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P638 Biologic therapy is safe and effective in inflammatory bowel disease (IBD) patients with previous cancer. Experience of a single tertiary IBD center

I. Bar-Yishay*, Y. Ron, E. Santo, I. Dotan

Tel Aviv Sourasky medical Center, Sackler School of Medicine, Tel Aviv University, Department of Gastroenterology and Liver Diseases, Tel-Aviv, Israel

Background

Immunomodulator and biologic therapy is a mainstay of treatment in IBD. However, these effective therapies confer an increased risk for malignancies, specifically lymphomas and non-melanoma skin cancer. Data concerning the safety of immunomodulation in IBD patients with previous cancer are vague. We aimed to evaluate the short and long term consequences of treating IBD patients with previous cancer with biologic therapies.

Methods

Case records from a single tertiary referral IBD Center were retrospectively reviewed. Records of patients with a new diagnosis of cancer which were treated with biologic therapies after cancer diagnosis within the study period were included. Outcome measures were survival, cancer recurrence, new cancer appearance and IBD activity at end of follow up using physician global assessment.

Results

In the period between November 2008- November 2014 eleven IBD patients (Male= 6 [54%], Crohn's disease= 7, ulcerative colitis=4) with a previous cancer were treated with biologic or immunomodulator and biologic combination therapy. Most patients (n=9) received immunomodulators/biologics in the past: thiopurines, methotrexate, and biologic therapies (63%, 45%, and 63%, respectively). Cancer types were: breast=3, squamous cell carcinoma (SCC)=3, colorectal cancer=2, carcinoid tumor=1, Hodgkins lymphoma=1, sarcoma=1. Mean age at cancer diagnosis was 52 ± 10.5 years. At cancer diagnosis mean disease duration was 16 ± 10.8 years.

Biologic therapy was either continued after cancer diagnosis (n=7) or started in the follow-up period (n=4), at an average of 28 ± 22 (range 6-59) months after cancer diagnosis. Five patients were concomitantly treated with immunomodulators (3 thiopurines, 2 methotrexate). Overall, a total of 16.3 patient years of biologic therapy, of which 6.1 years were combination therapies elapsed. One patient with dermatofibrosarcoma of the vulva had local recurrence 6 months after surgery. Since surgical margins were not free of tumor the role of biologic therapies on disease progression is unclear. A second patient with SCC (anal verrucous carcinoma) was diagnosed with facial basal cell carcinoma a year after SCC excision. Both patients received biologic (anti-TNF-alpha) monotherapy. No cases of mortality were noted. Seven patients had no or mild IBD activity during the follow up period while three experienced moderate to severe disease activity according to clinical indices and endoscopy.

Conclusion

Biologic monotherapy or in combination with an immunomodulators in IBD patients with a previous cancer seems to be safe and effective. Furthermore, it may be started soon after cancer diagnosis.