Thalomid (thalidomide) by Celgene, in combination with dexamethasone, is a treatment for myeloma, a type of blood cancer. Thalidomide was first marketed in Germany in 1957 and is considered an essential medicine by the World Health Organization. It’s available as a generic formulation from multiple companies.
What is myeloma?
Myeloma is a type of blood cancer that starts in the bone marrow where blood cells are made. Cancerous myeloma cells can appear simultaneously in the marrow of different bones and spread from one bone marrow location to another, which is why the disease is often called multiple myeloma.
Cancer cells grow and divide very rapidly, hijacking normal cell processes to gain uncontrolled growth. Myeloma cells also produce abnormal antibodies, which interfere with normal processes and lead to the symptoms of myeloma.
How does Thalomid work?
Thalomid is an oral immunomodulatory treatment that contains thalidomide, a synthetic derivative of an amino acid called glutamic acid. Amino acids are building blocks of proteins.
The exact mechanism by which Thalomid treats myeloma is not known. However, it is thought to reduce inflammation and modulate the immune system’s response to a stimulus.
Thalomid may also suppress the production of tumor necrosis factor-alpha (TNFa), which is a cell-signaling protein that plays important roles in cell survival, proliferation, differentiation, and death. However, the effect of Thalomid on TNFa varies widely between different health conditions.
Thalomid especially affects rapidly dividing cells, which is why it is able to target cancerous cells.
Thalomid in clinical trials
The efficacy of Thalomid in treating myeloma was demonstrated in a randomized multi-center, open-label clinical trial involving 207 patients who were newly diagnosed with myeloma.
The patients were randomly assigned to receive either Thalomid and dexamethasone (103 patients) or dexamethasone alone (104 patients). Patients received 200 mg of Thalomid daily, and 40 mg of dexamethasone on days 1 to 4, 9 to 12, and 17 to 20, every 28 days. Both groups were treated for four 28-day cycles. The primary endpoint was the response rate to treatment.
The combination therapy led to a response rate of 51.5% compared with 35.6% in patients receiving dexamethasone alone.
The common side effects of Thalomid include:
- life-threatening birth defects or the possible death of a newborn if either parent takes the medication at the time of conception or the mother takes it during pregnancy.
- risk of blood clots, including deep vein thrombosis and pulmonary embolism (blood clots in the arteries of the lungs) that can be life-threatening.
- leukopenia (low white blood cell counts).
- anemia (low red blood cell counts).
Last updated: Nov. 8, 2019
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