Thalidomide in multiple myeloma

Recent evidence suggests that angiogenesis is increased in multiple myeloma and has prognostic value in the disease. Based an the increased angiogenes is observed in myeloma thalidomide (Thalomid) has been studied as antiangio genic therapy. Although its mechanism of action in myeloma is unclear, seve ral trials show that thalidomide is active in 25% to 35% of patients with r elapsed myeloma. Since many patients who respond have failed other active r egimens, including transplantation, these results are impressive. Major tox icities include constipation, sedation, skin rash, fatigue, and peripheral neuropathy, Studies are ongoing to determine its role as initial treatment for myeloma. Trials are also underway combining thalidomide with other acti ve agents. This article summarizes the current status of thalidomide therap y in myeloma.