issue report

8/9/2019 Issue Report

1/13

Tomas Mann McLeod

Can Thalidomide be used to cure Myeloma cancer?

The Biological Problem

Myeloma is a cancer of the plasma cells produced in the bone marrow. Plasma cells areproduced in the bone marrow, in order to replace old and worn plasma cells in the body in a

controlled manor. If a person is diagnosed with Myeloma cancer however, the plasma cells

are produced in an uncontrolled way causing them to become abnormal, these abnormal

plasma cells are referred to as Myeloma cells. This is a problem for the sufferer of the cancer

because the abnormal out of control plasma cells fill up the bone marrow and interferes with

the production of standard white blood cells, red blood cells and platelets; all the components

of blood. (http://www.cancerresearchuk.org/cancer-help/type/myeloma/ ) !"

The Myeloma cells then spread through the whole bone

marrow structure. The large #uantity of the plasma cellscause serious damage to the bone, it causes the bone to

become thinner, leading to a lot of pain and in some

cases Myeloma can cause the bone to fracture because

of the over production of the Myeloma cells. The

fracturing of the bone leads to another side effect; the

bone fracture causes severe pain and limited use of the

area supported by the bone.

The mutated form of the cell produces a large #uantity

of a single type of antibody called immunoglobulin. This

antibody is ineffective with regards to fighting infection

and reduces the production of other useful antibodies which ma$e up the body%s immune

system, thus ma$ing the sufferer more prone to infection as there are less of the antibodies to

protect the body from harmful pathogens.

There are many types of Myeloma cancer, the type of Myeloma cancer is defined

by the type of the antibody (immunoglobulin) that it produces. In each different

sufferer of the cancer one type of immunoglobulin is over produced, the five basic

types are&' (found in mucous, tears and breast mil$ to brea$ down pathogens),

(part of the cell receptor, it activates basophils and mast cells), * (protects against

parasitic worms that are responsible for allergic reactions), M (may be attached to

the surface of a cell or secreted in the blood) and + (secreted in the plasma cells

in the blood and able to cross the placenta into the blood). The most common type

of Myeloma cancer is Ig+ and the least is Ig*. The different types refer to the

different type of immunoglobulin produced. [1][4]

The main ris$ factors of Myeloma cancer are being - and over,

(/0 of all sufferers of Myeloma cancer are of age - and over).

1

This image has been used as

it clearly illustrates the

number of Myeloma cellsincomparrison to normal

This image shows the

dierent structures of

immunoglobulins that

could be produced.


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Tomas Mann McLeod

'dditionally race is a large factor; Myeloma

is twice as common in blac$ people as

white and 'sian%s. 'dditionally being male

also drastically increases the chances of

Myeloma cancer. The cancer is the !

th

most common cancer with !1 people being

diagnosed in the 23 alone every day.

Myeloma cancer is a biological problem

because it is the cause of 4around 5,// people

(around !,6// men and around !,1//

women) died of myeloma in 5/!! in the 23,

that%s more than people every day.%

(http://www.cancerresearchuk.org/can cer-

ino/cancerstats/keyacts/myeloma/myeloma!mortality). In addition to this Myeloma

cancer appro7imately !0 of cancer cases identified !6"

Biological Method

The use of the medication thalidomide is currently being tested

as a treatment for Myeloma cancer, as well as other forms of

cancer. 8ancer re#uires a networ$ of new blood vessels in

order to spread. The cancer encourages this production of new

vessels. -"

s

2

This image illustrates those that hae

higher ris! of being diagnosed with

Myeloma cancer.

This image has been used

as it demonstrates the

form in which thalidomide


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Tomas Mann McLeod

Thalidomide however stops the production of the new vessels; this

type of drug that has this affect is angiogenesis inhibitors; it does

this by altering or removing the chemicals that encourage thisgrowth. The new vessels provide vital nutrients for the cancer

including 97ygen for the cancer to grow. 97ygen is vital for the

growth of the vessel, as o7ygen is needed for the respiration of the

cells that ma$e up the vessel. :ence, thalidomide then reduces the

growth of the cancer by stopping the new vessels that provide the

molecules cancerous plasma cells re#uire to grow.

#http://www.macmillan.org.uk/Cancerinormation/Cancertreatment/Treatmenttypes/Bi

ologicaltherapies/"ngiogenesisinhibitors/Thalidomide.asp#!$ynamic%umpMenuManag

er&'&"nchor&($

This method does not rid of the cancer, it stops it spreading and thus limiting the cancer to a

very few cells, as well as reducing the growth, thalidomide can also cause the number of

Myeloma affected cells to decrease to a sie that near enough ma$ing the cancer cells

ineffective. Therefore in Myeloma it stops the production of the uncontrolled plasma cells

that produce the different types of myeloma cancer. The different forms of the Myeloma

cancer do not affect

the different

treatments of the

cancer; thalidomide

can be used to treat all the types of Myeloma cancer.

