P358. Risk of incident cancer in patients with inflammatory bowel disease starting anti-TNF therapy while having prior malignancy within past 5 years (GETAID survey)
F. Poullenot1, P. Seksik2, L. Beaugerie2, A. Amiot3, M. Nachury4, V. Abitbol5, C. Stefanescu6, C. Reenaers7, M. Fumery8, A.-L. Pelletier9, S. Nancey10, L. Peyrin-Biroulet11, A. Bourreille12, X. Hebuterne13, H. Brixi14, G. Savoye15, N. Lourenco16, R. Altwegg17, G. Bommelaer18, C. Cazelles-Boudier19, A. Racine20, D. Laharie1, 1CHU de Bordeaux, Gastroenterologie, Pessac, France, 2Hopital Saint-Antoine - APHP, Gastroenterologie, Paris, France, 3Hôspital Henri-Mondor, Gastroenterologie, Creteil, France, 4CHU de Lille, Gastroenterologie, Lille, France, 5Hopital Cochin - APHP, Gastroenterologie, Paris, France, 6Hopital Beaujon - APHP, Gastroenterologie, Clichy, France, 7CHU de Liege, Gastroenterologie, Liege, Belgium, 8CHU de Amiens, Gastroenterologie, Amiens, France, 9Hopital Bichat - APHP, Gastroenterologie, Paris, France, 10Hopital Lyon Sud - APHL, Gastroenterologie, Pierre-Benite, France, 11CHU de Nancy, Gastroenterologie, Vandoeuvre-les-Nancy, France, 12CHU de Nantes, Gastroenterologie, Nantes, France, 13CHU de Nice, Gastroenterologie, Nice, France, 14CHU de Reims, Gastroenterologie, Reims, France, 15CHU de Rouen, Gastroenterologie, Rouen, France, 16Hopital Saint-Louis - APHP, Gastroenterologie, Paris, France, 17CHU de Montpellier, Gastroenterologie, Montpellier, France, 18CHU de Clermont-Ferrand, Gastroenterologie, Clermont-Ferrand, France, 19CH de Bayonne, Gastroenterologie, Bayonne, France, 20Hôpital du Kremlin-Bicetre - APHP, Gastroenterologie, Kremlin-Bicetre, France
Management of inflammatory bowel disease (IBD) patients with past or current malignancies is a challenge in clinical practice. Having prior malignancy within the last 5 years is considered as a contra-indication for anti-TNF while there is no scientific evidence to support this recommendation in IBD.
Aim: To assess survival without incident cancer in a cohort of patients with IBD exposed to anti-TNF therapy while having prior malignancy within past 5 years.
From September 2011 to May 2013, the GETAID conducted an ambispective survey collecting all IBD patients with malignancy diagnosed within the last 5 years before starting an anti-TNF agent. Date of study inclusion corresponded to the first anti-TNF administration after cancer diagnosis. The primary objective was to evaluate the cumulative incidence of incident (new or recurrent) cancer.
Twenty GETAID centres identified 79 cases of IBD patients (49W; median age: 47 [range: 18–84] years; 61 with Crohn's disease) with prior malignancy diagnosed 17 [1–65] months before inclusion. The most frequent cancer locations were breast (n = 17), skin (n = 15), urinary tract (n = 12) and those that can be attributed to chronic inflammation (n = 8 - including 3 small bowel and 2 colorectal adenocarcinomas). After a median follow up of 21 [1–119] months, 15 (19%) patients developed an incident cancer: 8 recurrent cancers and 7 new cancers, including 5 basal cell carcinomas. Survival without incident cancer was 96%, 86% and 72% at 1, 2 and 5 years, respectively. Two cases of unexpected recurrence were judged to be possibly related to anti-TNF administration: one case of metastatic rectal adenocarcinoma occurring 10 years after initial diagnosis and one case of early cerebral metastatic after lung surgery for T1N0M0 carcinoma.
In a cohort of 79 IBD patients exposed to an anti-TNF agent within 5 years following cancer diagnosis, survival without incident cancer was 96% and 72% at 1 and 5 years, respectively. Of these 15 incident cancers, 5 were new basal cell carcinomas. Pending large prospective studies, a case by case joint decision taken with the oncologist is recommended.