Lenalidomide (Len) is a crucial treatment for multiple myeloma (MM), improving progression-free survival (PFS), but it often causes a rash that leads to dose reductions or interruptions. Len rash occurs in over a quarter of patients, with 1% to 7% developing high-grade rashes, and while the rash is linked to improved PFS and overall survival, managing it is important for maintaining the full benefit of Len. In a study at Memorial Sloan Kettering Cancer Center, six patients with MM and refractory Len rash were treated successfully with dupilumab, an IL-4 receptor alpha antagonist, which allowed many to continue Len without significant adverse events.

Dupilumab, typically used for atopic dermatitis, was administered to the patients after unsuccessful attempts with steroids. In most cases, dupilumab controlled the rash, enabling patients to resume or continue Len therapy. The drug showed no adverse effects attributed to its use in this cohort, and it was especially effective for patients with persistent rashes that had failed other treatments. The mechanism behind its effectiveness is thought to be linked to its inhibition of Th2 responses, which may play a role in both the rash and the underlying MM. These findings suggest that dupilumab could be an effective therapeutic option for managing Len rash, and further studies are needed to optimize its use in this setting.

Reference: Kuo AM, Hassoun H, Shah U, et al. Dupilumab for the treatment of refractory lenalidomide rash in patients with multiple myeloma. Leuk Lymphoma. 2022;63(9):2233-2237. doi: 10.1080/10428194.2022.2068002.