Risk of New or Recurrent Cancer in Patients With Inflammatory Bowel Disease and Previous Cancer Exposed to Immunosuppressive and Anti-Tumor Necrosis Factor Agents

Axelrad, Jordan E.; Bernheim, Oren; Colombel, Jean–Frédéric; Malerba, Stefano; Ananthakrishnan, Ashwin N.; Yajnik, Vijay; Hoffman, Gila; Agrawal, Manasi; Lukin, Dana J.; Desai, Amit P.; McEachern, Elisa; Bosworth, Brian; Scherl, Ellen; Reyes, Andre; Zaidi, Hina; Mudireddy, Prashant; DiCaprio, David; Sultan, Keith; Korelitz, Burton I.; Wang, Erwin; Williams, Reneé; Chen, Lea Ann; Katz, Seymour; Itzkowitz, Steven H.

doi:10.1016/j.cgh.2015.07.037

Cited by 100 publications

(97 citation statements)

References 29 publications

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“…In rheumatoid arthritis, data from National registries of the United Kingdom [21] and Germany [17] did not show an increased risk of new or recurrent cancer during prolonged treatment with anti-TNF agents in patients with prior malignancy. In IBD, a recent study from the GETAID identified 79 patients with previous malignancy diagnosed 17 months (median; range 1-65) before inclusion treated with an anti-TNF agent for severe IBD.…”

Section: Anti-tnf Agentsmentioning

confidence: 92%

“…In patients with psoriasis and rheumatoid arthritis, observational data suggest there is no dramatic incidence of new or recurrent cancer in patients receiving immunomodulators [15,16] . In 333 patients with IBD and a history of cancer, Axelrad et al [17] observed similar incidence of new or recurrent cancer on immunomodulators compared with patients who did not receive immunosuppression, after adjusting for recurrence risk for type of prior cancer (hazard ratio 1.08; 95% CI 0.54-2.15). A similar negative finding was noted in 405 patients from the CESAME cohort including 20% of patients on thiopurines [3] .…”

Section: Immunomodulatorsmentioning

confidence: 99%

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What Should Be Done in Inflammatory Bowel Disease Patients with Prior Malignancy?

Cosnes

2017

Dig Dis

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Background: Treatment of inflammatory bowel disease (IBD) in patients with prior malignancy is challenging because therapeutic immunosuppression required for controlling IBD activity may increase the risk of cancer recurrence. Key Messages: Contrary to the observations in the post-transplant population, retrospective observational studies of IBD patients with prior malignancy have not demonstrated that immunosuppressive drugs increased significantly the risk of new or recurrent cancer. However, these studies are highly biased and do not permit the use of these drugs. Factors like the time since treatment completion, severity, and subtype of prior cancer should be weighed along with the current IBD activity before choosing the best therapeutic strategy. In practice, most cases of prior cancer require a delay of at least 2 years before starting or resuming immunosuppressants, including anti-TNF agents. This delay should be extended to 5 years in cancer with a high risk of recurrence including cancer of the urinary tract, gastrointestinal cancer, leukemias, and multiple myeloma. A special attention should be paid to cancers with a high risk of late metastasis (breast, melanoma, renal cell carcinoma). Enteral nutrition, Budesonide, mesalamine, and limited intestinal resection should be considered following the completion of cancer treatment and prior to the safe initiation of immunosuppressive treatment for IBD. Thiopurines should be avoided in case of prior Epstein-Barr virus-related lymphoma, HPV-related carcinomas, and cancer of the urinary tract. Methotrexate and anti-TNF agents seem to be safe except for the risk of recurrent melanoma for the latter. Conclusion: IBD patients with prior malignancy should benefit from individual decisions made on a case-by-case basis.

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Section: Anti-tnf Agentsmentioning

confidence: 92%

Section: Immunomodulatorsmentioning

confidence: 99%

What Should Be Done in Inflammatory Bowel Disease Patients with Prior Malignancy?

Cosnes

2017

Dig Dis

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“…195 196 In addition, a history of cancer does not seem to be a contraindication to the use of anti-TNFs. 197 However, annual skin examination is recommended for patients exposed to thiopurines or anti-TNF agents. 18 Similarly, an increased risk of infection is a potential concern with anti-TNF therapy.…”

Section: Malignancy and Infectionmentioning

confidence: 99%

Update on anti-tumor necrosis factor agents and other new drugs for inflammatory bowel disease

Cohen

Sachar

2017

BMJ

115

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The treatment of inflammatory bowel disease (IBD)-ulcerative colitis (UC) and Crohn's disease (CD)-has evolved beyond surgery with the introduction of biologic agents, primarily antibodies against mediators of inflammation and cell attraction. Anti-tumor necrosis factor (TNF) agents have been the first line treatment for moderate to severe ulcerative colitis and Crohn's disease for more than 15 years. During that time much has been learnt about how best to use these agents. This review will assess the evidence on how to optimize the use of anti-TNF agents; when and how to start treatment; how to monitor treatment and when to de-escalate it; and the potential adverse effects of these drugs. New and emerging treatments such as anti-attractants, anti-interleukins, and Janus kinase (JAK) inhibitors will also be discussed.

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“…79 Lastly, a retrospective study comprising of 333 IBD patients with a history of cancer across eight academic medical centers conducted by Axelrad et al found that those who were subsequently exposed to thiopurines, methotrexate or anti-TNF-α medications were at no increased risk of incident cancer than those IBD patients who received no such treatment. 83 …”

Section: Immunomodulatorsmentioning

confidence: 99%

Understanding the Cautions and Contraindications of Immunomodulator and Biologic Therapies for Use in Inflammatory Bowel Disease

Cohn

Dave

Loftus

2017

Inflammatory Bowel Diseases

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Ulcerative colitis and Crohn’s disease are chronic inflammatory bowel diseases for which there are no cures. These diseases are immunopathogenic, and medical treatment is centered on the temperance of a dysregulated immune response to allow mucosal healing and prevent the sequelae of fistulation and stenosis. Accordingly, the armamentarium of medications, which has expanded immensely in recent history, is not without significant infectious and neoplastic risks. Many of these untoward effects can be mitigated by screening and avoidance of contraindicated medications. This review seeks to highlight the cautions for use of immunomodulators, anticytokine and α4-integrin antagonists. The potential adverse events are further complicated by substantial heterogeneity in disease phenotype in the IBD population. Large patient registries and databases provide considerable experience and knowledge to calculate the incidence of safety outcomes. To identify rarer outcomes after prolonged therapy, more prospective studies and continued adverse event reporting will aid safe application and minimize potential harms.

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Risk of New or Recurrent Cancer in Patients With Inflammatory Bowel Disease and Previous Cancer Exposed to Immunosuppressive and Anti-Tumor Necrosis Factor Agents

Cited by 100 publications

References 29 publications

What Should Be Done in Inflammatory Bowel Disease Patients with Prior Malignancy?

What Should Be Done in Inflammatory Bowel Disease Patients with Prior Malignancy?

Update on anti-tumor necrosis factor agents and other new drugs for inflammatory bowel disease

Understanding the Cautions and Contraindications of Immunomodulator and Biologic Therapies for Use in Inflammatory Bowel Disease

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