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ONCOLOGY

Thalidomide Dosing in Patients with Relapsed or Refractory Multiple Myeloma

Clinical Instructor of Pharmacy, Oncology Pharmacotherapy Resident, School of Pharmacy, Virginia Commonwealth University Health System/Medical College of Virginia Hospitals and Physicians, Richmond, VA

Lea Ann Hansen, PharmD BCOP

Associate Professor of Pharmacy, Oncology Clinical Specialist, School of Pharmacy, Virginia Commonwealth University Health System/Medical College of Virginia Hospitals and Physicians

Reprints: Lea Ann Hansen PharmD BCOP, School of Pharmacy, Virginia Commonwealth University Health System/Medical College of Virginia Hospitals and Physicians, 410 N. 12th St., PO Box 980533, Richmond, VA 23298-0533, FAX 804/828-8359, E-mail lahansen{at}vcu.edu

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.

Key Words: multiple myeloma, thalidomide

Published Online, February 28, 2003. www.theannals.com, DOI 10.1345/aph.1A155