Proinflammatory cytokines, especially tumour necrosis factor, play a prominent role in the pathogenesis of cancer cachexia.
Thalidomide, which is an inhibitor of tumor necrosis factor synthesis, may represent a novel and rational approach to the treatment of cancer cachexia.
Dr Gordon and colleagues from England assessed the safety and efficacy of thalidomide in attenuating weight loss in patients with cachexia secondary to advanced pancreatic cancer.
The research team designed a single centre, double blind, randomised controlled trial with primary outcomes of change in weight and nutritional status.
The team randomized 50 patients with advanced pancreatic cancer who had lost at least 10% of their body weight to receive thalidomide 200 mg daily or placebo for 24 weeks.
|An improvement in physical functioning correlated positively with weight gain|
The investigators evaluated 33 (16 control and 17 thalidomide) at 4 weeks, and 20 patients (8 control, 12 thalidomide) at 8 weeks.
The researchers noted that at 4 weeks, patients who received thalidomide had gained on average 0.4 kg in weight and 1 cm3 in arm muscle mass compared with a loss of 2 kg and 5 cm3 in the placebo group.
At 8 weeks, patients in the thalidomide group had lost 0.06 kg in weight and 0.5 cm3 in arm muscle mass compared with a loss of 3.6 kg and 8 cm3 in the placebo group.
The team reported that an improvement in physical functioning correlated positively with weight gain.
Dr Gordon concludes, “Thalidomide was well tolerated and effective at attenuating loss of weight and lean body mass in patients with cachexia due to advanced pancreatic cancer.”