[Development of thalidomide analogs for the treatment of multiple myeloma (MM)]

After the introduction of thalidomide (Thal) in the treatment of MM in 90's, several thalidomide analogs have been developed. Among them, CC-5013 (lenalidomide: Lenal) is the most potent and promising novel oral agent. Compared with Thal, Lenal is 50 to 2,000 times more potent at stimulating T cell proliferation and 50 to 100 times more potent at augumenting several cytokines. A phase I trial established a maximal tolerated oral dose for Lenal of 25 mg daily. Phase II study showed significant anti-MM activity of Lenal with less or no reports of significant somnolence, constipation, or neuropathy as with Thal therapy. Based on these findings, several phase III studies are on going internationally.