OP020 Patients with Inflammatory Bowel Disease and a history of cancer: The risk of cancer following exposure to immunosuppression
J. Axelrad*1, O. Bernheim2, J.-F. Colombel2, S. Malerba3, A. Ananthakrishnan4, V. Yajnik4, G. Hoffman5, M. Agrawal6, D. Lukin7, A. Desai8, E. Mceachern9, B. Bosworth8, E. Scherl8, A. Reyes10, H. Zaidi11, P. Mudireddy12, D. DiCaprio13, K. Sultan11, B. Korelitz12, E. Wang14, R. Williams14, L. Chen15, S. Katz15, S. Itzkowitz2
1Icahn School of Medicine at Mount Sinai, Medicine, New York, United States, 2Icahn School of Medicine at Mount Sinai, Division of Gastroenterology, New York, New York, United States, 3Icahn School of Medicine at Mount Sinai, Department of Health Evidence and Policy, New York, United States, 4Massachusetts General Hospital, Division of Gastroenterology, Boston, United States, 5Albert Einstein College of Medicine, Medicine, New York, United States, 6Montefiore Medical Center, Medicine, New York, United States, 7Montefiore Medical Center, Division of Gastroenterology and Liver Diseases, New York, United States, 8New York Presbyterian Weill Cornell Medical Center, Division of Gastroenterology, New York, United States, 9Weill Cornell Medical College, Medicine, New York, United States, 10North Shore- Long Island Jewish University Hospital, Medicine, Manhasset, United States, 11North Shore- Long Island Jewish University Hospital, Division of Gastroenterology, Manhasset, United States, 12North Shore- Long Island Jewish Lenox Hill Hospital, Division of Gastroenterology, New York, United States, 13North Shore- Long Island Jewish Lenox Hill Hospital, Medicine, New York, United States, 14NYU Langone Medical Center, Medicine, New York, United States, 15NYU Langone Medical Center, Division of Gastroenterology, New York, United States
Most of our knowledge about the rates and types of malignancy associated with the use of antimetabolites and biologic agents in patients with inflammatory bowel disease (IBD) comes from studies of individuals who had no prior history of cancer. In patients with IBD and a history of cancer, little is known about their risk of new or recurrent cancer. The aim of this study was to investigate whether IBD patients with a history of cancer subsequently exposed to immunosuppression are at an increased risk of developing new or recurrent cancer.
Patients from 7 academic medical centers were identified based on a diagnosis of IBD and cancer with subsequent exposure to anti-TNF ("anti-TNF arm"), thiopurines or methotrexate ("antimetabolite arm"), or without subsequent immunosuppression exposure ("control arm"). Charts were reviewed for the primary outcome of incident cancer: new or recurrent. Baseline characteristics were compared with chi-square, anova, and t-test where appropriate. Time to incident cancer was compared between study arms using the log-rank test.
Of patients with IBD and a history of cancer, 255 met inclusion criteria. Prior cancers included 121 solid, 62 gastrointestinal, 55 dermatologic, and 17 hematologic malignancies. Patients in the control group were more likely to have later stage primary cancers compared to the other study arms (p = 0.0003). During the follow-up period, 75 (29.4%) patients developed subsequent cancer: 36 (14.1%) a new cancer, 33 (12.9%) a recurrent cancer, and 6 (2.4%) a new and recurrent cancer. Incident cancer rate per 100 person-years for patients exposed to anti-TNF was 2.6 with 795 person-years of follow up, 14.8 with 122 person-years of follow up for patients in the antimetabolite arm, and 8.52 with 422 person-years of follow up for controls. There was a significant difference in time to subsequent cancer between groups (Figure, Log-rank p = 0.0322), with patients exposed to anti-TNF being less likely to develop a new or recurrent cancer compared to controls (p= 0.0110). There were no significant differences in type of subsequent cancer between groups.
“Figure. Time to incident cancer, new or recurrent, between study groups.”
In this series of IBD patients with a history of cancer, exposure to either anti-TNF or an antimetabolite following a cancer diagnosis was not associated with an increased risk of an incident cancer compared to patients who did not receive these agents. Prospective data is needed to confirm these findings, but our study supports growing evidence for the safety of anti-TNF in IBD patients with a history of cancer.