Palliative oncology: thalidomide.
After decades of disuse because of its teratogenic effects, thalidomide has had a resurgence of use as a promising therapeutic agent for multiple myeloma. Its mechanism of action involves activation of the immune system, antiangiogenic effects, and inhibition of cytokines. Thalidomide does not interact with the cytochrome oxidase system. It is not significantly metabolized, but it does undergo nonenzymatic hydrolysis in plasma. The resulting products are inactive. Despite the potential adverse effects of peripheral neuropathy, constipation, deep vein thrombosis, somnolence, rash, and orthostatic hypotension, thalidomide is an effective first-line agent for multiple myeloma in combination with dexamethasone or melphalan and prednisone. It has also been studied in the palliative care of patients with cytokine-based syndromes such as anorexia-cachexia syndrome. This review describes its use in oncology, hematology, and palliative care.
Prommer
Eric E
EE
Division of Hematology and Oncology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA. prommer.eric@mayo.edu
D020533:Angiogenesis Inhibitors / Q000276:immunology / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use*; D003248:Constipation / Q000139:chemically induced; D016207:Cytokines / Q000187:drug effects; D003875:Drug Eruptions / Q000209:etiology; D006801:Humans; D006868:Hydrolysis; D007024:Hypotension, Orthostatic / Q000139:chemically induced; D007166:Immunosuppressive Agents / Q000276:immunology / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use*; D008495:Medical Oncology / Q000379:methods*; D008657:Metabolic Clearance Rate; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism; D010166:Palliative Care / Q000379:methods*; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced; D013723:Teratogens; D013792:Thalidomide / Q000276:immunology / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000139:chemically induced; D014851:Wakefulness / Q000187:drug effects
D020533:Angiogenesis Inhibitors; D016207:Cytokines; D007166:Immunosuppressive Agents; D013723:Teratogens; D013792:Thalidomide