How would you approach dose modifications and/or frequency of lenalidomide in patients with advanced renal impairment (eGFR <30)?
The FDA package insert suggests 2.5 mg daily in these settings, while the PrE1003 study demonstrated that a higher dose is feasible. Many oncologists might avoid lenalidomide entirely for these patients. What would you do?
2 Answers
Mednet MemberInvited Expert
Medical Oncology · University of Chicago
Answered on
Great question - comes up a lot in discussion with community providers.
The dosing is dependent on what your target dose would be.
If normal dosing was 25 mg and CrCl <30 and not on dialysis, then I follow the package insert "15 mg every other day". If the patient tolerates that ok, I increase to 10...
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Mednet MemberInvited Expert
Medical Oncology · Winship Cancer Institute of Emory University
Answered on
The "correct" dose for lenalidomide is a challenge. We know that renal function is a HUGE determinant of lenalidomide exposure (Chen et al., PMID 27351179 & Bridoux et al., PMID 27286995 & Guglieri-López et al., PMID 28039509), but it's NOT the only factor.
We should not forget that the right dose f...
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