Thalidomide and its use in renal and prostate cancer
Thalidomide was marketed as a sedative and antiemetic in the 1950’s, but it was withdrawn due to teratogenicity. It has since shown clinical benefit in certain benign diseases, and recently interest has focussed on its potential use in cancer management. It has anti-angiogenic properties, which are mediated by a variety of mechanisms including growth factor inhibition. First line management of advanced prostate cancer generally uses androgen ablation therapy. Progression and metastasis of prostate cancer following androgen ablation arises from growth factor- mediated mechanisms, in which angiogenesis is an important component. Clinical trials with thalidomide have shown partial response in a proportion of patients with androgen-independent prostate cancer. These trials provide some insight into possible mechanisms of cancer progression, and support future research into the role of thalidomide as an adjunctive therapeutic agent. Progression of renal cell cancer is poorly understood. Management of metastatic disease is unsatisfactory, since the tumours show little response to chemotherapy or radiotherapy, while systemic immunotherapy is effective in a minority of patients. Several clinical trials in renal cell cancer have employed thalidomide, but results have generally not suggested substantial benefit.
Dr. Marcus , Drake