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This information is about a drug called thalidomide, which may be used to treat myeloma| (a cancer of the plasma cells of the blood). Research| is taking place to see whether it might be effective as a treatment for other cancers.
Thalidomide was originally developed to prevent morning sickness in pregnant women. Many people have heard of thalidomide. Its use to treat morning sickness during pregnancy in the 1960s resulted in birth defects. Thalidomide changes the growth and development of new blood vessels. The birth defects were caused by its effect on the formation of blood vessels in developing babies.
Thalidomide is mainly used to treat myeloma. It is licensed to be given with melphalan| (a chemotherapy| drug) and prednisolone (a steroid|) for some people with myeloma. You may hear this combination of drugs referred to as MPT|.
Thalidomide is sometimes combined with other chemotherapy drugs - for example, the chemotherapy regime CTD| (cyclophosphamide|, thalidomide and dexamethasone). This is sometimes used as a treatment for myeloma.
How thalidomide works in the treatment of cancer is not fully understood. Cancers need to produce a network of new blood vessels in order to grow. Without forming these new blood vessels, cancers cannot grow larger than a pinhead.
Researchers hope that thalidomide can stop cancers from developing new blood vessels. This should reduce the cancer’s supply of oxygen and nutrients, which, it is hoped, will cause the tumour to shrink or at least to stop growing. Drugs that interfere with blood vessel growth in this way are called angiogenesis inhibitors| or anti-angiogenics.
Thalidomide can also be helpful in reducing some of the unpleasant symptoms that people with cancer may have. A substance produced naturally in the body, called tumour necrosis factor (TNF), stimulates the immune system to attack any cells that may be harmful.
When people have cancer, they may produce too much TNF. This causes their immune system to overreact and can lead to high temperatures, night sweats and severe weight loss. Thalidomide reduces the amount of TNF produced in the body and therefore may reduce these symptoms.
Thalidomide is available as 50mg capsules.
Thalidomide capsules should be swallowed whole with plenty of water an hour after food, preferably in the late evening. Thalidomide may be given in combination with chemotherapy drugs.
Each person’s reaction to cancer treatment is different. Some people have very few side effects while others may experience more. The side effects described below won't affect everyone having this treatment.
We've outlined the most common side effects, but haven't included those that are very rare and therefore unlikely to affect you. If you notice any effects that aren't listed below, discuss them with your doctor or specialist nurse.
You must not become pregnant or father a child while taking thalidomide, as it causes severe abnormalities in developing babies. Women of childbearing age will be asked to have a pregnancy test to check that they are not pregnant. They will also be advised to use a highly effective form of contraception (such as implanted or injected contraception) as well as a barrier method (such as a condom or cap).
Men taking thalidomide are advised to use a condom during sexual intercourse even if they have had a vasectomy. Both men and women of childbearing age will be asked to use contraception throughout treatment with thalidomide and for four weeks before and four weeks after treatment.
Because of the potential birth defects that thalidomide can cause, it's likely that you will have to take part in a risk-management programme. You'll need to sign a consent form and may have to be registered with the company that makes the drug. Registration will usually involve answering a confidential telephone survey. Your hospital doctor can only prescribe four weeks of thalidomide at a time, so you will need to make frequent visits to the hospital. Each time you have more thalidomide prescribed (every four weeks), you'll need to register on the risk management programme and answer the safety questions.
You may be given anti-sickness (anti-emetic)| medicines to prevent these side effects. Tell your doctor if you have nausea or vomiting when taking thalidomide.
You may be given a drug called warfarin to help prevent blood clots from forming while you're taking thalidomide. Let your hospital doctor know immediately if you develop pain, swelling or redness in your legs, especially your lower leg or calf. Also let your doctor know if you suddenly become breathless or have chest pain while taking thalidomide. This could be a sign of a blood clot, which needs urgent treatment.
On its own, thalidomide has only a small effect on blood cell numbers. However, if it's given with chemotherapy| drugs, the number of calls in your blood may fall and become low. You will have regular tests to count your blood cells.
It's important to tell your doctor if you feel tired| or sleepy. Many people feel sleepy when taking thalidomide. This sometimes improves after a few weeks of taking the drug. It may also help to take the capsules in the evening. If you feel sleepy, it's important not to drive or operate machinery.
Constipation| can usually be relieved by drinking plenty of fluids (2-3 litres a day), eating a high-fibre diet and taking gentle exercise. Sometimes you may need to take laxatives to stimulate your bowel. These can be prescribed by your doctor.
A dietitian or specialist nurse at your hospital can give advice about how to boost your appetite| and maintain your weight.
This is due to the effect of thalidomide on the nerves and is known as peripheral neuropathy|. It usually develops after taking thalidomide for a few months but may happen sooner. You may also begin to have difficulty with fiddly tasks such as doing up buttons. Always tell your doctor about any changes you notice. You may need to have the dose of thalidomide reduced or stopped for a time so that your symptoms don't become more severe. This is important because side effects may take several months to improve after treatment ends and can sometimes be permanent.
Let your doctor know if you have headaches while having treatment with thalidomide.
You may feel dizzy for a few moments if you stand up quickly. This is caused by a temporary fall in blood pressure. Moving slowly from lying to sitting and then sitting to standing may help. Tell your doctor if you've ever had any blood pressure problems and about any medicines you're taking.
Thalidomide can cause a rash, and dry, itchy skin. Your doctor can prescribe medicine to help. Occasionally thalidomide can cause a more serious skin rash with blistering. Let your doctor know straight away if this happens.
You may find that your ankles swell, particularly if you've been standing still or sitting down for a time. Putting your feet up when you are sitting helps reduce the problem. Talk to your doctor about medicines that may help. If the swelling is uncomfortable, your doctor may be able to prescribe elastic stockings to keep it under control.
It's important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they're not mentioned above.
Thalidomide may affect your ability to drive. Don't drive if you have dizziness, blurred vision, excessive tiredness or if you feel sleepy. Ask your doctor for advice if you are not sure whether you're safe to drive.
This section has been compiled using information from a number of reliable sources including:
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