Thalidomide Effective in Myeloma, But No Survival Advantage

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Current treatment for multiple myeloma entails a long and intricate chemotherapy regimen that includes one or two transplants with a patient's own stem cells accompanied by the drug melphalan. The anti-angiogenesis agent thalidomide has proven to be an effective component of therapy, but questions remain about where in the course of treatment it can best be used. In the March 9 New England Journal of Medicine, researchers report superior event-free and complete response rates when the drug was used before and during primary therapy and also thereafter for maintenance. Yet the controls who took no thalidomide lived just as long.

After 4.5 years, Dr. Bart Barlogie and colleagues from the University of Arkansas found that 56 percent of patients taking thalidomide had no adverse events - disease progression, relapse, or death from any cause - compared with 44 percent of controls following the same treatment regimen without the drug; and an even greater difference was seen in complete responses, 62 to 43 percent. But each group contributed comparably to the 190 patients who died during this time, "owing in part to significantly shorter survival after relapse in the thalidomide group," wrote the authors, 1.1 compared with 2.7 years. Further compromising the advantage for thalidomide were more serious adverse events, such as deep-vein thrombosis and severe peripheral neuropathy.

In an editorial, Drs. Michele Cavo and Michele Baccarani, of the University of Bologna in Italy, suggest one interpretation of the data was to reserve treatments such as thalidomide "for the sequential treatment of relapses as a means of controlling the growth or regrowth of tumor."

Biomarker Predicts Development of Precancerous Lung Disease

The circulating C-reactive protein (CRP) was shown to be an "excellent predictive" biomarker for progressive bronchial dysplasia - a precursor of lung cancer - in former and current smokers, according to a study in the March 1 American Journal of Respiratory and Critical Care Medicine.

The study, led by Dr. Don D. Sin of the University of British Columbia, measured baseline serum levels of CRP and other markers of inflammation in 65 subjects who had at least 1 site of bronchial dysplasia. The sites were also biopsied by the researchers. Additional bronchial biopsies at the same sites were taken 6 months later to determine if there was a worsening of the dysplastic lesions or new lesions.

"Half of the participants developed progressive dysplastic lesions after 6 months," the researchers report. "The baseline CRP levels in these participants were 64 percent higher than those without progressive disease." Among those with lower CRP levels (less than 0.5 mg/L), only 13 percent showed worsened conditions, compared with 54 percent with higher levels. "The odds of developing progressive disease were 9.6-fold higher in the latter than in the former group," the researchers add.

Although the results from the study need confirmation in larger, longer term trials, the researchers believe CRP, along with other prognostic methods, may be helpful in the urgent search for methods "to identify individuals harboring precancerous lesions and to use a chemopreventive agent to prevent progression of these lesions to invasive carcinomas." Currently, most lung cancer patients are diagnosed too late for effective surgical removal of the tumors, they note.

Cigarette Sales See Record Drop

U.S. sales of cigarettes dropped by 4.2 percent from 2004 to 2005, the largest single decrease in cigarette sales since 1999, the National Association of Attorneys General (NAAG) announced last week. More importantly, the NAAG reported, is that the 378 billion cigarettes sold last year represent the lowest sales figure since 1951; during that same period of time, the population of the United States more than doubled. The sales figures were compiled by the U.S. Treasury Department's Tobacco Tax Bureau.

Cigarette sales have declined 21 percent since 1998, the same year state attorneys general completed negotiations with the tobacco industry on the Master Settlement Agreement (MSA). The MSA imposed restrictions on a number of promotional and other activities in which tobacco companies could engage, including a prohibition on cigarette marketing and promotions aimed at minors.

"The continued enforcement efforts of the MSA's provisions by attorneys general, along with other health advocates, have made a marked difference in the number of smokers across the country, particularly among youth," said Iowa Attorney General Tom Miller, who co-chairs the NAAG Tobacco Committee, in a statement.

Mr. Miller also noted that states have sometimes been accused of not doing enough to slow tobacco sales because, under the MSA, part of the revenues from cigarette sales go back to the states. "Nothing could be further from the truth," he said.

Dr. Cathy Backinger, chief of NCI's Tobacco Control Research Branch, notes, "The decline in cigarette sales is good news for the American public. As cigarette sales decline, we can expect decreased tobacco-related deaths and health care costs."