Thalidomide is making a subsidized comeback in Australia to treat multiple myeloma. In the USA thalidomide is already available to treat prostate cancer. It has not been too effective on its own. Giving it in combination with other chemotherapy may increase side effects. But a team of oncologists has found that giving a blood-thinner to prevent clots from thalidomide plus taxane chemotherapy “could provide a therapeutic and survival advantage for patients….”

Thalidomide, which began as a sedative, has as its main mild side effect sleepiness. Since it comes as a pill, patients can be advised to take the dose at before settling down at night. Another commone side effect is constipation. Ina dditoon thalidomide causes peripheral neuropathy (foot and hand) and may cause deep vein thrombosis.

For background see Thalidomide in Trials for Treatment of Prostate and Other Cancers; Thalidomide: From dangerous sedative to anticancer drug.

Today some oncologists combine thalidomide with dexamethasone and/or Taxotere or Taxol. Phillip Kantoff at Dana-Farber mentions combining it with taxanes as does Daniel Petrylak at Columbia (2005). This combination would likely increase rate of neuropathy and possibly of thrombosis.

Metin Ozkan and team in Turkey have found that giving a blood clot preventive along with a thalidomide-taxotere combination improves tumor response. They used low-weight molecular heparin (dalteparin [Fragmin]; another brand is Lovenox. See Low-Molecular-Weight Heparin in Preventing and Treating DVT; and Blood Thinner, Heparin, Stops Cancer from Hiding from Immune System). Ozkan writes: “This trial demonstrated an improvement in overall survival for those patients randomly assigned to receive LMWH.”

From Australia, The Age has a human interest story of a woman with multiple myeloma who has been helped “Drug with a nasty past becomes a weapon in cancer fight.” The Australian looks at the reduced costs: The Australian: Thalidomide makes comeback as cancer drug [January 18, 2006] by Adam Cresswell, Health editor:

THALIDOMIDE, the drug that achieved infamy in the 1960s after causing thousands of horrendous birth defects, will pull off a remarkable medical turnaround next month when it wins a taxpayer subsidy for patients with a type of blood cancer – 40 years after it was banned.

The drug’s inclusion on the federal Government’s Pharmaceutical Benefits Scheme from February 1 for the treatment of multiple myeloma could prolong hundreds of patients’ lives, as well as saving them thousands of dollars in treatment costs.

The listing on the PBS means the taxpayer will now shoulder almost all the cost, which is expected to range between $5000 and $15,000 a year for each patient, depending on the dose.

Previously, the 1200 Australians diagnosed every year with multiple myeloma faced paying $420 a month even for a relatively low dose of the drug, if they failed to respond to conventional chemotherapy or their disease returned after therapy.

Multiple myeloma – the second-most common blood cancer – accounts for 1 per cent of all cancers and 2 per cent of cancer deaths. It causes excessive numbers of abnormal plasma cells in the bone marrow, damaging the immune system. Anaemia, kidney damage and increased vulnerability to infection can result. Although incurable, the disease is treatable.