IBD Patients with Prior Cancer May Run ‘Mild Risk’ of Recurrence with Use of Anti-TNF Therapy

IBD Patients with Prior Cancer May Run ‘Mild Risk’ of Recurrence with Use of Anti-TNF Therapy

Research into the risk of new cancers in inflammatory bowel disease (IBD) patients treated for a prior malignancy and undergoing anti-tumor necrosis factor (anti-TNF) therapy supported the treatment’s use, but found a slight risk of incident cancer existed and needed to be taken into account.

The study, titled “Risk of Incident Cancer in Inflammatory Bowel Disease Patients Starting Anti-TNF Therapy While Having Recent Malignancy” and published in the journal Inflammatory Bowel Diseases, recommended oncologists decide on anti-TNF use on a case-by-case basis, and considering factors such as cancer type and location.

Anti-TNF agents, which combat and reduce excessive inflammation, are usually contraindicated for IBD patients who have a history of cancer within the last five years, out of concern that this therapy could increase the risk of cancer recurrence and the development of new cancers. However, there is no direct evidence that such fears are legitimate.

Scientists aimed to assess survival rates without the development of new cancers in a group of IBD patients under anti-TNF therapy within five years of a cancer diagnosis. The study included clinical data from 79 IBD patients with a previous history of malignancy, who met the study’s criteria. The most frequent cancer locations were on the breast and the skin.

The team found that after a median follow-up of 21 months, 15 (19 percent) of the patients developed incident cancer, of which eight were recurrent cancers and seven were new cancers. Survival without incident cancer was 96 percent, 86 percent, and 66 percent at years one, two and five, respectively. Moreover, the overall incidence rate of cancer was 84.5 per 1,000 patient-years, meaning that if 1,000 patients were followed up for one year, 85 would develop cancer.

Researchers highlighted that this study included a “highly selected” group of patients whose IBD was uncontrollable, prompting their physicians to prescribe anti-TNF agents despite a malignancy diagnosed within 5 years. Their study concluded with the recommendation, “In a population of refractory IBD patients with recent malignancy, anti-TNF could be used taking into account a mild risk of incident cancer. Pending prospective and larger studies, a case-by-case joint decision taken with the oncologist is recommended for managing these patients in daily practice.”