P350 Comparative risk of incident cancer in patients with Inflammatory Bowel Disease with prior non-digestive malignancy according to immunomodulator: a multicenter cohort study.
Poullenot, F.(1);Amiot, A.(2);Nachury, M.(3);Viennot, S.(4);Altwegg, R.(5);Bouhnik, Y.(6);Abitbol, V.(7);Nancey, S.(8);Vuitton, L.(9);Peyrin-Biroulet, L.(10);Biron, A.(11);Fumery, M.(12);Picon, L.(13);Vidon, M.(14);Reenaers, C.(15);Serrero, M.(16);Savoye, G.(17);Beaugerie, L.(18);Rivière, P.(1);Laharie, D.(1);
(1)CHU de Bordeaux- Hôpital Haut-Lévêque- Service d’Hépato-gastroentérologie et oncologie digestive – Université de Bordeaux- F-33000 Bordeaux- France, Gastroenterology, Pessac, France;(2)Département de Gastroentérologie- Hôpitaux Universitaires Henri Mondor- AP-HP- EA7375 EC2M3, Gastroenterology, Creteil, France;(3)Univ. Lille- Inserm- CHU Lille- U1286 - INFINITE - Institute for Translational Research in Inflammation- F-59000 Lille- France, Gastroenterology, Lille, France;(4)Hepato-gastroenterology Departement- CHU Caen- Caen- France, Gastroenterology, Caen, France;(5)Department of Gastroenterology- Saint-Eloi Hospital- 34 000 Montpellier- France, Gastroenterology, Montpellier, France;(6)Gastroenterology and Nutrition Support Department- Department of Gastroenterology- Beaujon Hospital- Clichy- France., Gastroenterology, Clichy, France;(7)Hôpital Cochin AP-HP Gastro-entérologie 27 rue du faubourg saint Jacques 75014 Paris France et Université de Paris, Gastroenterology, Paris, France;(8)Department of Gastroenterology- CHU- Lyon- France, Gastroenterology, Lyon, France;(9)Department of Gastroenterology- CHRU- Besançon- France, Gastroenterology, Besançon, France;(10)Gastroenterology Departement- Nancy University Hospital- Université de Lorraine- Nancy- France, Gastroenterology, Nancy, France;(11)CHU Reims. Hôpital Robert Debré. Service Hépato-gastroentérologie et cancérologie digestive., Gastroenterology, Reims, France;(12)Department of Gastroenterology- CHU- Amiens- France, Gastroenterology, Amiens, France;(13)Hepato-gastroenterology Departement- CHRU Tours-TROUSSEAU Hospital- Tours- France, Gastroenterology, Tours, France;(14)Hôpital Intercommunal de Créteil. 40 avenue de Verdun – 94 000 Créteil, Gastroenterology, Créteil, France;(15)Hepato-gastroenterology Departement- CHU Sart Tilman- Liège University- Liège- Belgium, Gastroenterology, Liège, Belgium;(16)Hepato-gastroenterology Departement- APHM Hôpital Nord- Marseille- France, Gastroenterology, Marseille, France;(17)Department of Gastroenterology- Normandie University- UNIROUEN- INSERM U1073- Rouen University Hospital-Charles Nicolle- 1 rue de Germont- F-76031- Rouen Cedex- France, Gastroenterology, Rouen, France;(18)Sorbonne Université- INSERM- Institut Pierre Louis d’Epidémiologie et de Santé Publique- AP-HP- Hôpital Saint-Antoine- Department of Gastroenterology- F75012- Paris- France, Gastroenterology, Paris, France; GETAID
Knowledge about the cancer risk when initiating a biologic in Inflammatory Bowel Disease (IBD) patients with prior malignancy remains scarce especially for vedolizumab. Our aim was to evaluate the rate of incident cancer in a cohort of IBD patients with prior non-digestive malignancy according to the subsequent treatment given.
Consecutive cases of patients with IBD and a malignancy were retrospectively collected in 33 centers in two countries. Patients with a biliary- or digestive tract cancer were excluded. Inclusion date corresponded to diagnosis of malignancy. Patients were categorized into different cohorts according to the first treatment they were exposed to after the malignancy diagnosis and before incident cancer. Follow-up time was calculated from the first administration of therapy to last follow-up visit. For patients receiving no therapy, follow-up started at diagnosis of cancer. Incident cancer during follow-up was defined as recurrence of the known cancer or occurrence of a new cancer. Crude cancer incidence rates were compared between the cohorts using chi-square test. Patients from the anti-TNF, vedolizumab, and no treatment cohorts were matched on age, lymph node and metastasis extension and malignancy recurrence risk according to the Penn classification using a propensity-score analysis with a 1:1 ratio.
Among the 538 patients (58% female; mean [standard deviation (SD)] age inclusion: 52  years) analyzed, the most frequent malignancy was breast cancer (25%). First immunomodulator given after inclusion was a conventional immunosuppressant in 27% of patients, anti-TNF in 21% or vedolizumab in 9%. With a median (inter-quartile range (IQR)) follow-up duration of 55 (23-100) months, 100 incident cancers were observed. Crude cancer incidence rates per 1000 person-years were 47.0 for patients receiving no immunomodulator, 36.6 in the anti-TNF cohort and 33.6 in the vedolizumab cohort (p=0.23). Incident-cancer free survival rates were not different between patients receiving anti-TNF and those receiving vedolizumab (p=0.56). After adjustment, incidence rates were not different between patients receiving no immunomodulator, anti-TNF or vedolizumab.
On multivariate analysis, age ≥ 52 years at inclusion, follow-up after index cancer <55 months, and receiving immunomodulatory treatment within 12 months after index cancer, were associated with an increased risk of incident cancer.
In this large multicenter cohort study, we found no difference in terms of incident cancer rates in patients with IBD and a prior non-digestive malignancy treated by vedolizumab compared to those treated by other immunomodulatory therapies including anti-TNF.