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Anti-TNF linked to mild incident cancer risk in IBD, recent malignancy
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The results from a recent study showed that the risk for incident cancer associated with anti-tumor necrosis factor therapies among patients with inflammatory bowel disease and a recent malignancy is mild, leading researchers to recommend a case-by-case decision on treatment with these agents until additional data becomes available.
“Concerning conventional immunosuppressant use for treating IBD in case of previous malignancy, data from several case-control studies that included highly selected patients are suggesting that they have no major impact on the risk of new cancer or cancer recurrence,” David Laharie, PhD, from the Centre Hospitalier Universitaire de Bordeaux, France, and colleagues wrote. “Thus, this study aimed to assess the risk for incident cancer in a cohort of IBD patients exposed to anti-TNF therapy while having a history of malignancy within the past 5 years.”
David Laharie
Researchers from France and Belgium performed a retrospective and prospective survey from September 2011 to May 2013 involving 79 patients with refractory IBD from 20 centers. All patients were treated with at least one anti-TNF agent and had a histologically confirmed malignancy within 5 years before starting anti-TNF therapy (median diagnosis, 17 months before inclusion; range, 1-65 months).
Overall, 62% of patients were women, 77% had Crohn’s disease, 23% had ulcerative colitis, median age at inclusion was 47 years (range, 18-84 years), median IBD duration was 12 years (range, 1-40 years), and the most common cancer locations were breast and skin.
Survival without incident cancer during follow-up from inclusion until July 2013 served as the primary endpoint (median follow-up, 21 months; range, 1-119 months). During follow-up, 19% of patients developed an incident cancer, eight of which were recurrent, seven of which were new, and five of which were basal-cell carcinomas. Survival without incident cancer was 96% at 1 year, 86% at 2 years and 66% at 5 years. The crude incidence rate of cancer was 84.5 (95% CI, 83.1-85.8) per 1,000 patient-years.
“Making the decision to use anti-TNF in this specific population requires balancing the risks between reactivating dormant metastases and an uncontrolled IBD course,” the researchers concluded. “With pending additional data, a case-by-case decision should be taken with the oncologist and the patient, taking into account natural history of cancer according to location, histological type, and time since cancer diagnosis and IBD prognosis.” – by Adam Leitenberger
Disclosure: Laharie reports consulting and lecture fees from AbbVie and Merck. Please see the study for a full list of all other researchers’ relevant financial disclosures.
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