Malignancies in systemic lupus erythematosus: an update

Abstract

The purpose of this review is to underline important advancements in the understanding of cancer risks in systemic lupus erythematosus (SLE). In SLE, there is an increased risk of specific kinds of malignancy. For example, the risk of non-Hodgkin's lymphoma is increased several-fold in SLE versus the general population. In addition, heightened risks for lung cancer, thyroid cancer and cervical dysplasia in SLE have been found. Some have postulated that immunosuppressive drugs play a role, as well as other important mediators, such as lupus disease activity itself. One new frontier being explored is the significant finding of a decreased risk of certain nonhematologic cancers (e.g., breast, ovarian, endometrial and prostate) in SLE. The reasons for this are currently under study. Keywords cancer; immunosuppressive drug; malignancy; risk; systemic lupus erythematosusIn systemic lupus erythematosus (SLE), there appears to be specific differences in cancer susceptibility, compared with the general population. To date, data indicate an overall increase in cancer in SLE (10-15%) [1], with definite increases in hematologic cancers, particularly non-Hodgkin's lymphoma (NHL) as well as lung, thyroid and vulvar cancer [1][2][3][4]. Cervical dysplasia (a precancerous lesion) is another condition of potential concern.It has been postulated that immunosuppressive drugs may play a role in increased cancer risk in SLE, but there may also be other important factors, including SLE activity itself. According to recent findings, the risk for certain nonhematologic cancers, such as breast, endometrial and ovarian cancers in women [5], and prostate cancers in men, may be decreased in individuals with SLE [6,7]. Exploring the reasons for this is itself a whole new avenue of potential research, as will be discussed.

Trends in Hospital Admissions and Death Causes in Patients with Systemic Lupus Erythematosus: Spanish National Registry

“…Despite the increased risk of malignancy in SLE patients, neoplasms have not yet been uniformly identified as a main cause of admission or death [40,41]. We found, in this study, that neoplasms increased as a cause of admission from 2.4% in 1997-2000 to 5.5% in 2010-2015 and became the third cause of death (from 7.4% to 13.8%).…”

A ceRNA regulatory network in systemic lupus erythematosus and its molecular interplay with cancer

“…Potential risk factors include inherent autoimmune features, such as chronic inflammation, use of immunosuppressive drugs (ISDs), and susceptibility to viral infections (26). SLE patients have an increased incidence of hematological malignancies (non-Hodgkin's lymphoma, leukemia) and certain solid cancers (vulva and cervix, thyroid, lung, liver) (27). In contrast, SLE appears to play a protective role in hormone-sensitive cancers, such as breast and prostate cancers (28,29).…”

High-grade spheno-orbital meningioma in patients with systemic lupus erythematosus: Two case reports and literature review

“…Prevailing theories have proposed an association between malignancies and SLE, including relatively high expression of interleukin 6 (IL-6) and IL-10 in patients with non-Hodgkin lymphoma and in patients with SLE. [31] Moreover, cyclophosphamide exposure has been reported as a risk factor for bladder cancer, [38,54] as was a higher susceptibility to specific viral infections such as Epstein-Barr virus and human papilloma virus in patients with SLE, both of which play a role in the pathogenesis of hepatobiliary and gynecological malignancies. [14,31,54] IL-6 expression was suggested to be an important factor in the pathogenesis of CM; [1,19] therefore, patients with SLE may have an increased risk of developing CM.…”

“…[31] Moreover, cyclophosphamide exposure has been reported as a risk factor for bladder cancer, [38,54] as was a higher susceptibility to specific viral infections such as Epstein-Barr virus and human papilloma virus in patients with SLE, both of which play a role in the pathogenesis of hepatobiliary and gynecological malignancies. [14,31,54] IL-6 expression was suggested to be an important factor in the pathogenesis of CM; [1,19] therefore, patients with SLE may have an increased risk of developing CM. Moreover, SLE is treated with a variety of medical therapies, including glucocorticoids, antimalarials (hydroxychloroquine, chloroquine, and mepacrine), methotrexate, azathioprine, cyclophosphamide, mycophenolate mofetil, calcineurin inhibitors (cyclosporine A and tacrolimus), thalidomide, rituximab, and belimumab.…”