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Review
. 2023 Mar 22;12(6):2432.
doi: 10.3390/jcm12062432.

The Optimal Management of Inflammatory Bowel Disease in Patients with Cancer

Panu Wetwittayakhlang  1   2 , Paraskevi Tselekouni  1 , Reem Al-Jabri  1 , Talat Bessissow  1 , Peter L Lakatos  1   3
Affiliations
Review

The Optimal Management of Inflammatory Bowel Disease in Patients with Cancer

Panu Wetwittayakhlang et al. J Clin Med. .

Abstract

Patients with inflammatory bowel disease (IBD) have an increased risk of cancer secondary to chronic inflammation and long-term use of immunosuppressive therapy. With the aging IBD population, the prevalence of cancer in IBD patients is increasing. As a result, there is increasing concern about the impact of IBD therapy on cancer risk and survival, as well as the effects of cancer therapies on the disease course of IBD. Managing IBD in patients with current or previous cancer is challenging since clinical guidelines are based mainly on expert consensus. Evidence is rare and mainly available from registries or observational studies. In contrast, excluding patients with previous/or active cancer from clinical trials and short-term follow-up can lead to an underestimation of the cancer or cancer recurrence risk of approved medications. The present narrative review aims to summarize the current evidence and provide practical guidance on the management of IBD patients with cancer.

Keywords: Crohn’s disease; anti-tumor necrosis factors; biologic; cancer; inflammatory bowel disease; risk; thiopurine; ulcerative colitis; ustekinumab; vedolizumab.

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Conflict of interest statement

P.W. has been a speaker and/or advisory board member for Takeda, Pfizer, Janssen, Ferring, A. Menerini, Sandoz, and MSD. T.B. has been a speaker or advisory board member for Takeda, Janssen, Abbvie, Merck, Pfizer, Pendopharm, Ferring, Shire, Sandoz, B.M.S., Roche, Fresenius Kabi, and Viatris. P.L.L. has been a speaker and/or advisory board member for AbbVie, Arena, Falk Pharma GmbH, Ferring, Genetech, Janssen, Kyowa Hakko Kirin Pharma, Mitsubishi Tanabe Pharma Corporation, MSD, Pfizer, Roche, Shire, Takeda, and Tillots, and has received unrestricted research grants from AbbVie, MSD, and Pfizer. P.T. and R.A.J. declared no conflict of interest.

Figures

Figure 1
Figure 1
The risk of type-specific cancer associated with IBD therapies Note: a: 5-ASA has a protective effect for CRC; b: thiopurine has a protective effect for CRC and high-grade dysplasia; c: the increased risk was reported in meta-analyses and observational studies but not replicated in several studies, including RCTs, meta-analyses, and registry cohorts; d: the increased risk was reported in large population-based and case-control studies, but meta-analyses did not find an increased risk; e: insufficient data on the risk of lymphoma in IBD patients exposed to anti-TNF in combination with methotrexate. * Data on the risk of cancer in MTX alone were relatively limited, based on a small number of MTX-exposed patients and small numbers of cancer events. ** For vedolizumab, ustekinumab, and JAK inhibitors, long-term data are limited. No increased risk was reported with VDZ and UST exposures (excluding NMSC in UST). For JAK inhibitors, one safety RCT reported an increased risk of overall cancer, particularly lymphoma and lung cancer.
Figure 2
Figure 2
The risk of type-specific cancer associated with IBD therapies Management of IBD therapy in patients with a history of previous cancer (adapted from ECCO guideline 2015 [106]). Abbreviations: anti-TNF—anti-tumor necrosis factors; NMSC—non-melanoma skin cancer; JAK inhibitors—Janus kinase inhibitors.
Figure 3
Figure 3
The practical treatment algorithm for the management of IBD in patients with a previous history of cancer. Abbreviations: IBD—inflammatory bowel disease; anti-TNF—anti-tumor necrosis factors; MTX—methotrexate; VDZ—vedolizumab; UST—ustekinumab; 5-ASA—5-amino salicylic acid.
Figure 4
Figure 4
The practical treatment algorithm for the management of IBD in patients with active cancer. Abbreviations: IBD—inflammatory bowel disease; AZA—azathioprine; 6-MP—Mercaptopurine; CMT—chemotherapy; ICIs—immune checkpoint inhibitors; anti-TNF—anti-tumor necrosis factors; VDZ—vedolizumab.
Figure 5
Figure 5
Conceptual framework of decision-making for treatment of IBD in patients with cancer.
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