骨髓瘤患者慎用沙利度胺(English)
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Thalidomide Can Harm Skin in Myeloma Patients
By Adam Marcus
HealthSCOUT Reporter
WEDNESDAY, Sept. 27 (HealthSCOUT) -- Thalidomide, the once-pariah pregnancy drug turned promising bone cancer therapy, can cause serious skin problems when used in combination with another tumor treatment.
Researchers are reporting three cases of severe skin problems, including one requiring hospitalization, in patients who took a front-line combination of thalidomide and dexamethasone for their multiple myeloma, a particularly deadly form of bone marrow cancer.
, http://www.100md.com
Despite the complications, which caught experts by surprise, cancer specialists remain hopeful about the use of thalidomide and dexamethasone in treating myeloma.
"I think it's a very exciting regimen," says Dr. S. Vincent Rajkumar, an assistant professor of medicine at Mayo Medical School and co-author of a write-up of the case in the Sept. 28 issue of the New England Journal of Medicine.
A 1999 study found that thalidomide significantly improved the short-term prognosis for patients with relapsed myeloma. The drug, which was once banned for its propensity to cause birth defects, was hailed as a great advance for patients with the deadly disease, which strikes nearly 14,000 Americans -- and kills roughly 11,400 -- each year.
, 百拇医药
Thalidomide, which starves tumors of blood and other nutrients and may help the body kill cancer cells in other ways, has also been shown to be effective against colon cancer, as well as leprosy.
Experts still optimistic
Although thalidomide hasn't been approved by the Food and Drug Administration for use in cancer patients, clinical trials with the compound are under way nationwide. In addition to being the most effective new treatment for myeloma, the drug is also popular among patients because it can be taken as a pill, unlike other potent chemotherapies that must be taken in injection form.
, http://www.100md.com
In the Mayo report, the three patients, who suffered a variety of blisters, die-offs of skin cells, and ulcers, were among a group of eight people being treated with the "thal-dex" combination for newly diagnosed myeloma. They responded very well to the treatment, and the rapid falloff in tumor burden could have exacerbated the skin reactions, Rajkumar says.
"If you're really in the end stages of myeloma, the chances that you'll see toxicity may be lower," he says.
, 百拇医药
Dr. Seema Singhal, a myeloma expert at the University of South Carolina in Columbia, and one of the pioneers in the use of thalidomide to treat the disease, calls the Mayo report "puzzling."
"I've never seen it, but obviously as the body of experience grows there are going to be these cases," says Singhal, who has tested the "thal-dex" combination in more than 20 patients without encountering such side effects.
Particularly intriguing, Singhal says, is that dexamethasone is a steroid that's supposed to prevent immune system assaults on the skin and other organs. So the complications must have something to do with the way these particular patients were processing the combination of the two drugs.
, http://www.100md.com
Rajkumar and his colleagues say the fact that the patients in their study had strong immune systems that had not been battered previously by chemotherapy could help explain the severity of the skin reactions, all of which were fully resolved with treatment.
What To Do
Earlier research has shown that as many as 25 percent of patients on thalidomide alone suffer minor skin problems, but severe reactions are rare, they say.
Therefore, doctors should not offer the combination of thalidomide and dexamethasone until they know what doses are safe, unless they are doing so in the context of a well-monitored clinical trial., http://www.100md.com
By Adam Marcus
HealthSCOUT Reporter
WEDNESDAY, Sept. 27 (HealthSCOUT) -- Thalidomide, the once-pariah pregnancy drug turned promising bone cancer therapy, can cause serious skin problems when used in combination with another tumor treatment.
Researchers are reporting three cases of severe skin problems, including one requiring hospitalization, in patients who took a front-line combination of thalidomide and dexamethasone for their multiple myeloma, a particularly deadly form of bone marrow cancer.
, http://www.100md.com
Despite the complications, which caught experts by surprise, cancer specialists remain hopeful about the use of thalidomide and dexamethasone in treating myeloma.
"I think it's a very exciting regimen," says Dr. S. Vincent Rajkumar, an assistant professor of medicine at Mayo Medical School and co-author of a write-up of the case in the Sept. 28 issue of the New England Journal of Medicine.
A 1999 study found that thalidomide significantly improved the short-term prognosis for patients with relapsed myeloma. The drug, which was once banned for its propensity to cause birth defects, was hailed as a great advance for patients with the deadly disease, which strikes nearly 14,000 Americans -- and kills roughly 11,400 -- each year.
, 百拇医药
Thalidomide, which starves tumors of blood and other nutrients and may help the body kill cancer cells in other ways, has also been shown to be effective against colon cancer, as well as leprosy.
Experts still optimistic
Although thalidomide hasn't been approved by the Food and Drug Administration for use in cancer patients, clinical trials with the compound are under way nationwide. In addition to being the most effective new treatment for myeloma, the drug is also popular among patients because it can be taken as a pill, unlike other potent chemotherapies that must be taken in injection form.
, http://www.100md.com
In the Mayo report, the three patients, who suffered a variety of blisters, die-offs of skin cells, and ulcers, were among a group of eight people being treated with the "thal-dex" combination for newly diagnosed myeloma. They responded very well to the treatment, and the rapid falloff in tumor burden could have exacerbated the skin reactions, Rajkumar says.
"If you're really in the end stages of myeloma, the chances that you'll see toxicity may be lower," he says.
, 百拇医药
Dr. Seema Singhal, a myeloma expert at the University of South Carolina in Columbia, and one of the pioneers in the use of thalidomide to treat the disease, calls the Mayo report "puzzling."
"I've never seen it, but obviously as the body of experience grows there are going to be these cases," says Singhal, who has tested the "thal-dex" combination in more than 20 patients without encountering such side effects.
Particularly intriguing, Singhal says, is that dexamethasone is a steroid that's supposed to prevent immune system assaults on the skin and other organs. So the complications must have something to do with the way these particular patients were processing the combination of the two drugs.
, http://www.100md.com
Rajkumar and his colleagues say the fact that the patients in their study had strong immune systems that had not been battered previously by chemotherapy could help explain the severity of the skin reactions, all of which were fully resolved with treatment.
What To Do
Earlier research has shown that as many as 25 percent of patients on thalidomide alone suffer minor skin problems, but severe reactions are rare, they say.
Therefore, doctors should not offer the combination of thalidomide and dexamethasone until they know what doses are safe, unless they are doing so in the context of a well-monitored clinical trial., http://www.100md.com
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