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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

Background

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.

Methods

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.

Results

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.

Conclusion

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.