Should Patients with Refractory IBD and Prior Cancer Receive Anti-TNF Therapy?
In patients with refractory inflammatory bowel disease (IDB) with recent cancer, anti-tumor necrosis factor (anti-TNF) treatment could be used taking into account a mild risk of incident cancer. The findings come from a new study by researchers in France, published in the journal Inflammatory Bowel Diseases.
Anti-TNF therapy is typically contraindicated in patients with IBD and a history of malignancy within the last 5 years. This study was the first to assess cancer risk associated with anti-TNF therapy in IBD patients with prior cancer.
The authors identified 79 patients with prior cancers who received anti-TNF therapy through a nationwide survey on IBD therapies. In total 19% (15 individuals) of these patients were identified as developing cancer during a median follow-up time of 21 months; 8 of the these cancers were recurring and 7 were new.
Survival without incident cancer was 96%, 86%, and 66% at 1, 2, and 5 years, respectively. Total incidence of recurrent or new cancers was roughly 85 per 1000 patient-years. When less-serious skin cancers were excluded from the statistics, the incidence rate of crude cancer dropped to 67 per 1,000 patient-years.
The authors conclude "pending prospective and larger studies, a case-by-case joint decision taken with the oncologist is recommended for managing these patients in daily practice."
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