The drug thalidomide may have a new lease of life as a cancer treatment. A small study published in Gut suggests that it slows down the weight loss and wasting associated with advanced disease in patients with pancreatic cancer.
Severe wasting (cachexia) is the direct cause of death in one in five patients with advanced cancer. It results from the disturbances in metabolism caused by a combination of the body's immune response to the disease and the cancer's production of a cocktail of powerful chemicals.
The researchers base their findings on 50 patients who were terminally ill with pancreatic cancer, all of whom had lost at least 10% of their body weight. The patients were randomly assigned to either 200 mg daily of thalidomide or a dummy drug for a period of 24 weeks.
Thirty three patients were assessed after four weeks and 20 after eight weeks of treatment. After a month, the patients taking thalidomide had gained an average of 0.37 kg of weight and had slightly increased their arm muscle bulk (1 cm).
The patients on the dummy treatment had lost an average of 2.21 kg and their arm muscle bulk had shrunk by 4.46 cm.
By eight weeks, patients taking thalidomide had lost 0.06 kg of weight compared with 3.62 kg in the dummy group, and their arm muscle bulk had decreased by 0.5 cm, compared with 8.4 cm in the dummy group.
There was no overall difference in survival times between the two groups, but increases in weight were matched by increases in physical capacity. Thalidomide had few side effects.
Thalidomide dampens down inflammation in the body, say the authors, although exactly how it does this, is as yet unknown. Previous research has shown that the drug can improve the wasting typical of AIDS and reduce the weight loss characteristic of tuberculosis.
They speculate that thalidomide may target pancreatic cancer directly. "In the future, combination of thalidomide with nutritional supplements and pharmacological agents may ultimately lead to a better clinical outcome," they suggest.
An accompanying editorial suggests that thalidomide has several useful actions that could potentially make it a useful anti-cancer drug. It is also cheap, and safe, if not used in pregnant patients. Further large scale studies should be undertaken as soon as possible.
Contacts: Paper: Dr John Gordon, Division of Infection, Inflammation and Repair, Southampton University Hospital School of Medicine, Southampton, Hants, UK Tel:+ 44 (0) 2392 286 000 Email: [email protected]
Editorial: Dr Michael Stroud, Institute of Human Nutrition, Southampton General Hospital, Southampton, Hants, UK Tel: +44 (0) 2380 796 317 Email: [email protected]
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