination of lenalidomide plus oral pulse
dexamethasone versus dexamethasone alone in
patients with multiple myeloma who had
received at least one prior therapy. Revlimid
(lenalidomide) was administered at a starting
dose of 25 mg/day orally as a single 25 mg
capsule on days 1‑21 of repeated 28-day
cycles. Dexamethasone was administered orally
at a dose of 40 mg/day on days 1‑4, 9‑12, and
17‑20 of each 28‑day cycle for the first 4
cycles and then 40 mg/day orally on days 1‑4
every 28 days in both treatment arms of both
studies.
Data were
evaluated from 692 patients in the two
studies, 341 patients in Study 1 and 351
patients in Study 2. The primary endpoint of
time-to-progression (TTP) was evaluated in a
pre-specified interim analysis in each study.
In Study 1, median TTP was 37.1 weeks in the
lenalidomide/dexamethasone arm compared to
19.9 weeks with dexamethasone alone (HR=0.356;
95% CI [0.257, 0.494]; p < 0.0001). In Study
2, median TTP was not reached in the
lenalidomide/dexamethasone arm compared to 20
weeks in the dexamethasone alone arm
(HR=0.392; 95% CI [0.274, 0.562]; p < 0.0001).
Safety data
were evaluated from 691 patients in the two
studies. Grade 3 and 4 neutropenia,
thrombocytopenia, leukopenia, lymphopenia,
febrile neutropenia, deep vein thrombosis,
pulmonary embolism, atrial fibrillation,
constipation, diarrhea, fatigue, pneumonia,
hypokalemia, hypocalcemia, muscle weakness,
neuropathy and depression were reported in a
greater proportion of patients treated with
the combination of lenalidomide and
dexamethasone compared to dexamethasone alone.
Thrombotic or
thromboembolic events, including deep vein
thrombosis, pulmonary embolism, thrombosis,
and intracranial venous sinus thrombosis were
reported more frequently in patients treated
with the combination of lenalidomide plus
dexamethasone (12%) compared to dexamethasone
alone (4%) in the pooled analyses. Patients
and physicians are advised to be observant for
the signs and symptoms of thromboembolism. It
is unknown whether prophylactic
anticoagulation or antiplatelet therapy
prescribed in conjunction with lenalidomide
may reduce the potential for venous
thromboembolic events. The decision to
prescribe prophylactic measures should be
considered carefully after an assessment of an
individual patient's underlying risk factors.
Patients with
renal impairment were excluded from the
studies. Because lenalidomide is primarily
excreted by the kidney, renal function should
be carefully monitored.
Females should be advised to avoid pregnancy
while taking lenalidomide. Lenalidomide is an
analogue of thalidomide, a known human
teratogen that causes severe life-threatening
human birth defects. Reproductive toxicity
studies are ongoing to assess lenalidomide's
potential teratogenicity. To avoid fetal
exposure, lenalidomide is only available under
a special restricted distribution program
called RevAssist. Under this program, only
prescribers and pharmacists registered with
the program can prescribe and dispense the
product. Patients enrolled in the program to
receive the drug must agree to comply with the
requirements of the RevAssist program.
Full prescribing information including
clinical trial information, safety, dosing,
drug-drug interactions and contraindications
is available at
www.fda.gov/cder/foi/label/2005/021880lbl.pdf.
Healthcare professionals should report all
serious adverse events suspected to be
associated with the use of any medicine and
device to FDA's MedWatch Reporting System by
phone at 1-800-FDA-1088; by facsimile
1-800-FDA-0178 by mail using the Form 3500 at
http://www.fda.gov/medwatch.index.html.
For further information related to oncology
drug approvals, regulatory information, and
other oncology resources, please refer to the
FDA “Oncology Tools” website at
www.fda.gov/cder/cancer.
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