Study: Thalidomide boosts short-term survival in multiple myeloma patients | VailDaily.com
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Study: Thalidomide boosts short-term survival in multiple myeloma patients

Linda A. Johnson

On the heels of disappointing results for thalidomide as a treatment for bone marrow cancer, a smaller study suggests the drug may prolong survival of elderly patients, but at a price.In people over 65 – who are most likely to be diagnosed with the cancer multiple myeloma – thalidomide increased survival when added to milder chemotherapy, the newest research showed. The milder drugs have been standard because most older patients can’t tolerate the bone marrow transplants and stronger cancer drugs considered more effective.After three years, 80 percent of the older patients who got thalidomide along with standard treatment were still alive, versus 64 percent who got traditional treatment alone. However, twice as many patients on thalidomide suffered dangerous side effects.The study will appear in Saturday’s edition of The Lancet, a British medical journal. A larger study that has followed patients longer appeared Thursday in the New England Journal of Medicine and it had indicated thalidomide did not increase survival.Thalidomide, used a half-century ago in other countries for morning sickness and insomnia, was banned worldwide in 1962 because it caused birth defects. It’s been resurrected recently as a promising cancer drug.Experts said the patients in the newest study must be followed longer to see if the drug increases long-term survival, but they think thalidomide will soon be part of standard therapy for elderly patients.About two-thirds of people diagnosed with multiple myeloma are over 65. The disease includes a half-dozen types of incurable cancers of the bone marrow, the body’s blood-manufacturing plant.”Even though this is a relatively mild treatment, the results are actually pretty good,” similar to those for grueling regimens that include bone marrow stem cell transplants, said Dr. Brian Durie, chairman of the International Myeloma Foundation. “This is probably the way to go.”Durie expects the foundation this spring will change the recommended treatment for elderly patients to thalidomide plus the two standard drugs, partly because of positive findings from other research.In the Lancet study, researchers at 54 Italian hospitals gave 126 patients standard myeloma drugs. Another 129 got those drugs plus thalidomide.The thalidomide was provided by Pharmion Corp. It licensed rights to sell it in several countries from Celgene Corp. of Summit, N.J., which sells it in the United States as Thalomid.At two years, just over half those in the thalidomide group had not suffered a relapse or severe side effects, versus one-fourth of the other group.However, half the patients on thalidomide suffered infections, blood clots, heart problems and other side effects, which killed nearly one in 10 patients within nine months and forced nearly two-thirds to stop taking the drug within several months.A 668-patient study by researchers at the University of Arkansas for Medical Sciences, which was reported Thursday, found thalidomide given on top of a grueling chemotherapy regimen with two stem cell transplants did not prolong survival.In both studies, many patients not on thalidomide who worsened then got the drug as salvage therapy; that could have improved their outcomes.Dr. Shaji Kumar of the Mayo Clinic in Rochester, Minn., wrote in an editorial that thalidomide should now be the standard treatment along with the other cancer drugs for elderly patients, but doctors need to limit thalidomide’s side effects.”This is a historic moment in myeloma therapy,” Kumar wrote, because, after decades with little progress, several experimental drugs hold promise.—On the Net: http://content.nejm.org/International Myeloma Foundation: http://www.myeloma.orgVail, Colorado


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