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According to results presented at the 2006 annual meeting of the American Society of Clinical Oncology (ASCO), the addition of thalidomide (Thalomid®) to chemotherapy improves survival in patients with extensive small cell lung cancer.

Small cell lung cancer (SCLC) accounts for approximately 20–25% of lung cancers. “Small cell” refers to the type of cell within the lung where the cancer originated. Extensive SCLC refers to advanced cancer, in which the cancer has spread from the lung to distant sites in the body. Small cell lung cancer is considered to be an aggressive or fast-growing cancer.

Typically, patients with extensive SCLC are treated with a combination of chemotherapy agents. However, since long-term survival needs much improvement, researchers continue to evaluate ways extend survival time for patients with this disease.

Thalidomide is an agent that stops or reduces the growth of blood vessels to a tumor. This action prevents food and nourishment from reaching cancer cells, slowing the process of growth and spread of the cancer. Thalidomide also has properties that stimulate the immune system to help fight the cancer, all of which are not entirely understood.

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Researchers from France recently conducted a phase III (phase of trial prior to FDA review) trial to evaluate thalidomide in the treatment of SCLC. This trial included 119 patients, all of whom initially underwent chemotherapy with a regimen referred to as PCDE (comprised of four chemotherapy agents). If patients achieved an anticancer response to PCDE, they were then treated with additional PCDE plus placebo (inactive substitute) or thalidomide plus PCDE. Treatment groups were directly compared.

  • Overall anticancer responses were achieved in 81.6% of patients treated with the addition of thalidomide compared with 62.8% for those treated with PCDE only.
  • At one year, 49% of patients treated with thalidomide were alive compared with only 30% of patients treated PCDE only.
  • Nearly half of the patients treated with thalidomide were still alive at one year compared with approximately nine months for those treated with PCDE only.
  • One-third of patients discontinued treatment with thalidomide due to side effects associated with its treatment.
  • Severe constipation and neuropathy (numbness, tingling, and pain in hands or feet) were more common with treatment including thalidomide.

The researchers concluded that the addition of thalidomide to chemotherapy significantly improves survival for patients with extensive SCLC. However, side effects associated with thalidomide lead one-third of patients to discontinue treatment.

Reference: Pujol J, Breton J, Gervais R, et al. A Prospective Randomized Phase III, Double-Blind, Placebo-Controlled Study of Thalidomide in Extended-Disease (ED) SCLC Patients After Response to Chemotherapy (CT): An Intergroup Study FNCLCC Cleo04-IFCT 00-01. Proceedings from the 42nd annual meeting of the American Society of Clinical Oncology (ASCO). June 2006. Atlanta, GA. Abstract #7057.

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