BOSTON--The thalidomide analogue
lenalidomide (Revlimid), which is
approved for use in multiple myeloma
and in certain myelodysplastic syndromes,
is associated with skin reactions,
mainly rashes and pruritus. Kathleen
Finn, RNC, ANP, director of the clinical
trials program at Boston University Medical
Center, says that such problems can
be successfully managed if patients are
encouraged to report skin reactions
promptly and if clinical assessment and
management are fairly aggressive. Ms.
Finn worked with lenalidomide as part
of a clinical trial in patients with amyloid
light chain amyloidosis (ALA).
"Skin reactions associated with Revlimid
in ALA can be effectively treated
with prompt management using overthe-
counter [OTC] antihistamines and
steroid creams," Ms. Finn said at the Oncology
Nursing Society 31st Annual Congress
(abstract 4). "Oncology nurses involved
with clinical studies have a unique
opportunity to observe adverse events and
a responsibility to share their observations
to positively impact patient care."
The phase II clinical trial compared
lenalidomide alone to
lenalidomide with dexamethasone
in 33 patients with
ALA. Of these, two had a
complete remission on lenalidomide
alone and six on
lenalidomide plus dexamethasone
"Responses were sometimes not
seen until after nine cycles of therapy,
and to keep them on therapy was a challenge,"
Ms. Finn said. "We observed
grade 1-3 rashes in 52% of patients."
These were typically
maculopapular eruptions occurring
frequently on the extremities,
but also on the face
and trunk, she said. Pruritus
accompanied rash in 57% of
patients. The rash lasted a median
of 8 days (range, 1 to 22 days).
"We asked patients to describe symptoms
over the phone. We also asked them
to take digital photos of their lesions and
email them to us," Ms. Finn said. Patients
who developed skin problems over
more than half of the body were referred
immediately to a local dermatologist.
Ms. Finn told ONI that the key to
controlling skin problems is a thorough
patient education program before treatment
that includes photos illustrating the
various skin problems that may develop.
The investigators encouraged patients to
report skin reactions promptly by telephone,
and patients knew in advance how
treatment would proceed (see Table). Diphenhydramine 25 to 50 mg
every 6 hours and topical OTC steroids
were used to treat rashes and scalp itch.
If lenalidomide was interrupted due
to skin problems, prophylactic diphenhydramine
was used when treatment was
resumed and sometimes with subsequent
cycles. With this approach, only two of
three patients who developed grade 3
desquamating rash had to stop treatment.