Thalidomide seems to slow the rate of weight loss and wasting associated with advanced disease in patients with pancreatic cancer, according to an article in the April issue of the journal Gut. Severe cachexia is the direct cause of death in 20 percent of patients with advanced cancer.

In the current study, British researchers evaluated 50 patients who were terminally ill with pancreatic cancer, all of whom had lost at least 10 percent of their body weight. The patients were randomly assigned to 200 mg thalidomide daily or placebo for 24 weeks.

At 4 weeks, 33 patients were assessed. The thalidomide patients had gained an average of 0.37 kg and had slightly increased their arm muscle bulk (1 cm). In contrast, placebo patients lost an average of 2.21 kg and arm muscle bulk shrank by 4.46 cm.

At 8 weeks, 20 patients were assessed. The thalidomide patients had lost 0.06 kg weight compared with 3.62 kg among placebo patients, and their arm muscle bulk had decreased by 0.5 cm compared with 8.4 cm in the placebo group.

There was no overall difference in survival times between the two groups, but increases in weight were matched by increases in physical capacity. Thalidomide had few side effects.

The authors noted that thalidomide dampens inflammation in the body, although the underlying mechanism is unknown. Previous research has shown that the drug can improve the wasting typical of AIDS and reduce the weight loss characteristic of tuberculosis.

The authors speculate that thalidomide may target pancreatic cancer directly. "In the future, combination of thalidomide with nutritional supplements and pharmacological agents may ultimately lead to a better clinical outcome," they suggested.

An accompanying editorial suggests that thalidomide has several useful actions that could potentially make it a useful anti-cancer drug. It is also cheap and safe if not used in pregnant patients. Further large-scale studies should be undertaken as soon as possible.