PDF(Pubmed)
Abstract：
Lenalidomide is a second-generation new immunomodulatory medication used to treat multiple myeloma (MM). Its mechanism of action involves affecting the expression of vascular endothelial growth factor, interleukin-6, cytochrome c, caspase-8, as well as other factors including immunological modulation and the direct killing of cells, among others, rendering it a fundamental medication, useful for the treatment of MM. Combining lenalidomide with other medications such dexamethasone, bortezomib, ixazomib, carfilzomib and daratumumab can markedly alleviate MM. When autologous-hematopoietic stem cell transplantation (ASCT) cannot be utilized to treat newly diagnosed individuals with MM (NDMM), monotherapy maintenance following lenalidomide and dexamethasone may be employed. Following ASCT, single-agent maintenance with lenalidomide can be performed as an additional treatment. The combination of bortezomib and lenalidomide has been demonstrated to be associated with favorable response rates, tolerable toxicity, and therapeutic benefits although caution is warranted to prevent the onset of peripheral neuropathy with its use. A new-generation oral drug with an excellent safety profile, ixazomib, is more practical and therapeutically applicable in relapsed refractory MM. However, the frequent occurrence of cardiovascular events, hematocrit, and infections with it require flexible adjustment in its clinical application. Carfilzomib produces a rapid and profound response in patients with NDMM eligible for transplantation, but its cardiovascular side effects need to be closely monitored. The primary aim of the present review was to examine the pharmacological properties and pharmacokinetics of lenalidomide, as well as the efficacy and safety of lenalidomide-based treatments with reference to data from clinical trials and real-world studies.
摘要：
来那度胺是一种第二代新的免疫调节药物，用于治疗多发性骨髓瘤（MM）。其作用机制涉及影响血管内皮生长因子的表达,白细胞介素-6，细胞色素c，caspase-8，以及其他因素，包括免疫调节和直接杀死细胞，其中,使其成为一种基本药物，对MM的治疗有用。联合来那度胺与其他药物如地塞米松，硼替佐米,艾沙佐米,卡非佐米和达雷木单抗可以明显缓解MM。当自体造血干细胞移植（ASCT）不能用于治疗新诊断的MM（NDMM）患者时，可以使用来那度胺和地塞米松后的单一疗法维持。在ASCT之后，来那度胺的单一药物维持可以作为额外治疗。硼替佐米和来那度胺的组合已被证明与良好的反应率相关。可耐受的毒性，和治疗益处，尽管谨慎使用它可以防止周围神经病变的发作。新一代口服药物具有优异的安全性，艾沙佐米,在复发性难治性MM中更实用和治疗上适用。然而,心血管事件的频繁发生，血细胞比容,和感染需要在临床应用中灵活调整。卡非佐米在符合移植条件的NDMM患者中产生快速而深刻的反应，但是它的心血管副作用需要密切监测。本综述的主要目的是研究来那度胺的药理特性和药代动力学，以及基于来那度胺治疗的疗效和安全性，并参考临床试验和现实世界研究的数据。
