How is Thalomid used in multiple myeloma?
Thalomid® (thalidomide, Celgene) is used in combination with another drug or drugs and is used in several treatment settings. Such settings include newly diagnosed disease (both for individuals who are candidates for stem cell transplantation and for those who are not candidates), relapsed/refractory disease, and maintenance therapy (treatment that is started after remission in order to reduce the risk for relapse).
The combination of Thalomid and dexamethasone (dex), known as Thal-dex, is FDA approved for the treatment of newly diagnosed multiple myeloma. The National Comprehensive Cancer Network (NCCN), which develops guidelines for cancer treatments based on evidence from clinical trials, suggests that Thalomid can also be used in combination with melphalan and prednisone (MP) to treat newly diagnosed disease in patients who are not candidates for stem cell transplantation. This combination is known as MPT.
Other combinations recommended as treatment options include Thal-dex with Velcade® (bortezomib, Takeda Oncology) for treatment before transplantation and Thalomid alone or in combination with Velcade or prednisone, a corticosteroid, for maintenance therapy.
How does Thalomid work?
Thalomid increases the immune system’s response against myeloma cells, but its precise mechanism of action is unknown. The drug appears to have multiple actions, including the ability to inhibit the growth and survival of myeloma cells in a variety of ways.
Recently it has been shown in studies the Multiple Myeloma Research Consortium (MMRC) helped to fund that Thalomid and other IMiDs bind a protein in myeloma cells called cereblon. This binding triggers myeloma cell death. In some studies higher levels of cereblon are associated with better outcomes after treatment.
What types of individuals benefit from Thalomid?
Thalomid-based treatment has been shown to be effective in a wide range of individuals with multiple myeloma, including:
- Older individuals (65 years or older) as well as younger individuals
- Patients who have had high-dose chemotherapy and stem cell transplantation
- Two studies have shown that maintenance therapy with Thalomid after transplantation results in better overall survival
- Patients with reduced kidney function (renal impairment)
- Studies have shown that patients with renal impairment can receive the same dose as patients with normal kidney function without risk of adverse events
Patients who should not take Thalomid include:
- Pregnant or nursing women (male and female individuals of childbearing potential must be willing to take extreme precautions to avoid pregnancy, including registering with the Thalomid REMS™ program)
- Patients with a history of moderate peripheral neuropathy or of blood clots (known as deep vein thrombosis or DVT) because of the increased risk of these conditions as a side effect