Thalidomide For Myeloma

After having earned a bad reputation several decades ago, thalidomide has made a comeback as a drug treatment for multiple myeloma. Originally developed in the 1950s to treat insomnia and morning sickness, thalidomide was taken off the market when scientists discovered it caused major birth defects.

In 2006, the U.S. Food and Drug Administration once again approved thalidomide, this time for the treatment of multiple myeloma.

What is Thalidomide?

Thalidomide is an “immunomodulatory agent”–that is, a drug that affects the immune system. Unlike chemotherapy, which destroys myeloma cells, thalidomide boosts your body’s immune response to myeloma cell growth. Scientists are not entirely sure how thalidomide affects immune response, but it appears to produce a number of effects on the body, including:

  • Enhancing immune function, making the immune system more effective at eliminating cancer cells
  • Interfering with certain chemicals–called “cytokines”–that cancer cells use to signal to one another
  • Preventing myeloma cells from making new blood vessels, a process known as “angiogenesis.” Without a fresh blood supply, tumors can’t grow or spread.
  • Stopping myeloma cells from attaching to bone marrow cells.

What to Expect When Taking Thalidomide for Myeloma

Thalidomide is available in capsule form and is usually taken at night with a glass of water. Typically, you begin at low dosage, which your doctor increases over time. Your maximum dosage depends on a number of factors, such as whether or not you are taking any other drugs for multiple myeloma. Thalidomide response time is slow. Most patients don’t experience an improvement until about three months after beginning treatment.

Thalidomide can be used as a front line therapy, maintenance therapy or relapse therapy for myeloma. It is often used in combination with other drugs, such as dexamethasone, a corticosteroid drug.

Thalidomide Side Effects

Thalidomide for myeloma can produce a number of unwanted side effects, including structural birth defects. Other side effects include:

  • Constipation
  • Deep vein thrombosis (blood clots, usually in the legs)
  • Dizziness (due to low blood pressure)
  • Drowsiness
  • Infertility
  • Leukopenia (low levels of infection-fighting white blood cells)
  • Peripheral neuropathy (tingling sensations in hands and feet)
  • Seizures
  • Shaky hands (due to peripheral neuropathy)
  • Skin rashes.

Less-common thalidomide side effects may include confusion, mood changes and pain in various places throughout the body. You should talk to your doctor if you experience any of the above side effects. She may be able to adjust your dosage or give you an alternative medication.

Because thalidomide can cause birth defects, you and your partner should take extra precautions to avoid pregnancy while you’re undergoing treatment. This drug does not produce defects in grown adults.

Effectiveness of Thalidomide for Myeloma

In clinical trials, thalidomide has been shown to produce disease stabilization (no current tumor growth), partial response (partial reduction in tumor size) and complete response (remission) in patients at varying stages of multiple myeloma. Thalidomide is an effective form of multiple myeloma treatment by itself or as part of a multi-drug treatment plan.

Resources

Cancer Research UK. (2009). Thalidomide. Retrieved October 4, 2010, from http://www.cancerhelp.org.uk/about-cancer/treatment/cancer-drugs/thalidomide

International Myeloma Foundation. (2005). Retrieved October 4, 2010, from http://myeloma.org/pdfs/Understanding_Thalidomide.pdf

Mayo Foundation for Medical Education and Research. (2008). Thalidomide: Research advances in cancer and other conditions. Retrieved October 4, 2010, from http://www.mayoclinic.com/health/thalidomide/HQ01507

Myeloma Canada. (2010). Treatment options. Retrieved October 4, 2010, from http://www.myelomacanada.ca/en/treatment_options.htm

Seattle Cancer Care Alliance. (2010). New treatments for myeloma. Retrieved October 4, 2010, from http://www.seattlecca.org/diseases/new-treatments.cfm