Inflammatory Bowel Disease Can be Managed With Anti-TNF Therapy in Cancer Survivors
Patients who have had cancer recently can still be treated with antibodies against tumor necrosis factor (anti-TNF) for inflammatory bowel disease (IBD), according to results of a study. Anti-TNF treatment can be used for patients with IBD that is not controlled with other treatments.1
"Anti-TNF could be used taking into account a mild risk of incident cancer," according to the report by David Laharie, PhD, of Centre Hospitalier Universitaire de Bordeaux, France, and colleagues.
A large IBD database from 20 centers was analyzed to identify patients treated with anti-TNF agents who had a history of cancer within the past 5 years. The researchers identified 79 cases of patients with IBD who had had a malignancy diagnosed a median of 17 months previously (range, 1 to 65 months). The most common types of cancer were breast (n=17) and skin (n=15).
The patients had all had extensive prior treatment for their IBD, including one-half of patients receiving anti-TNF therapy and one-third undergoing major abdominal surgery.
During a median follow-up of 21 months (range, 1 to 119 months), incident cancer developed in 15 patients (19%). Of these incident cancers, 8 were recurrent and 7 were new cancers. These included 5 basal cell carcinomas. A total of 5 patients died; 4 deaths had resulted from recurrent disease.
Among patients who did not develop incident cancers, survival was 96% at 1 year, 86% at 2 years, and 66% at 5 years. The crude incidence rate of cancer was 84.5 per 1000 patient-years (95% CI, 83.1-85.8).
The researchers noted that their study included a highly selected group of patients. The patients all had uncontrolled IBD that prompted their physicians to prescribe anti-TNF therapy, despite a history of cancer. With advances in treatment over the past 2 decades, doctors are seeing more patients with IBD and previous or current cancer, with earlier and longer use of anti-TNF and other immunomodulatory treatments.
"Pending additional data," the researchers wrote, "it should be a case-by-case decision taken with the oncologist and the patient, taking into account natural history of cancer according to location, histological type, time since cancer diagnosis, and IBD prognosis."
1. Poullenot F, Seksik P, Beaugerie L, et al. Risk of incident cancer in inflammatory bowel disease patients starting anti-TNF therapy while having recent malignancy [published online ahead of print February 24, 2016]. Inflamm Bowel Dis. doi:10.1097/MIB.0000000000000741.