Unknown; possible modulation of tumor necrosis factor–alpha (TNF-a) and vascular endothelial growth factor (VEGF).

For the treatment of multiple Myeloma, thalidomide is administered in combination with dexamethasone in 28-day treatment cycles. The dose is 200 mg once daily with water, preferably at bedtime and at least 1 hour after the evening meal. Dexamethasone 40 mg daily on days 1-4, 9-12 and 17-20 every 28 days.

Currently in clinical trial phases I, II, and III for Kaposi's sarcoma; prostate, lung, breast, colon, and renal cancers; hepatocellular cancer; glioblastoma; and myeloma. Indicated in combination with dexamethasone for treatment of newly-diagnosed multiple myeloma.

Birth defects, drowsiness and/or somnolence, orthostatic hypotension, peripheral neuropathy, dizziness, rash, anorexia, appetite increase and/or weight gain, constipation, neutropenia, and increase in HIV viral load

Oral medication

Participation in the S.T.E.P.S.^® program is mandatory.

Administer weekly pregnancy test during the first four weeks of therapy, then monthly or every two weeks depending on menses regularity.

Obtain monthly labs, including complete blood count with differential. Perform monthly weight check. Discontinue treatment if patient

• Becomes pregnant
• Develops peripheral neuropathy.

Provide extensive birth control education in conjunction with Celgene's literature.

Patients who develop side effects such as constipation, oversedation, or peripheral neuropathy may benefit by either temporarily discontinuing the drug or continuing at a lower dose. As symptoms improve, the drug may be started at a lower dose or at the previous dose based on clinical judgment.