%

This diagram illustrates

the way thalidomide stops

angiogenesis (the

physiological process

through which new blood

vessels form from preome types of

chemotherapy for

myeloma are tablets

that you swallow.

9thers are a li#uid

given into your

vein.% < (http://www.cancerresearchuk.org/cancer-

help/type/myeloma/treatment/chemotherapy/about-chemotherapy-or-myeloma ) and asteroid drug if the sufferer is over -and aren%t suitable for large doses of treatment with stem

cell support, Some steroids are taken as tablets. 4e7amethasone, prednisolone and

methylprednisolone are the steroid drugs most commonly used for myeloma and are ta$en in

the form of an in?ection.%(http://www.cancerresearchuk.org/cancer-

help/type/myeloma/treatment/steroid-treatment-or-myeloma!how ). 'll of which are

other methods that wor$ to cure Myeloma cancer.

)ecti*eness o methodology

The methods mentioned are proven to be effective, because now the use of recent biological

methods have dramatically increased. 9ver - year survival rate has more than tripled over the

last 1- years; with thalidomide, chemotherapy and steroids% being used as the main source of

treatment it is proven to be successful, all of which have been developed, improved and used

as treatments over this period. In addition to this it is proven that one in seven from *ngland

and @ales will survive for the cancer for !/ years plus, this emphasises the successfulness of

the treatments available for Myeloma as the ma?ority of the sufferers of Myeloma are - and

above, strongly suggesting that their death was caused by wear and tear rather than the cancer

because the life e7pectancy in the 23 is currently at A! years of age. This statistic means that

people diagnosed with Myeloma in *ngland and @ales are 1 times more li$ely to survive formore than !/ years than those diagnosed in the !B/%s.

The aim of the treatment is to limit the effects of the cancerous plasma cells and increase life

e7pectancy. These statistics prove that the treatments of Myeloma cancer are successful.

4


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Tomas Mann McLeod

This graph reinforces

the successfulness of the

new treatments

available as the number

of new cases of

Myeloma cancer is

increasing, yet deaths

are falling. Collowing

the pattern that the

graph illustrates

Myeloma mortality rate

is set to decrease ever

further. The graph illustrates that there is a 5&! ratio of new cases to death rates. This isevident as the graph demonstrates 4that in 5/!/ there were 1//,/// deaths due to Myeloma

and -/,/// new incidents of Myeloma%.

+mplications

Thalidomide was originally created and prescribed in +ermany that was used as a hypnotic or

as a sedative, shortly after it was used by pregnant women to prevent morning sic$ness and

was sold as an over the counter drug. :owever, soon after in !B! it became clear that thedrug was the cause of mutations in the limbs of the offspring of the patients that used the

drug. It first made doctors suspicious of the drug when many patients had damage in the

nerves of their limbs after long term use.

Thalidomide caused mutations of !/,///

children. This disaster was the cause of more

vigorous drug testing. espite the large

number of mutated offspring, not all the

children whose mothers too$ the drug were

affected; only the ones that too$ the drug inthe early stages of pregnancy. 's well as the

offspring however, the Myeloma sufferer can

also suffer nerve ending issues, this is due to

peripheral neuropathy (damage to nerves

outside the central nervous). [11]

)thical implications:

&

This graph was used as it shows the no. of deaths

compared to new cases of Myeloma. [1']

This graph shows the relationship

between thalidomide sales and mutations

in children, the graph shows a cleardistinct pattern, clearly showing that as

more thalidomide was consumed, more

offspring were affected.


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Tomas Mann McLeod

Curthermore, with the treaments of

Myeloma cancer such as using thalidomide

only cost the government more money. Crom the

table it is clear that the cost of treating cancer is

only increasing !5" . y 5/5! the cost oftreating cancer is estimated to cost the F:>

G!1,!B! million, an increase of -0, this is

not a true reflection of the implications of the

treatment as a previous graph illustrates

that there are more numbers of new cases diagnosed. *conomically many would argue that

this money could be spent more wisely on education for e7ample.

$isad*antages o method

's well as mutated offspring, thalidomide can also cause the following side effects&

Eis$ of blood clotting& In Myeloma cancer, thalidomide wor$s by clotting the blood cells that

cause the cancer to grow, however as the drug is ta$en orally, it does not only affect the area

around the bone marrow, therefore it can cause the blood to clot unwillingly. :owever in

order to counter this blood thinning drugs can be ta$ing alongside the thalidomide.

The use of these blood thinning drugs lead to another disadvantage. The average cancer

treatment cost G1/,/// per person; the use of thalidomide only increases this price, with

blood thinning drugs pushing this price up even further. This has a $noc$


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Tomas Mann McLeod

"d*antages o method

's highlighted earlier the advantage of using

thalidomide is that it can increase the life

e7pectancy of Myeloma suffers. espite

being an effective method of treating those

with Myeloma cancer it is also a cheaper

method than other available alternatives. '

capsule pac$ of -/mg capsules costing G1//

(5A capsules) and only one capsule is used

per . 8hemotherapy and radio therapy on the

other hand cost G1-,///, in addition to this

radiotherapy is more dangerous than

thalidomide, this is because radiotherapy

causes damage to the bone in Myeloma

sufferers which can cause bone fractures.4Eadiotherapy sometimes slows down the

cells in the bone marrow that produce your

blood cells. This is more li$ely if you are having a large area of the body treated or if

treatment is to the bones of your legs, chest, abdomen or pelvis.%

(http://www.cancerresearchuk.org/ca

n

c

e

r

-

help/about-

cancer/treatment/radiotherapy/side-

eects/general/radiotherapy-eects-

on-your-blood).

