Risk of New or Recurrent Cancer in Patients With Inflammatory Bowel Disease and Previous Cancer Exposed to Immunosuppressive and Anti-Tumor Necrosis Factor Agents

Jordan Axelrad¹, Oren Bernheim², Jean-Frederic Colombel², Stefano Malerba³, Ashwin Ananthakrishnan⁴, Vijay Yajnik⁴, Gila Hoffman⁵, Manasi Agrawal⁶, Dana Lukin⁷, Amit Desai⁸, Elisa McEachern⁹, Brian Bosworth⁸, Ellen Scherl⁸, Andre Reyes¹⁰, Hina Zaidi¹¹, Prashant Mudireddy¹², David DiCaprio¹³, Keith Sultan¹¹, Burton Korelitz¹², Erwin Wang¹⁴, Renee Williams¹⁵, LeaAnn Chen¹⁵, Seymour Katz¹⁵, Steven Itzkowitz¹⁶; New York Crohn's and Colitis Organization

Affiliations

¹ Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Digestive and Liver Diseases, Department of Medicine, New York Presbyterian/Columbia University Medical Center, New York, New York.
² Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
³ Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
⁴ Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts and Harvard Medical School, Boston, Massachusetts.
⁵ Albert Einstein College of Medicine, New York, New York.
⁶ Department of Medicine, Montefiore Medical Center, New York, New York.
⁷ Division of Gastroenterology and Liver Diseases, Department of Medicine, Montefiore Medical Center, New York, New York.
⁸ Division of Gastroenterology and Hepatology, Department of Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, New York.
⁹ Weill Cornell Medical College, New York, New York.
¹⁰ Department of Medicine, North Shore-Long Island Jewish University Hospital, Manhasset, New York.
¹¹ Division of Gastroenterology, Department of Medicine, North Shore-Long Island Jewish North Shore University Hospital, Manhasset, New York.
¹² Division of Gastroenterology, Department of Medicine, North Shore-Long Island Jewish Lenox Hill Hospital, New York, New York.
¹³ Department of Medicine, North Shore- Long Island Jewish Lenox Hill Hospital, New York, New York.
¹⁴ Department of Medicine, NYU Langone Medical Center, New York, New York.
¹⁵ Division of Gastroenterology, Department of Medicine, NYU Langone Medical Center, New York, New York.
¹⁶ Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: steven.itzkowitz@mountsinai.org.

PMID: 26247164
DOI: 10.1016/j.cgh.2015.07.037

Risk of New or Recurrent Cancer in Patients With Inflammatory Bowel Disease and Previous Cancer Exposed to Immunosuppressive and Anti-Tumor Necrosis Factor Agents

Jordan Axelrad et al. Clin Gastroenterol Hepatol. 2016 Jan.

. 2016 Jan;14(1):58-64.

doi: 10.1016/j.cgh.2015.07.037. Epub 2015 Aug 3.

Authors

Affiliations

¹ Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Digestive and Liver Diseases, Department of Medicine, New York Presbyterian/Columbia University Medical Center, New York, New York.
² Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
³ Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
⁴ Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts and Harvard Medical School, Boston, Massachusetts.
⁵ Albert Einstein College of Medicine, New York, New York.
⁶ Department of Medicine, Montefiore Medical Center, New York, New York.
⁷ Division of Gastroenterology and Liver Diseases, Department of Medicine, Montefiore Medical Center, New York, New York.
⁸ Division of Gastroenterology and Hepatology, Department of Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, New York.
⁹ Weill Cornell Medical College, New York, New York.
¹⁰ Department of Medicine, North Shore-Long Island Jewish University Hospital, Manhasset, New York.
¹¹ Division of Gastroenterology, Department of Medicine, North Shore-Long Island Jewish North Shore University Hospital, Manhasset, New York.
¹² Division of Gastroenterology, Department of Medicine, North Shore-Long Island Jewish Lenox Hill Hospital, New York, New York.
¹³ Department of Medicine, North Shore- Long Island Jewish Lenox Hill Hospital, New York, New York.
¹⁴ Department of Medicine, NYU Langone Medical Center, New York, New York.
¹⁵ Division of Gastroenterology, Department of Medicine, NYU Langone Medical Center, New York, New York.
¹⁶ Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: steven.itzkowitz@mountsinai.org.

PMID: 26247164
DOI: 10.1016/j.cgh.2015.07.037

Abstract

Background & aims: Our understanding of malignancy associated with immunosuppression in patients with inflammatory bowel disease (IBD) comes from studies of individuals with no history of cancer. We investigated whether patients with IBD and a history of cancer who were subsequently immunosuppressed have an increased risk of developing incident cancer.

Methods: We performed a retrospective analysis of data from 333 patients with IBD treated at 8 academic medical centers who developed cancer and subsequently received treatment with anti-tumor necrosis factor (TNF), anti-TNF with an antimetabolite (thiopurines, methotrexate), antimetabolites, or no subsequent exposure to immunosuppressive agents (controls). We collected data on their primary outcomes of incident cancers (new or recurrent). Hazard ratios (HRs) were calculated by using Cox proportional hazards and Kaplan-Meier survival curves; study groups were compared by using the log-rank test.

Results: During the follow-up period, 90 patients (27%) developed an incident cancer. Patient characteristics between groups differed, but matching was not possible because of the relatively small sample sizes. There was no difference in time to incident cancer (P = .14) or type of incident cancer (P = .61) among the 4 groups. After adjusting for recurrence risk for type of prior cancer, there was no difference in risk of incident cancer (HR for anti-TNF, 0.32; 95% confidence interval [CI], 0.09-1.09; HR for anti-TNF with an antimetabolite, 0.64; 95% CI, 0.26-1.59; HR for an antimetabolite, 1.08; 95% CI, 0.54-2.15) or time to subsequent cancer between study arms (P = .22).

Conclusion: On the basis of a retrospective study, in patients with IBD and a history of cancer, exposure to an anti-TNF agent or an antimetabolite after cancer was not associated with an increased risk of incident cancer, compared with patients who did not receive immunosuppression. Larger, matched, prospective studies are needed to confirm these findings.

Keywords: Crohn’s Disease; Drug; Tumor; Ulcerative Colitis.

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Risk of New or Recurrent Cancer in Patients With Inflammatory Bowel Disease and Previous Cancer Exposed to Immunosuppressive and Anti-Tumor Necrosis Factor Agents

Affiliations

Risk of New or Recurrent Cancer in Patients With Inflammatory Bowel Disease and Previous Cancer Exposed to Immunosuppressive and Anti-Tumor Necrosis Factor Agents

Authors

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Abstract

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