Immunsuppressive therapy in IBD patients with prior malignacy
Description:
In late April 2016 an international symposium was organized by the Falk Foundation in Prague entitled "Evolving Therapies in Clinical Practice in IBD". The goal was to discuss current developments in this field and thus further enhance the medical treatment of patients with inflammatory bowel disease or abbreviated, IBD. Professor Jacques Cosnes, from Paris, spoke about the difficulties of immunosuppression treatment of IBD patients with a case history of malignant tumors. Immunosuppressive medication increases the risk of certain cancers. Treatment with thiopurines in particular increases the likelihood of EBV-associated lymphoma and non-melanoma skin cancers, while treatment with TNF-alpha inhibitors increases the danger of a malignant melanoma. However, the risk of a colorectal carcinoma falls. But what impact does that have on treating patients with a case history of malignant tumors? A recent study based on follow-up data from more than 30,000 patient-years showed no increased risk of new or relapsing carcinoma for patients with prior malignancy receiving monotherapy with immunosuppressants (1). Without immunosuppressive therapy the rate stood at 37.5 cases per 1000 patient-years while with an immunomodulator it was 36.2 and with TNF-alpha blockers it was 33.8 cases. An increase to 54.5 cases was observed under combination therapy. Patients with a history of carcinoma can be treated with immunosuppressants under the following conditions: before beginning treatment, a residual or latent carcinoma should be ruled out. At least 2 to 5 years should elapse between developing cancer and beginning treatment. The choice of immunosuppressant should take account of the sort of tumor the patient had. More specifically that means: No azathioprine or 6-MP for patients who had EBV- or HPV-associated tumors or a carcinoma in the urogenital tract. No TNF-alpha inhibitors for patients who had a malignant melanoma and no vedolizumab for those who had a gastrointestinal carcinoma.
(1) Shelton E et al. Gastroenterology. 2016;151(1):97–109.e4.
