Thalidomide is an agent with complex antiangiogenic and immunomodulatory properties. It has been demonstrated to reduce mRNA and protein expression of bFGF and VEGF with resulting inhibitory effects on endothelial cell proliferation. Several small studies of thalidomide as a single agent in RCC have reported no complete responses, partial responses ranging from 0-17%, and stable disease in 17-64% of patients. In these studies, thalidomide was generally started at a low dose of 100-200 mg per day, and further escalated to higher doses until toxicity was achieved. When thalidomide analog, lenalidomide became available, it was studied in renal cell carcinoma as well.
Thalidomide has minimal activity. In a recent metastatic study(Margulis et al), single-agent thalidomide was inactive, and that the risk-benefit ratio clearly did not favor the use of thalidomide In small randomized, controlled 2009 trial (Jonasch et al), adjuvant thalidomide therapy after complete resection of high-risk RCC did not improve the 2- and 3-year RFS rates or cancer-specific death rates.
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NCCN, renal cell carcinoma