Cancer risks along the disease trajectory in antineutrophil cytoplasmic antibody associated vasculitis

Thet, Zaw; Lam, Alfred King‐Yin; Ranganathan, Dwarakanathan; Aung, Soe Yu; Khoo, Tien K.

doi:10.1007/s10067-020-05055-x

Cited by 10 publications

(14 citation statements)

References 51 publications

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“…It is also necessary to further evaluate the drugs used to treat GPA and their impact on the mechanisms leading to carcinogenesis. There is a continued need for alternatives to CYC that are less toxic and for cancer screening in patients with a high risk of neoplasm development [58]. Bronchoscopy with biopsy and histopathological examination are crucial in proper differential diagnosis.…”

Section: Discussionmentioning

confidence: 99%

New lung mass in a patient with granulomatosis with polyangiitis

et al. 2020

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Granulomatosis with polyangiitis (GPA) is a potentially lethal ANCA-associated small-vessel vasculitis characterized by a typical triad of upper respiratory tract, lung, and kidney involvement. Lung involvement in GPA occurs in 25–80% of cases. The most common radiographic and computed tomography (CT) abnormalities of pulmonary GPA are lung nodules and masses, very often multiple and with cavitation. As there are various clinical presentations, the diagnosis of GPA can be challenging, and the illness is difficult to distinguish from other diseases such as infection or malignancy. Following the improved survival rates in patients with GPA, there is accumulating evidence to suggest an increased occurrence of different types of cancer. Exposure to cyclophosphamide seems to be one of its main causes. We present the case of a patient with chronic GPA who was hospitalized owing to a new infiltrate in the lung, suggesting relapse of the disease, and finally diagnosed with small cell lung cancer. Data regarding lung cancer in GPA patients are limited. While there are some case reports and short case series in the literature, there are no detailed data regarding an association between CYC exposure and lung cancer development in vasculitis. It is necessary to consider the causes of pulmonary masses other than a GPA relapse. Bronchoscopy with biopsy and histopathological examination are crucial in proper differential diagnosis. GPA patients require long-term follow-up to monitor for the development of complications during treatment.

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Section: Discussionmentioning

confidence: 99%

New lung mass in a patient with granulomatosis with polyangiitis

et al. 2020

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“…The Danish Renal Biopsy Registry found the incidence of cancer was rare in patients < 45 years with glomerular diseases but increased significantly beyond 45 years of age [36] . In patients with ANCA associated vasculitis, it was proposed that cancer screening should be based on the clinical context and supportive screening criteria, such as age ≥ 45 years, heavy current or ex-smokers, heavy alcohol users and patients with a history of previous cancer, concurrent hepatitis (HBV, HCV), human immunodeficiency virus (HIV) infections and significant family history of malignancy [11] . A further emphasis was mentioned for patients who had relapsing, or refractory glomerular disease treated with additional immunosuppressants that incurred a higher cumulative dose and longer duration as well as those who received a cumulative dose of >36g of cyclophosphamide.…”

Section: Cancer Screening In Glomerular Diseasementioning

confidence: 99%

“…Observational studies, case reports and case series have supported a link between glomerular disease and cancer. Some glomerular diseases require treatment with long-term immunosuppressants known to have oncogenic adverse effects and they may accelerate oncogenesis and neoplastic progression by direct mutagenesis or disruption in immune surveillance [8] , [9] , [10] , [11] , [12] . In addition, glomerular diseases associated with malignancy (paraneoplastic glomerulopathy) may be secondary complications of primary cancers and due to altered immune responses associated with cancer [13] , [14] , [15] , [16] .…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, long-term use of immunosuppressants, exposure to environmental factors, and oncogenic viral pathogens, such as hepatitis B virus (HBV), hepatitis C virus (HCV), Epstein Barr virus (EBV), human papilloma virus (HPV) could play important roles in the development of de novo cancers [ 15 , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] ]. Furthermore, genetic predisposition and lifestyle-related risk factors (for example, smoking, exposure to ultraviolet radiation) may increase cancer risk in patients with glomerular disease [ 11 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

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Critical evaluation of cancer risks in glomerular disease

Thet

Lam

Ranganathan

et al. 2022

Translational Oncology

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“… 6,8‐10 Studies suggested that the risk of cancer, including skin cancer, was increased in patients with all types of GD. 9,13 Risk factors for skin cancers in renal transplant are duration and intensity of immunosuppression, ultraviolet sun exposure, previous history of skin cancer, fair skin complexion or phototype, age at renal transplantation, smoking, male gender and viral infection with human papillomavirus 14 . Among these, a significant modifiable risk factor in skin cancer is the duration and intensity of exposure to ultraviolet radiation 15 …”

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confidence: 99%

Comparison of skin cancer awareness and sun protection behaviours between renal transplant recipients and patients with glomerular disease treated with immunosuppressants

Thet

Lam

et al. 2020

Nephrology

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Background There is no previous study that compare skin cancer awareness and photoprotective behaviours between renal transplant recipients (RTR) and patients with glomerular disease (GD). Objectives/Methods Sixty‐one RTR and 51 patients with GD were given a self‐reported questionnaire to evaluate skin cancer awareness and photoprotective behaviours in this cross‐sectional study. The former group received a formal education on skin cancer and the latter an informal session prior to immunosuppressant use. Results Ninety‐three percent (n = 57) of RTRs and 88% (n = 45) of patients with GD responded to the survey. Majority of participants from both groups were aware that ultraviolet radiation could play a role in the occurrence of skin cancers and the awareness increased in participants with higher education (odds ratio [OR] = 1.50, 95% confidence interval [CI] = 1.15‐1.95, P = .003). Ninety‐eight percent vs 71% were aware that immunosuppressants can increase the risk of developing cancer (P < .001) and higher awareness was noted in younger participants (OR = 0.92, 95% CI = 0.87‐0.97, P = .003). Suboptimal photoprotective behaviours (sun avoidance, sunscreen usage and sun‐protective clothing) were noted in both cohorts and slightly lower sun protection rates were reported in RTR when compared with patients having GD. The level of sun protective measures in RTR based on high, moderate and minimal use of photoprotective measures were 21%, 46% and 33%, respectively. In terms of patients with GD, the latter practices were 13%, 50% and 37%, respectively (P = .560). Higher educational status was significantly associated with better sunscreen usage in RTR (P = .017) whereas this finding was not observed in patients with GD. Conclusion Patients with GD and RTR should have formal education on the risks of skin cancers before starting immunosuppressants. Follow‐up education and surveillance is required to improve skin protective practices in these patients.

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Cancer risks along the disease trajectory in antineutrophil cytoplasmic antibody associated vasculitis

Cited by 10 publications

References 51 publications

New lung mass in a patient with granulomatosis with polyangiitis

New lung mass in a patient with granulomatosis with polyangiitis

Critical evaluation of cancer risks in glomerular disease

Comparison of skin cancer awareness and sun protection behaviours between renal transplant recipients and patients with glomerular disease treated with immunosuppressants

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