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P106 Screening for melanoma and non melanoma skin cancer in IBD patients before and after thiopurines and anti-TNFs: A single-center prospective cohort study

E. Lolli*1, R. Saraceno2, E. Calabrese1, M. Ascolani1, C. Petruzziello1, P. Scarozza1, A. Ruffa1, S. Onali1, S. Chimenti2, F. Pallone1, L. Biancone1

1Università di Roma Tor Vergata, Medicina dei sistemi, cattedra di Gastroenterologia, Roma, Italy, 2Università degli Studi di Roma "Tor Vergata", Medicina dei Sistemi, Rome, Italy

Background

An increased frequency of skin cancers has been reported in Inflammatory Bowel Disease (IBD). An increased risk of Non Melanoma Skin Cancer (NMSC) and melanoma has recently been associated with thiopurines (IS) and anti-TNFs use, respectively. In a prospective study, we aimed to assess the frequency of NMSC and melanoma in a cohort of IBD patients (pts.) screened for skin cancer before and 1 year after IS o anti-TNFs treatments.

Methods

From January 2012 to November 2014, IBD pts. with indication for IS or anti-TNFs were screened by a dedicated dermatologist. Assessments were performed by the same IBD-dedicated team. Dermatological assessment focused in detecting NMSC and melanoma was performed before (T0), at 6 (T6) and 12 mos (T12) after IS. Data were expressed as median (range).

Results

Dermatological screening was performed in 110 IBD pts. (55 M,age 44 [21-71]; IBD duration 8.5 yrs, [1-48]). IBD pts. included 29 UC (16 M, age 46 [24-71]; duration 8 [2-48] yrs; proctits 5,left-sided 4,extensive 19, IPAA 1), 81 CD (39M,age 44 [21-67] yrs;duration 9[1-31] yrs; CD colitis 6,ileo-colitis 17,ileitis 58). Combo therapy (1 azathioprine, AZA+Infliximab, IFX;3 AZA+adalimumab,ADA) was given after T0 in 4 (4%) pts. Monotherapy included AZA in 35 (32%) IBD (13 UC,22 CD), 6-MP in 4 (4%) IBD (1 UC,3 CD), anti-TNFs in 67 (61%) IBD (14 UC,53 CD): IFX (n=37;34%)(12 UC,25 CD), ADA (n=30; 27%) pts. (2 UC,28 CD). Before IS or anti-TNFs, NMSC occurred in 2 (2%) pts, melanoma in no pts. (0%). At T0, all pts. received local photolyase to prevent skin cancer. At T6, 44 pts (40%) already completed the screening: 15 (14%) discontinued therapies due to: intolerance 8 (AZA 6,IFX 1), pregnancy (1), IFX; infections 3 (1 IFX, 2 ADA), relapse 3 (1 IFX,1AZA,1 ADA), 3 (3%), lost at follow up, death 2 (2%)(cirrhosis,sepsis), low compliance 38 (34%), 7 (6%) pts. are in follow up. At T12, 85 (77%) pts. are in follow up. Screening was completed in 31/85 (36%) pts.: 4 (5%) discontinued AZA (n=1), ADA (n=2) or IFX (n=1) for intolerance, no compliance 37 (43%), 17 (20%) pts. are in follow up. At T24, 82/110 (74%) pts. are in follow up. Screening was already performed in 21/82 (26%) pts: 2/82 (2.4%) pts. discontinued IFX (n=1; pregnancy) or ADA (n=1; relapse), 21 low compliance (26%), 40 pts. (48%) are in follow up. No cases of NMSC or melanoma occurred at 6,12 or 24 mos.

Conclusion

In a cohort of IBD pts. from a Mediterranean area, dermatologic screening before immunomodulators showed a low frequency of NMSC and no melanoma. Screening and photoprotection are however indicated during immunomodulatory treatments in IBD pts., at higher risk of skin cancer.