Risk of New or Recurrent Cancer in Patients With Inflammatory Bowel Disease and Previous Cancer Exposed to Immunosuppressive and Anti-Tumor Necrosis Factor Agents

on behalf of the New York Crohn's and Colitis Organization (NYCCO)

Research output: Contribution to journalArticle

Abstract

Background & Aims: Our understanding of malignancy associated with immunosuppression in patients with inflammatory bowel disease (IBD) comes from studies of individuals with no history of cancer. We investigated whether patients with IBD and a history of cancer who were subsequently immunosuppressed have an increased risk of developing incident cancer. Methods: We performed a retrospective analysis of data from 333 patients with IBD treated at 8 academic medical centers who developed cancer and subsequently received treatment with anti-tumor necrosis factor (TNF), anti-TNF with an antimetabolite (thiopurines, methotrexate), antimetabolites, or no subsequent exposure to immunosuppressive agents (controls). We collected data on their primary outcomes of incident cancers (new or recurrent). Hazard ratios (HRs) were calculated by using Cox proportional hazards and Kaplan-Meier survival curves; study groups were compared by using the log-rank test. Results: During the follow-up period, 90 patients (27%) developed an incident cancer. Patient characteristics between groups differed, but matching was not possible because of the relatively small sample sizes. There was no difference in time to incident cancer (P = .14) or type of incident cancer (P = .61) among the 4 groups. After adjusting for recurrence risk for type of prior cancer, there was no difference in risk of incident cancer (HR for anti-TNF, 0.32; 95% confidence interval [CI], 0.09-1.09; HR for anti-TNF with an antimetabolite, 0.64; 95% CI, 0.26-1.59; HR for an antimetabolite, 1.08; 95% CI, 0.54-2.15) or time to subsequent cancer between study arms (P = .22). Conclusion: On the basis of a retrospective study, in patients with IBD and a history of cancer, exposure to an anti-TNF agent or an antimetabolite after cancer was not associated with an increased risk of incident cancer, compared with patients who did not receive immunosuppression. Larger, matched, prospective studies are needed to confirm these findings.

Original languageEnglish (US)
Pages (from-to)58-64
Number of pages7
JournalClinical Gastroenterology and Hepatology
Volume14
Issue number1
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

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Immunosuppressive Agents
Inflammatory Bowel Diseases
Tumor Necrosis Factor-alpha
Antimetabolites
Neoplasms
Confidence Intervals
Immunosuppression
Kaplan-Meier Estimate
Methotrexate
Sample Size

Keywords

  • Crohn's Disease
  • Drug
  • Tumor
  • Ulcerative Colitis

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Risk of New or Recurrent Cancer in Patients With Inflammatory Bowel Disease and Previous Cancer Exposed to Immunosuppressive and Anti-Tumor Necrosis Factor Agents. / on behalf of the New York Crohn's and Colitis Organization (NYCCO).

In: Clinical Gastroenterology and Hepatology, Vol. 14, No. 1, 01.01.2016, p. 58-64.

Research output: Contribution to journalArticle

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title = "Risk of New or Recurrent Cancer in Patients With Inflammatory Bowel Disease and Previous Cancer Exposed to Immunosuppressive and Anti-Tumor Necrosis Factor Agents",
abstract = "Background & Aims: Our understanding of malignancy associated with immunosuppression in patients with inflammatory bowel disease (IBD) comes from studies of individuals with no history of cancer. We investigated whether patients with IBD and a history of cancer who were subsequently immunosuppressed have an increased risk of developing incident cancer. Methods: We performed a retrospective analysis of data from 333 patients with IBD treated at 8 academic medical centers who developed cancer and subsequently received treatment with anti-tumor necrosis factor (TNF), anti-TNF with an antimetabolite (thiopurines, methotrexate), antimetabolites, or no subsequent exposure to immunosuppressive agents (controls). We collected data on their primary outcomes of incident cancers (new or recurrent). Hazard ratios (HRs) were calculated by using Cox proportional hazards and Kaplan-Meier survival curves; study groups were compared by using the log-rank test. Results: During the follow-up period, 90 patients (27{\%}) developed an incident cancer. Patient characteristics between groups differed, but matching was not possible because of the relatively small sample sizes. There was no difference in time to incident cancer (P = .14) or type of incident cancer (P = .61) among the 4 groups. After adjusting for recurrence risk for type of prior cancer, there was no difference in risk of incident cancer (HR for anti-TNF, 0.32; 95{\%} confidence interval [CI], 0.09-1.09; HR for anti-TNF with an antimetabolite, 0.64; 95{\%} CI, 0.26-1.59; HR for an antimetabolite, 1.08; 95{\%} CI, 0.54-2.15) or time to subsequent cancer between study arms (P = .22). Conclusion: On the basis of a retrospective study, in patients with IBD and a history of cancer, exposure to an anti-TNF agent or an antimetabolite after cancer was not associated with an increased risk of incident cancer, compared with patients who did not receive immunosuppression. Larger, matched, prospective studies are needed to confirm these findings.",
keywords = "Crohn's Disease, Drug, Tumor, Ulcerative Colitis",
author = "{on behalf of the New York Crohn's and Colitis Organization (NYCCO)} and Jordan Axelrad and Oren Bernheim and Colombel, {Jean Frederic} and Stefano Malerba and Ashwin Ananthakrishnan and Vijay Yajnik and Gila Hoffman and Manasi Agrawal and Dana Lukin and Amit Desai and Elisa McEachern and Brian Bosworth and Ellen Scherl and Andre Reyes and Hina Zaidi and Prashant Mudireddy and David DiCaprio and Keith Sultan and Burton Korelitz and Erwin Wang and Renee Williams and Lea Chen and Seymour Katz and Steven Itzkowitz",
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T1 - Risk of New or Recurrent Cancer in Patients With Inflammatory Bowel Disease and Previous Cancer Exposed to Immunosuppressive and Anti-Tumor Necrosis Factor Agents

