The current status of thalidomide in the management of multiple myeloma
The current status of thalidomide in the management of multiple myeloma
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DOI：
10.1159/000087037
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发表时间：
2005-01-01
影响因子：
2.4
通讯作者：
von Lilienfeld-Toal, M
中科院分区：
文献类型：
--
作者：
Glasmacher, A;von Lilienfeld-Toal, M
20世纪60年代，由于沙利度胺引发的灾难，涉及沙利度胺的早期抗癌研究被放弃，但在20世纪90年代，当沙利度胺的抗血管生成和抗肿瘤坏死因子特性被探索时，研究工作得到了加强。据估计，迄今已有超过5万名多发性骨髓瘤患者接受了沙利度胺的治疗。沙利度胺的研究提供了明确和令人信服的证据，证明沙利度胺单药治疗多发性骨髓瘤复发和难治性患者是有效的。结果通常显示一致的30%（95%置信区间27 - 32%）缓解率（部分缓解+完全缓解，定义为单克隆蛋白减少至少50%）。沙利度胺治疗优于多发性骨髓瘤的其他典型治疗方法。在包括332例患者的7项试验中，长春新碱、阿霉素和地塞米松（VAD）的有效率为39%(32 - 45%)，而在193例患者的一项试验中，硼替佐米的有效率为27%（21 - 34%）。在联合治疗中使用沙利度胺可以进一步提高其疗效。需要进行更多的研究来观察这种药物的毒性。尽管沙利度胺有着黑暗的过去，但这种药物引起了人们的极大兴趣，并可能以一种受控的方式重新投入临床使用。版权所有(c) 2005 S. Karger AG，巴塞尔。
Early anticancer research involving thalidomide was abandoned in the 1960s as the catastrophe surrounding the drug emerged, but research efforts were picked up in the 1990s when thalidomide's antiangiogenic and anti-tumour necrosis factor properties were explored. More than 50,000 patients with multiple myeloma are estimated to have been treated with thalidomide to date. Research with thalidomide provides clear and convincing evidence that thalidomide monotherapy is efficacious in relapsed and refractory patients with multiple myeloma. Results typically show a consistent 30% (95% confidence interval 27 - 32%) response rate (partial response + complete response, defined as a reduction of at least 50% in the monoclonal protein). Thalidomide treatment compares favourably with other typical treatments for multiple myeloma. In seven trials that included 332 patients, vincristine, adriamycin and dexamethasone (VAD) had a response rate of 39% (32 - 45%), while a trial in 193 patients showed a response rate with bortezomib of 27% (21 - 34%). The use of thalidomide in combination therapy could boost its efficacy further. More studies to look at the toxicity of the drug need to be carried out. Despite thalidomide's dark past, this drug is of major interest and could be brought back to clinical use in a controlled manner. Copyright (c) 2005 S. Karger AG, Basel.