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P109. Thiopurines and anti-TNFs after a diagnosis of cancer in patients with inflammatory bowel disease

S. Onali, C. Petruzziello, G. Condino, M. Ascolani, E. Calabrese, E. Lolli, A. Ruffa, F. Pallone, L. Biancone, Università di Roma Tor Vergata, Medicina dei sistemi, cattedra di Gastroenterologia, Roma, Italy

Background

The possible role of immunomodulators (IMM) in the development or outcome of cancer in patients with Inflammatory Bowel Disease IBD) is still debated. Whether IBD patients with a previous diagnosis of cancer may be treated with IMM, including anti-TNFs is undefined. In order to address this issue, the outcome of all patients with IBD under regular follow up treated with IMM and/or anti-TNFs after a diagnosis of cancer was evaluated.

Methods

In a retrospective cohort study, clinical characteristics of all IBD pts under regular follow up at our tertiary IBD center from 2000 to 2013, with a certain diagnosis of cancer were reviewed. Among these subgroup of pts with both IBD and cancer, only pts treated with IMM and/or anti-TNFs after the diagnosis of cancer were considered. Parameters considered:

  1. Type of IBD (Crohn's Disease, CD vs Ulcerative Colitis, UC);
  2. Gender;
  3. Age at diagnosis of IBD;
  4. Age at diagnosis of cancer (yr);
  5. Type of IMM (Azathioprine, AZA, 6-mercapopurine, 6MP, others) or anti-TNF (Infliximab, IFX, Adalimumab, AD, others);
  6. Duration of IBD at diagnosis of cancer;
  7. Time interval between diagnosis of cancer and IMM;
  8. Follow up duration after diagnosis of cancer;
  9. Type of cancer. Statistic. Data expressed as median (range).

Results

During 12 yrs period, a history of cancer was recorded in 82 IBD pts. Among these 82 IBD pts with cancer, 15 (18.2%) were treated with IMM for IBD after the diagnosis of cancer. IBD group included 12 CD and 3 UC, (8 M, 5 F), with a median age at diagnosis of cancer of 41 (range 21–69). The age at diagnosis of IBD was 27 (range 12–66), and the duration of IBD at time of diagnosis of cancer was 10 (range 1–38). IMM used after the diagnosis of cancer included thiopurines in 12 (AZA n = 8; 6MP n = 4), anti-TNFs in 3 (ADA n = 0.2; local IFX n = 1). Among the 15 IBD pts treated with IMM after the diagnosis of neoplasia, cancer involved: thyroid (n = 4), skin (n = 2; 1 basal cell carcinoma, 1 spinal cell carcinoma); breast (n = 2), colon (n = 2), prostatic cancer (n = 2) lymphoma (HL n = 1), seminoma (n = 1), carcinoid of the appendix (n = 1). The time interval between the diagnosis of cancer and IMM was 6 yrs (range 1–26). After a median follow up from the diagnosis of cancer of 10 yrs (range 3–30), none of the 15 IBD pts treated with IMM after the diagnosis of cancer showed recurrence of cancer, or had a cancer-related death. Death was observed in 1 CD pt, due to cirrhosis.

Conclusion

In a preliminary retrospective study, treating IBD pts with thiopurines or anti-TNFs after a diagnosis of cancer currently appeared not to determine a recurrence of the neoplastic disease. Larger prospective longitudinal studies are needed to further address this open issue in IBD.