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DOP072. Management and course of inflammatory bowel disease patients with associated cancer

I. Guerra1, A. Algaba1, E. Quintanilla2, J.L. Pérez-Calle3, M.C. García-Sánchez4, C. Taxonera5, G.J. Gómez6, M. Chaparro7, B. Botella8, R. Pajares9, M.D. Martín-Arranz10, Á. Castaño11, M. Arias2, A. López-Sanromán4, F. Bermejo1, 1Hospital Universitario de Fuenlabrada, Gastroenterology, Madrid, Spain, 2Hospital Universitario Severo Ochoa, Gastroenterology, Madrid, Spain, 3Hospital Universitario Fundación Alcorcón, Gastroenterology, Madrid, Spain, 4Hospital Universitario Ramón y Cajal, Gastroenterology, Madrid, Spain, 5Hospital Clinico San Carlos, Gastroenterology, Madrid, Spain, 6Hospital Doce de Octubre, Gastroenterology Unit, Madrid, Spain, 7Hospital Universitario La Princesa, Gastroenterology, Madrid, Spain, 8Hospital Universitario Infanta Cristina, Gastroenterology, Madrid, Spain, 9Hospital Universitario Infanta Sofía, Gastroenteology, Madrid, Spain, 10Hospital Universitario La Paz, Gastroenterology, Madrid, Spain, 11Hospital Universitario de Fuenlabrada, Pathology, Madrid, Spain

Background

Our aims were: (1) To describe the clinical management of patients with inflammatory bowel disease (IBD) and cancer (2) To determine how the therapies prescribed for treatment of IBD can affect to the risk of developing different cancers and (3) To study the evolution and treatment of cancer in these patients.

Methods

Retrospective, multicenter, observational, 5-year follow-up study (2007–2011) in IBD patients diagnosed with cancer. IBD treatment at the time of cancer diagnosis and therapeutic strategies for the management of patients after tumour diagnosis were collected. A possible association between IBD therapy and malignancy risk, and the treatment and evolution of cancer were also reviewed.

Results

96 IBD patients (47 Crohn's disease, 47 ulcerative colitis, 2 unclassified colitis) and 107 tumours were studied. Mean age was 58±14 years, 57% males, 38% smokers, 25% with family history of cancer. Seventeen tumours (15.9%) were diagnosed in patients receiving treatment with thiopurines, 3 in patients on methotrexate (2.8%), 2 during anti-TNF-α therapy (1.9%), and 11 were identified in patients on combined therapy with an immunosuppressive (9 thiopurines and 2 methotrexate) and an anti-TNF-α drug (10.3%). The median duration of treatment was: 72 months for thiopurines (IQR 6–102) and 6 months for adalimumab or infliximab (IQR 2–13). After the diagnosis of cancer, IBD treatment was maintained in 8 (47.1%) patients on thiopurines and in 1 (11.1%) patient with combined therapy. In the remaining patients on immunosuppressive and/or anti-TNF-α drug (n = 24), the treatment was withdrawn, and in 5 (20.8%) of these cases the therapy was reintroduced later in agreement with the Oncology team. We could not find an association between thiopurines/anti-TNF-α drugs and malignancy risk. Regarding the evolution of cancer, 55 tumours (51.4%) were managed only with oncological surgery, 9 (8.4%) with chemotherapy, 2 (1.9%) with radiotherapy and 33 tumours (30.8%) with combined therapy. Of these therapies, 82.5% were curative and 17.5% were palliative intent treatments. Patients were followed-up for a median of 39 months (IQR 24–57) from tumour diagnosis. During this period, 15 patients died (15.6%) due to cancer (mean age= 66±13 years), 4 (4.2%) had tumour recurrence and 77 (80.2%) patients remained in remission.

Conclusion

1.) Thiopurine treatment is maintained in approximately half of IBD patients after a cancer diagnosis. In contrast, anti-TNF-α drugs are withdrawn in most cases. 2.) An association between these drugs and a higher cancer risk was not found in our series; these findings support the subsequent reintroduction of these therapies in selected patients, always in agreement with the oncologist's recommendations.