Dear OncoLink "Ask The Experts,"
I am a nurse taking care of an MS patient who has a recurrent melanoma on the side of her face. She was treated with Thalidomide and it was stopped because she could not tolerate it. The oncologist's next step will be to try Temadar. I am looking for your comments on how to proceed.
Julia Draznin Maltzman, MD, Attending Physician at the University of Pennsylvania School of Medicine, responds:
Recurrent or metastatic melanoma is a very difficult disease to treat. There are few effective therapies and it usually carries a poor prognosis. Currently a chemotherapy called DTIC is the only FDA-approved treatment. To be active, DTIC must undergo activation in the liver. More recently, an oral drug called temozolomide (Temadar) has become available. Unlike DTIC, Temadar does not require hepatic activation. Both DTIC and Temadar have the same active metabolite that alkylates DNA and thus inhibits tumor growth. Temadar has become an attractive alternative to DTIC, and is used now almost universally.
Thalidomide is not yet approved for melanoma but is being used quite often in the setting of this disease. Melanoma is a highly vascular tumor. This fact suggested to some researchers the possible role for an anti-angiogenic agent. Thalidomide has been shown to have anti-angiogenic properties. Studies are on the way to look into the combination of Thalidomide and Temadar.
I wish you both best of luck with the new therapy.