Peter K K Wong1,2, Hanish Bagga3, Claire Barrett4,5,6, Geoff Chong7, Patrick Hanrahan8,9, Teja Kodali3,10, Mona Marabani11, H Miles Prince12,13, John Riordan14, Phillip Swarbrick15, Ray White16, Laurel Young4,5,6. 1. Mid-North Coast Arthritis Clinic, Coffs Harbour, New South Wales, Australia. pkkw12@gmail.com. 2. University of New South Wales Rural Clinical School, Coffs Harbour, New South Wales, Australia. pkkw12@gmail.com. 3. Mid-North Coast Arthritis Clinic, Coffs Harbour, New South Wales, Australia. 4. Redcliffe Hospital, Redcliffe, Queensland, Australia. 5. Redcliffe and Northside Rheumatology, Redcliffe, Queensland, Australia. 6. Faculty of Medicine, University of Queensland, St Lucia, Australia. 7. Olivia Newton John Cancer, Wellness & Research Centre, Austin Health, Heidelberg, Victoria, Australia. 8. Private Rheumatology practice, South Perth, Western Australia, Australia. 9. School of Medicine, University of Western Australia, Crawley, Western Australia, Australia. 10. Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. 11. Campsie Rheumatology Clinic and Canterbury Hospital, Sydney, New South Wales, Australia. 12. Molecular Oncology and Cancer Immunology, Epworth Healthcare, Richmond, Victoria, Australia. 13. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia. 14. Illawarra Rheumatology and University of Wollongong Graduate School of Medicine, Wollongong, New South Wales, Australia. 15. Private Dermatology Practice, Burswood, Western Australia, Australia. 16. Private Rheumatology Practice, Campbelltown, New South Wales, Australia.
Abstract
PURPOSE OF REVIEW: Conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) have been used in the treatment of inflammatory arthritis (IA) for many years. More recently, biologic (bDMARDs) and targeted synthetic (tsDMARDs) DMARDs have further improved treatment. Due to increased patient longevity and effective oncology treatment, rheumatologists often encounter patients with IA and previous malignancy. The immunosuppressive effect of DMARDs causes concern regarding impaired tumour surveillance with a potential increased risk of malignancy. We reviewed the literature regarding the risk of malignancy in patients on cs-/b-/tsDMARDS and sought to provide practical advice regarding use of these drugs in patients with previous malignancy. RECENT FINDINGS: Data from randomised controlled trials is limited as patients with pre-existing malignancy are often excluded. Reassuringly, an increasing range of "real world" data from various national b/tsDMARD registries has not provided a convincing signal that these drugs increase tumour recurrence. Nevertheless, awareness of, and adherence to, national screening guidelines for malignancy is important. Given the improvement in quality of life achieved with these novel and well-tolerated therapeutic agents, the benefit/risk profile remains overwhelmingly favourable in most patients.
PURPOSE OF REVIEW: Conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) have been used in the treatment of inflammatory arthritis (IA) for many years. More recently, biologic (bDMARDs) and targeted synthetic (tsDMARDs) DMARDs have further improved treatment. Due to increased patient longevity and effective oncology treatment, rheumatologists often encounter patients with IA and previous malignancy. The immunosuppressive effect of DMARDs causes concern regarding impaired tumour surveillance with a potential increased risk of malignancy. We reviewed the literature regarding the risk of malignancy in patients on cs-/b-/tsDMARDS and sought to provide practical advice regarding use of these drugs in patients with previous malignancy. RECENT FINDINGS: Data from randomised controlled trials is limited as patients with pre-existing malignancy are often excluded. Reassuringly, an increasing range of "real world" data from various national b/tsDMARD registries has not provided a convincing signal that these drugs increase tumour recurrence. Nevertheless, awareness of, and adherence to, national screening guidelines for malignancy is important. Given the improvement in quality of life achieved with these novel and well-tolerated therapeutic agents, the benefit/risk profile remains overwhelmingly favourable in most patients.
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