Here's a Lancet report on the low-dose Thal in multiple myeloma. I especially like the bit about "first or second-line treatment rather than last resort."
Low-dose thalidomide seems to be effective in multiple myeloma
Thalidomide given at relatively low, tolerable doses reduces tumour burden in patients with relapsing or progressing multiple myeloma, according to results presented at the International Myeloma Workshop last week (Sept 1-5, Stockholm, Sweden). "Nothing untoward happened in the way of side effects", says lead investigator Brian Durie (Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA, USA). "Thalidomide is working well enough now for us to think about using it as a first or second-line treatment", rather than as a last resort.
At the meeting, Durie presented data from an ongoing, open-label phase II study in which patients were given 50-400 mg thalidomide daily for a minimum of 8 weeks. Eight of 24 (24%) patients responded, some for up to 6 months; nine patients could not tolerate the drug. Side-effects included somnolence, tremor, confusion, dizziness, nausea, bone pain, rash, and constipation. The findings are consistent with those of an earlier study, adds Durie. A formal dose finding study is now underway which will also investigate whether responders to low doses of drug are any different from non-responders.
"Progress in the treatment of multiple myeloma over the past two decades has really been minimal. From that standpoint, these findings would have to be considered quite encouraging", says Harmon Eyre of the American Cancer Society. The incidence of multiple myeloma is increasing in younger age groups, and up to 15% of patients are now younger than 45 years old, adds Susie Novis of the International Myeloma Foundation (IMF; myeloma.org ). "Having a relatively non-debilitating and non-invasive option for therapy could enable patients and their families to stay together longer as a healthy, functioning unit", she says.
"We're excited, but given the history of thalidomide, quite worried, as well", observes Eric Low, head of IMF's UK affiliate. UK trials of thalidomide in multiple myeloma have been recruiting easily, he adds, but the exact doses patients are taking isn't clear. "There is tremendous variability. Physicians basically are giving as high a dose as the person can tolerate. My hope is that now people will start receiving lower doses." Low is also concerned that many UK patients are receiving thalidomide outside clinical trials. "The only way to work out the most appropriate and effective dose to give, and in what patients it should be given, is in an official clinical trial", he asserts.
thelancet.com
Peter
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