TNF inhibitors do not significantly impact survival in lung, prostate colorectal cancer
Key takeaways:
- TNF inhibitors within 3 years of diagnosis had no statistically significant negative link with colorectal, lung or prostate cancer survival.
- Glucocorticoid use lowered survival across all three.
TNF inhibitor use demonstrates no negative impact on survival among patients recently diagnosed with colorectal, lung or prostate cancer, according to data published in The Lancet Rheumatology.
“There have been concerns about using TNF inhibitors in patients with rheumatoid arthritis and recently diagnosed cancer because the immunosuppressant properties of these agents could conceivably impair tumor immunity and lead to cancer progression or recurrence,” Maria E. Suarez-Almazor, MD, PhD, of the University of Texas MD Anderson Cancer Center, told Healio. “Most of the studies have been performed in cancer survivors who have been free of malignancy for many years, but little was known about the safety of TNF inhibitors in patients with early cancer.”
She added that her previous research had found no safety risks from TNF inhibitors in women with early breast cancer. To investigate the issue in other common malignancies, Suarez-Almazor and colleagues analyzed a dataset linking two population-based sources: Medicare claims and drug prescriptions, plus the Surveillance, Epidemiology and End Results database, which features tumor registry information on 48% of the U.S. population.
The study included 1,981 patients with RA split into three different groups — those with early-stage colorectal cancer (n = 514), lung cancer (n = 864) and prostate cancer (n = 603), all diagnosed from January 2008 through December 2019. Eligible participants were aged at least 66 years, so that they would have at least 1 year of Medicare data.
The study compared overall deaths, and deaths due to cancer, among patients using TNF inhibitors vs. those on conventional synthetic disease-modifying anti-rheumatic drugs. The researchers additionally conducted landmark analyses at years 1, 2 and 3 using propensity-score-adjusted Cox proportional hazards models.
According to the researchers, there were no statistically significant negative impacts from TNF inhibitors on overall, or cancer-specific, survival at years 1, 2 or 3.
For year 1, patients using TNF inhibitors demonstrated overall survival hazard ratios of 0.72 (95% CI, 0.43-1.21; P = .022) for colorectal cancer, 0.7 (95% CI, 0.49-1; P = .05) for lung cancer and 0.8 (95% CI, 0.44-1.44; P = .45) for prostate cancer vs. patients using conventional synthetic DMARDs.
Across all three cancers, both overall and cancer-specific survival were lower among those who used glucocorticoids in the first year after diagnosis.
“Glucocorticoids are broadly immunosuppressant and could conceivably impair antitumor immune responses, resulting in accelerated cancer progression or recurrence,” Suarez-Almazor and colleagues wrote. “In patients with rheumatoid arthritis, glucocorticoid therapy is associated with higher mortality.”
The lack of a significant negative impact on cancer outcomes from TNF inhibitors is “consistent with previous smaller studies,” they added, granting that there could still be some “potential effect of unknown confounders.”
Suarez-Almazor told Healio additional studies are needed for other types of cancer, such as melanoma where “immunity plays an important role in controlling cancer growth.”
“Many of these tumors are treated with cancer immunotherapy to enhance anti-tumor responses,” she said in an interview. “We still don’t know if TNF inhibitors may interfere with the efficacy of these agents, as the available data has been somewhat contradictory.”
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