How would you approach dose modifications and/or frequency of lenalidomide in patients with advanced renal impairment (eGFR <30)?

Great question - comes up a lot in discussion with community providers.

The dosing is dependent on what your target dose would be.

If normal dosing was 25 mg and CrCl <30 and not on dialysis, then I follow the package insert "15 mg every other day". If the patient tolerates that ok, I increase to 10...

The "correct" dose for lenalidomide is a challenge. We know that renal function is a HUGE determinant of lenalidomide exposure (Chen et al., PMID 27351179 & Bridoux et al., PMID 27286995 & Guglieri-López et al., PMID 28039509), but it's NOT the only factor.

We should not forget that the right dose f...