Thalidomide and Dexamethasone: A New Standard of Care for Initial Therapy in Multiple Myeloma

Abstract
InthisissueoftheJournalofClinicalOncology,Rajkumaretal report on the results of a randomized phase III clinical trial of thalidomide plus dexamethasone compared to high-dose dexa- methasone alone in newly diagnosed multiple myeloma. 1 In this study, coordinated by the Eastern Cooperative Oncology Group, 207 patients were randomly assigned to either thalidomide plus dexamethasoneorhigh-dosedexamethasonealone.Responserate, the primary end point, was significantly higher with thalidomide plus dexamethasone than single-agent high-dose dexamethasone (63% v 41%, respectively, P.002); however, this benefit was associated with important toxicities, including deep vein throm- bosis (DVT) and treatment-related mortality, which were 5% and 4%, respectively. 1