AU - on behalf of the New York Crohn's and Colitis Organization (NYCCO)

AU - Axelrad, Jordan

AU - Bernheim, Oren

AU - Colombel, Jean Frederic

AU - Malerba, Stefano

AU - Ananthakrishnan, Ashwin

AU - Yajnik, Vijay

AU - Hoffman, Gila

AU - Agrawal, Manasi

AU - Lukin, Dana

AU - Desai, Amit

AU - McEachern, Elisa

AU - Bosworth, Brian

AU - Scherl, Ellen

AU - Reyes, Andre

AU - Zaidi, Hina

AU - Mudireddy, Prashant

AU - DiCaprio, David

AU - Sultan, Keith

AU - Korelitz, Burton

AU - Wang, Erwin

AU - Williams, Renee

AU - Chen, Lea

AU - Katz, Seymour

AU - Itzkowitz, Steven

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background & Aims: Our understanding of malignancy associated with immunosuppression in patients with inflammatory bowel disease (IBD) comes from studies of individuals with no history of cancer. We investigated whether patients with IBD and a history of cancer who were subsequently immunosuppressed have an increased risk of developing incident cancer. Methods: We performed a retrospective analysis of data from 333 patients with IBD treated at 8 academic medical centers who developed cancer and subsequently received treatment with anti-tumor necrosis factor (TNF), anti-TNF with an antimetabolite (thiopurines, methotrexate), antimetabolites, or no subsequent exposure to immunosuppressive agents (controls). We collected data on their primary outcomes of incident cancers (new or recurrent). Hazard ratios (HRs) were calculated by using Cox proportional hazards and Kaplan-Meier survival curves; study groups were compared by using the log-rank test. Results: During the follow-up period, 90 patients (27%) developed an incident cancer. Patient characteristics between groups differed, but matching was not possible because of the relatively small sample sizes. There was no difference in time to incident cancer (P = .14) or type of incident cancer (P = .61) among the 4 groups. After adjusting for recurrence risk for type of prior cancer, there was no difference in risk of incident cancer (HR for anti-TNF, 0.32; 95% confidence interval [CI], 0.09-1.09; HR for anti-TNF with an antimetabolite, 0.64; 95% CI, 0.26-1.59; HR for an antimetabolite, 1.08; 95% CI, 0.54-2.15) or time to subsequent cancer between study arms (P = .22). Conclusion: On the basis of a retrospective study, in patients with IBD and a history of cancer, exposure to an anti-TNF agent or an antimetabolite after cancer was not associated with an increased risk of incident cancer, compared with patients who did not receive immunosuppression. Larger, matched, prospective studies are needed to confirm these findings.

AB - Background & Aims: Our understanding of malignancy associated with immunosuppression in patients with inflammatory bowel disease (IBD) comes from studies of individuals with no history of cancer. We investigated whether patients with IBD and a history of cancer who were subsequently immunosuppressed have an increased risk of developing incident cancer. Methods: We performed a retrospective analysis of data from 333 patients with IBD treated at 8 academic medical centers who developed cancer and subsequently received treatment with anti-tumor necrosis factor (TNF), anti-TNF with an antimetabolite (thiopurines, methotrexate), antimetabolites, or no subsequent exposure to immunosuppressive agents (controls). We collected data on their primary outcomes of incident cancers (new or recurrent). Hazard ratios (HRs) were calculated by using Cox proportional hazards and Kaplan-Meier survival curves; study groups were compared by using the log-rank test. Results: During the follow-up period, 90 patients (27%) developed an incident cancer. Patient characteristics between groups differed, but matching was not possible because of the relatively small sample sizes. There was no difference in time to incident cancer (P = .14) or type of incident cancer (P = .61) among the 4 groups. After adjusting for recurrence risk for type of prior cancer, there was no difference in risk of incident cancer (HR for anti-TNF, 0.32; 95% confidence interval [CI], 0.09-1.09; HR for anti-TNF with an antimetabolite, 0.64; 95% CI, 0.26-1.59; HR for an antimetabolite, 1.08; 95% CI, 0.54-2.15) or time to subsequent cancer between study arms (P = .22). Conclusion: On the basis of a retrospective study, in patients with IBD and a history of cancer, exposure to an anti-TNF agent or an antimetabolite after cancer was not associated with an increased risk of incident cancer, compared with patients who did not receive immunosuppression. Larger, matched, prospective studies are needed to confirm these findings.

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KW - Drug

KW - Tumor

KW - Ulcerative Colitis

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