In addition to cost and the success rate of the cure of Myeloma cancer, thalidomide is

prescribed in a tablet form, therefore it is orally which re#uires less hassle than chemotherapy

and even more so than radiotherapy which costs the F:> millions in electricity and the

e#uipment.

/

This image shows the magnitude of

radiotherapy treatment in comparison to

thalidomide as illustrated preiously.

This graph shows the li$elihood of

the symptoms induced from radio

therapy


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Tomas Mann McLeod

'dditionally the to7icity report of thalidomide is 4substantially milder% than chemotherapy.

This suggests that there are more ris$s of using chemotherapy in comparison to thalidomide.

In addition to its success rate of a treatment for Myeloma cancer, it can also wor$ if the

sufferer has a relapsed or a treatment on its own if none of the other treatments have wor$ed

to cure the disease. This has been proven to wor$ in -/0 of patients, reinforcing its success

of being a treatment.

's well as all the advantages listed, the main advantage is that it e7tends the life of Myeloma

cancer sufferers. This has been proven as thalidomide being used in the treatment of

Myeloma e7tended the life e7pectancy by an average of nine months longer than someone

not receiving thalidomide in their Myeloma treatment.

,ther Methods

Chemotherapy:

8hemotherapy wor$s by $illing the cancer

cells completely unli$e thalidomide, it $ills

of the cancer cells by affecting the mitosis

of the cells, and mitosis is how all body

tissues are made, by the replication of cells

that have identical structure and function;

cancer cells however divide at a much faster

rate than tissue cells, thus ma$ing

chemotherapy is a very effective method of

stopping the production of new cancer cells

causing the cancer to spread ". In

Myeloma chemotherapy stops the

reproduction of the plasma cells by altering

the cells that are cancerous (they produce the immunoglobulin antibody) so it stops them

being able to spread across the bone marrow by changing some of the genes in cancers

chromosomes and limiting the production of other factors of the blood, causing them to

decrease until they%re unrecognisable and will no longer

multiply.

teroids:

>teroids are given as part of a cancer treatment. They are

substances that are produced naturally by our bodies in

the adrenal glands. It can also be produced outside of our

bodies and be used as drugs. >teroids are used alongside

chemotherapy in the treatment of Myeloma 5" as well

as other forms of cancer A". It wor$s by increasing the effects of the chemotherapy, which

stops the mitosis of the cells. 8hemotherapy drugs are inserted into the blood supply. >teroid

drugs are put into the blood supply also as the two need to wor$ in sync to optimise its

0

This shows how chemotherapy can be gien

to a patient. [0]


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Tomas Mann McLeod

effectiveness. It also reduces the immune systems responses, so if the body re?ects the

chemotherapy then the steroids will decrease the re?ection.

ources

These are the main sources that have been used&

!.

http&==www.macmillan.org.u$=8ancerinformation=8ancertreatment=Treatmenttypes=iolog

icaltherapies='ngiogenesisinhibitors=Thalidomide.asp7

5. 'ntitumor 'ctivity of Thalidomide in Eefractory Multiple Myeloma H

>eema >inghal, M.., ayesh Mehta, M.., Eaman esi$an, M.., an 'yers, M.>., PaulaEoberson, Ph.., Paul *ddlemon, .>., Fi$hil Munshi, M.., *lias 'naissie, M.., 8arla

@ilson, M.., Ph.., Madhav hodap$ar, M.., erome Jeldis, M.., avid >iegel, M..,

Ph.., ohn 8rowley, Ph.., and art arlogie, M.., Ph H ' non


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Tomas Mann McLeod

Macmillan is a highly regarded cancer charity, as well as an information website on all types

of cancer. The information it provides its audiences with has to be reliable as many cancer

sufferers will visit this website in order to find out information on the disease they have, such

as treatment and the cancers causes. 's well as giving cancer patients support, it offers an

insight on cancer to the public. I%ve cross chec$ed the data gained from Macmillan using

@i$ipedia and 8ancer Eesearch to ensure reliability. 'nother reason as to why this source isreliable is that it is a non


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Tomas Mann McLeod

(Image on Myeloma bone marrow)

http&==www.myeloma.org.au=Portals=/=images=graphics=figure!.?pgH last accessed on !5th

anuary 5/!6 1"

(ifferent types of Myeloma cancersH allparagraphs) teroids.asp7H last accessed on !-thanuary 5/!6 A"

(8hemotherapy image)

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