Thalidomide, which is also known as Thalomid, is a drug used to fight aggressive cancers, particularly those that have metastasized, or spread.
Purpose
There are many studies, either in progress or recently completed, that suggest thalidomide can slow or stop the spread of cancer of the brain, breast, colon and prostate, as well as multiple myeloma (a cancer of the marrow of the bone). Research studies that consider the benefit of thalidomide in treating other cancers are multiplying rapidly. The use of the drug in cancer therapy is likely to increase.
Description
Thalidomide was first introduced in 1957 primarily as a tranquilizer, a medication prescribed particularly for imparting drowsiness and sleep. Then, it was given to pregnant women to provide them with relief from morning sickness. Soon after being prescribed to pregnant women, thalidomide was linked to death or severe disabilities in newborns. Some children who had been exposed to thalidomide while in the womb (in utero) failed to develop limbs or had very short limbs. Others were born blind or deaf or with other physical problems.
The same action of thalidomide that harms babies, may make it useful as a powerful cancer fighter. Thalidomide interferes with the formation of blood vessels. It is called an antiangiogenic drug because angiogenesis refers to the formation of blood vessels.
Cancers that spread have a lot of blood vessels (are highly vascularized). Thus, when cancer cells are not nourished by a blood supply, they die. One way to stop the spread of cancer is to stop the formation of the blood vessels that carry nourishment to the cancer cells, and that is what thalidomide is thought to do. (Researchers are also interested in other activities of thalidomide, particularly the ones that make it capable of eliminating skin eruptions, such as sores, or ulcers, in the mouths of patients with AIDS and leprosy.)
Recommended dosage
Dosages being used depend on the type of cancer being attacked. For example, in one study, to treat multiple myeloma, a starting dose of 200 milligrams per day was increased to 800 milligrams per day over a two-week period.
In a colon cancer study, 400 milligrams per day of thalidomide were given in combination with the anti-cancer drugirinotecan. The dose of irinotecan was between 300 and 350 milligrams per day. Used in combination with irinotecan, thalidomide contributed its own cancer-fighting properties and it also seemed to reduce the side effects of irinotecan.
In a trial using thalidomide to treat prostate cancer, both low doses (as low as 200 milligrams per day) and high doses (as high as 1200 milligrams per day) were tried. The patients taking high doses fared somewhat better.
Precautions
The serious threat thalidomide poses to fetuses cannot be overstated. No pregnant woman and no woman who has any chance of becoming pregnant should take thalidomide. (Only women who have had a hysterectomy or who are at the age of menopause and have been in a menopausal state, which is no menses, or periods, for 24 consecutive months, can be considered as having no chance of becoming pregnant.)
Patients taking thalidomide must meet strict criteria for use. Pharmacies that dispense thalidomide must have special registration.
Side effects
Besides the extreme risk thalidomide poses to fetuses, it also produces side effects in the person taking the
drug. The side effects of thalidomide are much milder than many other anticancer drugs, and because the drug poses less discomfort than other cancer-fighting drugs, it is particularly attractive to oncologists, or physicians who treat cancer patients.
Among the side effects are erratic heartbeat, swelling (edema), digestive upsets of all sorts, including both constipation and diarrhea, pain in muscles in the back and neck, and skin problems.
Interactions
Both barbiturates, salts and esters used to encourage sleep, and alcohol increase the effect of thalidomide's power of sedation. They should not be taken with the drug. Food interferes with the absorption of thalidomide, and it should be taken when the stomach is empty.
Diane M. Calabrese
Angiogenesis
—The process by which tumors gain access to a blood supply, allowing tumor growth.
Fetus
—Human embryo.
Kilogram
—Metric measure that equals 2.2 pounds.
Milligram
—One-thousandth of a gram, and there are one thousand grams in a kilogram. A gram is the metric measure that equals about 0.035 ounces.
Sedation
—Process of reducing a particularly excited or agitated state.
