Thalidomide, after being banned from the market in the early 1960s because of the worldwide
teratogenesis disaster, is currently being rediscovered because of its multiple
therapeutic effects in various serious diseases and symptoms. Original studies examined the
anxiolytic, mild
hypnotic,
anti-emetic and adjuvant
analgesic properties of this
drug. Subsequently,
thalidomide was found to be highly effective in managing the cutaneous manifestations of
leprosy (
erythema nodosum leprosum) and even to be superior to
aspirin (
acetylsalicylic acid) in controlling
leprosy-associated
fever. Recent research shows promising results with
thalidomide in patients with progressive bodyweight loss related to advanced
cancer and
HIV infection.
Thalidomide therapy of diseases such as
tuberculosis,
sarcoidosis,
aphthous ulcers in HIV syndrome and
Behcet's disease,
rheumatoid arthritis,
multiple myeloma,
graft-versus-host disease,
pyoderma gangrenosum,
inflammatory bowel disease, Sjögren's syndrome, lupus erythematosus and a variety of solid tumours is currently being explored. Furthermore, in preliminary studies,
thalidomide has been found to be effective in several syndromes related to advanced
cancer, such as the
cancer cachexia syndrome, chronic
nausea,
insomnia, profuse sweating and
pain. Whether
thalidomide has a
therapeutic effect on neoplastic
fever has yet to be elucidated. These intriguing features make the use of the
drug potentially attractive for
palliative care. In addition, by a distinct mechanism of action compared with most other drugs,
thalidomide offers the possibility of combined treatment with other agents with non-overlapping toxicities. The mechanism of action of
thalidomide is probably based on the suppression of tumour
necrosis factor-alpha and the modulation of
interleukins. However, it is not possible to identify a single dominant mechanism, since the action of
cytokines and the effect of
thalidomide appear to be complex. This review article discusses the original uses and teratogenic effects of
thalidomide within its historical context and, linking recent research at the molecular level with clinical findings, aims to provide the reader with insight into the current understanding of its
biological actions, toxicities and potential benefits.