Role for thalidomide in prevention of weight loss in cancer patients
Cancer patients on thalidomide had less weight loss than those taking
placebo |
Patients with cancer who are experiencing a significant loss of body weight could have a new treatment option in the future in the form of thalidomide. New research has shown that the drug — which
acts as a tumour necrosis factor inhibitor — slows the rate of
weight loss in patients with cachexia due to pancreatic cancer.
Researchers randomised 50 patients with advanced pancreatic cancer who
had lost 10 per cent of their body weight to thalidomide 200mg daily
or placebo for 24 weeks.
Of 33 patients reviewed after four weeks, those in the thalidomide group
had gained an average of 0.37kg and 1cm3 in arm muscle mass, compared
with those on placebo, who had lost an average of 2.21kg (absolute difference –2.59kg,
95 per cent confidence interval –4.3 to –0.8, P=0.005) and
4.46cm3 in arm mass (absolute difference –5.6cm3, 95 per cent CI –8.9
to –2.2, P=0.002).
After eight weeks, 20 patients were assessed. Those in the thalidomide
group had lost 0.06kg and 0.5cm3 arm muscle mass compared with a loss
of 3.62kg (absolute difference –3.57kg 95 per cent CI –6.8
to –0.3, P=0.034) and 8.4cm3 (absolute difference –7.9cm3,
95 per cent CI –14.0 to –1.8, P=0.014) in the placebo group.
The researchers also noted a positive correlation between improvement
of physical functioning and weight gain.Although mechanism of this effect
is unknown, the researchers say that thalidomide may attenuate weight
loss by modulating the inflammatory response, possibly by down regulation
of cytokines such as TNF-alfa.
The researchers say that although it is unclear whether these results
can be generalised to all cancers, or whether slowing of weight loss
prolongs survival, in the future combination of thalidomide with other
nutritional supplements may lead to a better outcome for patients (Gut 2005;54:540). |
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