BOSTON—The thalidomide(Drug information on 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(Drug information on dexamethasone) in 33 patients with ALA. Of these, two had a complete remission on lenalidomide alone and six on lenalidomide plus dexamethasone (24%).
“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(Drug information on 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.