Florian Poullenot1, Philippe Seksik, Laurent Beaugerie, Aurélien Amiot, Maria Nachury, Vered Abitbol, Carmen Stefanescu, Catherine Reenaers, Mathurin Fumery, Anne-Laure Pelletier, Stephane Nancey, Laurent Peyrin-Biroulet, Arnaud Bourreille, Xavier Hébuterne, Hedia Brixi, Guillaume Savoye, Nelson Lourenço, Romain Altwegg, Anthony Buisson, Christine Cazelles-Boudier, Antoine Racine, Julien Vergniol, David Laharie. 1. 1CHU de Bordeaux, Hôpital Haut-Le[Combining Acute Accent]vêque, Service d'He[Combining Acute Accent]pato-gastroente[Combining Acute Accent]rologie, University of Bordeaux, Bordeaux, Pessac, France; 2Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, ERL 1157 INSERM/UMRS 7203, DHU 12B, UPMC, Paris, France; 3Department of Gastroenterology, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Paris Est Creteil University, Paris, France; 4CHRU de Lille, Hôpital Claude Huriez, Service des Maladies de l'Appareil Digestif-Endoscopie Digestive, Lille, France; 5Department of Gastroenterology, Cochin Hospital, Assistance Publique Hôpitaux de Paris and Paris V University, Paris, France; 6Hôpital Beaujon, Gastroente[Combining Acute Accent]rologie, Maladies Inflammatoires Chroniques de l'Intestin et Assistance Nutritive, AP-HP, Universite[Combining Acute Accent] Paris VII, Clichy, France; 7Department of Gastroenterology, CHU of Liège, University of Liège, Belgium; 8GIGA Research, University of Liege, Belgium; 9Service d'He[Combining Acute Accent]pato-Gastroente[Combining Acute Accent]rologie, CHU Amiens, Université de Picardie Jules Verne, Amiens, France; 10Department of Gastroenterology, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; 11Department of Gastroenterology, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre Benite, France; 12INSERM U1111, CIRI, Lyon, France; 13INSERM U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Université Henri Poincaré 1, Vandoeuvre-lès-Nancy, France; 14Inserm CIC 1114 and Institut des Maladies de l'Appareil Digestif, University Hospital, Nantes, France; 15CHU de Nice, Hôpital de l'Archet 2, Service de Gastroente[Combining Acute Accent]rologie et Nutrition Clinique, Nice, France; 16Department of Hepato-Gastroenterology and Digestive Oncology Hôpital Robert Debré, Reims, France; 17CHU de Rouen, Hôpital Charles Nicolle, Service de Gastroente[Combining Acute A
Abstract
BACKGROUND: Patients with inflammatory bowel disease (IBD) and history of malignancy within the last 5 years are usually contraindicated for receiving anti-tumor necrosis factor (anti-TNF) agents. The aim of this study is to assess survival without incident cancer in a cohort of IBD patients exposed to anti-TNF while having previous malignancy within past 5 years. METHODS: Data from IBD patients with previous malignancy diagnosed within the last 5 years before starting an anti-TNF agent were collected through a Groupe d'Etude Thérapeutiques des Affections Inflammatoires du tube Digestif multicenter survey. Inclusion date corresponded to the first anti-TNF administration after cancer diagnosis. RESULTS: Twenty centers identified 79 cases of IBD patients with previous malignancy diagnosed 17 months (median; range: 1-65) before inclusion. The most frequent cancer locations were breast (n = 17) and skin (n = 15). After a median follow-up of 21 (range: 1-119) months, 15 (19%) patients developed incident cancer (8 recurrent and 7 new cancers), including 5 basal-cell carcinomas. Survival without incident cancer was 96%, 86%, and 66% at 1, 2, and 5 years, respectively. Crude incidence rate of cancer was 84.5 (95% CI, 83.1-85.8) per 1000 patient-years. CONCLUSIONS: In a population of refractory IBD patients with recent malignancy, anti-TNF could be used taking into account a mild risk of incident cancer. Pending prospective and larger studies, a case-by-case joint decision taken with the oncologist is recommended for managing these patients in daily practice.
BACKGROUND:Patients with inflammatory bowel disease (IBD) and history of malignancy within the last 5 years are usually contraindicated for receiving anti-tumornecrosis factor (anti-TNF) agents. The aim of this study is to assess survival without incident cancer in a cohort of IBDpatients exposed to anti-TNF while having previous malignancy within past 5 years. METHODS: Data from IBDpatients with previous malignancy diagnosed within the last 5 years before starting an anti-TNF agent were collected through a Groupe d'Etude Thérapeutiques des Affections Inflammatoires du tube Digestif multicenter survey. Inclusion date corresponded to the first anti-TNF administration after cancer diagnosis. RESULTS: Twenty centers identified 79 cases of IBDpatients with previous malignancy diagnosed 17 months (median; range: 1-65) before inclusion. The most frequent cancer locations were breast (n = 17) and skin (n = 15). After a median follow-up of 21 (range: 1-119) months, 15 (19%) patients developed incident cancer (8 recurrent and 7 new cancers), including 5 basal-cell carcinomas. Survival without incident cancer was 96%, 86%, and 66% at 1, 2, and 5 years, respectively. Crude incidence rate of cancer was 84.5 (95% CI, 83.1-85.8) per 1000 patient-years. CONCLUSIONS: In a population of refractory IBDpatients with recent malignancy, anti-TNF could be used taking into account a mild risk of incident cancer. Pending prospective and larger studies, a case-by-case joint decision taken with the oncologist is recommended for managing these patients in daily practice.
Authors: Edward Shelton; David Laharie; Frank I Scott; Ronac Mamtani; James D Lewis; Jean-Frederic Colombel; Ashwin N Ananthakrishnan Journal: Gastroenterology Date: 2016-04-01 Impact factor: 22.682