Randomized phase 2 trial of low versus high dose lenalidomide for children with pilocytic astrocytoma or optic pathway glioma

Children with low-grade glioma often require long-term therapy and suffer from treatment morbidity. A randomized phase 2 trial by the Children’s Oncology Group compared low-dose (20 mg/m² once daily for 21 days of 28-day cycles) versus high-dose (115 mg/m² once daily for 21 days of 28-day cycles) lenalidomide in children with pilocytic astrocytomas or optic pathway gliomas after failure of initial therapy. Both treatments were equally active, with ORR 10.8%. The low dose was better tolerated, with median number of cycles completed 14 (range 2-26) with the low dose versus 11 (range 1-26) with the high dose. The authors conclude that low-dose lenalidomide warrants further exploration.