Thalidomide in hematologic malignancies: Future directions

Alternatives to traditional cytotoxic agents are needed to target the biologic processes associated with progression of multiple myeloma. Recent studies suggest that angiogenesis is sustained when patients with multiple myeloma achieve remission and may contribute to disease relapse and poor patient survival. Antiangiogenic therapy has been proposed as a strategy for reducing the risk of disease recurrence in patients with multiple myeloma. Accumulating evidence suggests that the combination of cytotoxic chemotherapy and antiangiogenic therapy has increased antitumor effects compared with either strategy alone. Preliminary findings of phase II studies suggest that thalidomide, an agent with antiangiogenic properties, has major activity in patients with refractory multiple myeloma. Based on this promising activity, a number of clinical trials are ongoing or planned to further assess the therapeutic potential of thalidomide as a single agent and in combination with chemotherapy in multiple myeloma and other hematologic malignancies. Copyright (C) 2000 by W.B. Saunders Company.