Jennifer L Thompson1, Lea Ann Hansen. 1. School of Pharmacy, Virginia Commonwealth University Health System/Medical College of Virginia Hospitals and Physicians, Richmond, VA 23298, USA.
Abstract
OBJECTIVE: To evaluate the literature regarding the dosing of thalidomide in multiple myeloma. DATA SOURCES: A MEDLINE search (1990-February 2003) using the search terms thalidomide and multiple myeloma was performed to identify clinical trials and abstracts. Identified literature was then cross-referenced for further pertinent data. DATA SYNTHESIS: Patients with relapsed or refractory multiple myeloma have few therapeutic options. Thalidomide is a promising agent, although many dose-related issues are still in question. Starting doses studied ranged from 50 to 200 mg/d, usually given at bedtime. Gradual dose escalation up to 800 mg/d has been studied, with some evidence of improved outcome with doses of 400-600 mg/d, while thalidomide appears to be best tolerated at doses </=400 mg/d. CONCLUSIONS: A reasonable approach for use of thalidomide in multiple myeloma is to initiate therapy at 50-100 mg nightly and escalate every 2 weeks in 50- to 100-mg increments as tolerated. Efforts should be made to titrate the dose to 400-600 mg/d, especially in patients with poor prognostic features. Efficacy should be assessed at approximately 8 weeks and the dose maintained if desired response is achieved.
OBJECTIVE: To evaluate the literature regarding the dosing of thalidomide in multiple myeloma. DATA SOURCES: A MEDLINE search (1990-February 2003) using the search terms thalidomide and multiple myeloma was performed to identify clinical trials and abstracts. Identified literature was then cross-referenced for further pertinent data. DATA SYNTHESIS: Patients with relapsed or refractory multiple myeloma have few therapeutic options. Thalidomide is a promising agent, although many dose-related issues are still in question. Starting doses studied ranged from 50 to 200 mg/d, usually given at bedtime. Gradual dose escalation up to 800 mg/d has been studied, with some evidence of improved outcome with doses of 400-600 mg/d, while thalidomide appears to be best tolerated at doses </=400 mg/d. CONCLUSIONS: A reasonable approach for use of thalidomide in multiple myeloma is to initiate therapy at 50-100 mg nightly and escalate every 2 weeks in 50- to 100-mg increments as tolerated. Efforts should be made to titrate the dose to 400-600 mg/d, especially in patients with poor prognostic features. Efficacy should be assessed at approximately 8 weeks and the dose maintained if desired response is achieved.