What is the administration frequency of Lenalidomide (Len) and Pembrolizumab (Pembro)?

From the Guidelines

Lenalidomide (Len) is typically administered orally once daily, while Pembrolizumab (Pembro) is administered as an intravenous infusion every 3 weeks. The standard dosing for Lenalidomide varies by indication but commonly ranges from 10-25 mg daily for 21 days of a 28-day cycle, with 7 days off. Pembrolizumab is usually given at a fixed dose of 200 mg or a weight-based dose of 2 mg/kg as an intravenous infusion over 30 minutes, repeated every 3 weeks until disease progression or unacceptable toxicity, as supported by 1. When used in combination therapy, these administration schedules are generally maintained, though dose adjustments may be necessary based on patient tolerance and specific protocols. The different administration frequencies reflect their distinct pharmacokinetic properties - Lenalidomide requires daily dosing to maintain therapeutic blood levels due to its shorter half-life, while Pembrolizumab's longer half-life and mechanism as an immune checkpoint inhibitor allows for less frequent dosing while maintaining efficacy. Some key points to consider include:

• The dosing schedule for Pembrolizumab can vary, but a common regimen is 200mg intravenous infusion, day 1, repeat every 3 weeks, as seen in 1.
• Lenalidomide dosing may vary by indication, but a typical schedule is 25 mg oral, days 1-21, every 28 days, as mentioned in 1.
• Pembrolizumab can also be given at a weight-based dose of 2 mg/kg, as an intravenous infusion, day 1, repeat every 3 weeks, as noted in 1. It's essential to consult the latest clinical guidelines and patient-specific factors to determine the optimal dosing regimen for Lenalidomide and Pembrolizumab. Key considerations for dosing include:
• Patient tolerance and toxicity profiles
• Specific protocols and clinical guidelines
• Indication and disease severity
• Combination therapy and potential interactions
• Pharmacokinetic properties and half-life of each medication. In clinical practice, the administration frequency of Lenalidomide and Pembrolizumab is crucial for maximizing efficacy while minimizing toxicity, as supported by 1.

From the Research

Administration Frequency of Lenalidomide and Pembrolizumab

• The administration frequency of Lenalidomide (Len) and Pembrolizumab (Pembro) can vary depending on the specific treatment regimen and cancer type.
• In the KEYNOTE-185 trial 2, patients received oral lenalidomide 25 mg on days 1-21 and oral dexamethasone 40 mg on days 1,8,15, and 22 of repeated 28-day cycles, with or without intravenous pembrolizumab 200 mg every 3 weeks.
• In other studies, such as the combination of lenvatinib and pembrolizumab for anaplastic and poorly differentiated thyroid carcinoma 3, lenvatinib was started at 14-24 mg daily and combined with pembrolizumab at a fixed dose of 200 mg every three weeks.
• For endometrial cancer, lenvatinib plus pembrolizumab was administered at a dose of 20 mg once daily orally plus pembrolizumab 200 mg intravenously once every 3 weeks, in 3-week cycles 4, 5.
• In patients with metastatic renal cell carcinoma, lenvatinib plus pembrolizumab was administered at a dose of 20 mg once daily orally plus pembrolizumab 200 mg intravenously once every 3 weeks 6.

Dosing Patterns

• The majority of patients initiated lenvatinib and pembrolizumab combination therapy at label-recommended starting doses/interval 4.
• Less than half of the patients changed the lenvatinib dose over time 4.
• The median duration of therapy was 5.1 months for patients in second line and 5.8 months for patients in third line or later 4.