Cancer Recurrence Following Immune-Suppressive Therapies in Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis

doi:10.1053/j.gastro.2016.03.037

Gastroenterology

Volume 151, Issue 1, July 2016, Pages 97-109.e4

https://doi.org/10.1053/j.gastro.2016.03.037 Get rights and content

Background & Aims

Physicians frequently encounter patients with immune-mediated diseases and a history of malignancy. There are limited data on the safety of immunosuppressive therapy for these patients. Published studies have been small with few events, precluding robust estimates of risk.

Methods

We searched Medline, EMBASE, and conference proceedings for terms related to immune-mediated disease, immune-suppressive therapy, and cancer recurrence from inception to April 2015. We included 16 studies (9 of patients with rheumatoid arthritis, 8 of patients with inflammatory bowel disease, and 1 of patients with psoriasis) and stratified studies by type of immune-suppressive therapy (monoclonal antibodies to tumor necrosis factor [anti-TNF], conventional immune-modulatory agents, or no immune suppression). A random-effects meta-analysis was performed to calculate the pooled incidence rates as well as risk differences between the various treatments.

Results

Our analysis included 11,702 persons contributing 31,258 person-years (p-y) of follow-up evaluation after a prior diagnosis of cancer. Rates of cancer recurrence were similar among individuals receiving anti-TNF therapy (33.8 per 1000 p-y), immune-modulator therapy (36.2 per 1000 p-y), or no immunosuppression (37.5 per 1000 p-y), but were numerically higher among patients receiving combination immune suppression (54.5 per 1000 p-y) (P > .1 for all). Subgroup analysis of new and recurrent cancers separately, type of immune-modulator therapy, or immune-mediated disease showed similar results, with no increase in risk. We found similar pooled incidence values for new or primary cancers when immunosuppression was initiated within 6 years (33.6 per 1000 p-y for immune-modulatory agents and 43.7 per 1000 p-y for anti-TNF agents) vs more than 6 years after the index cancer (32.9 per 1000 p-y for immune-modulatory agents, P = .86; and 21.0 per 1000 p-y for anti-TNF agents, P = .43).

Conclusions

In a meta-analysis of 16 studies, we observed similar rates of cancer recurrence among individuals with prior cancer who received no immunosuppression, anti-TNF therapy, immune-modulator therapy, or combination treatments. Prospective studies are needed to ascertain optimal intervals for re-initiation of immune-suppressive therapies for individuals with specific cancers.

Section snippets

Literature Search

We conducted separate MEDLINE (inception to April 2015) and EMBASE (inception to April 2015) searches of all relevant English language articles and manually searched reference lists from potentially relevant studies. In addition, abstracts of scientific meetings from the American Gastroenterological Association, the American College of Gastroenterology, United European Gastroenterology Week, the European Crohn’s and Colitis Organization, the Inflammatory Skin Disease Summit, the American

Literature Search

Our search identified 570 citations in MEDLINE and 1526 citations in EMBASE (Figure 1). After reviewing the title and abstract and, if necessary, full publications, 5 relevant studies (5 full reports) from MEDLINE and 24 relevant studies from EMBASE (10 full reports and 14 conference abstracts) were retrieved for full review. After direct communication, the corresponding author provided 1 unpublished study currently in submission corresponding to a prior abstract.⁴⁶ Eleven articles represented

Discussion

Historically, physicians have been reluctant to recommence immunosuppressive therapy in patients with a history of cancer. For example, in a study from Saint-Antoine Hospital, IBD patients with prior cancer had comparable disease activity, but had lower use of IMM and higher rates of surgery than those without prior cancer.⁴² Data on risk of new cancer in those with prior malignancy exposed to immunosuppressive therapy are sparse and the published studies to date have been limited by the small

Acknowledgments

The authors gratefully acknowledge Professor Jacques Cosnes, Dr Sylvie Rajca, Dr Kalle Aaltonen, Dr Livia Biancone, Dr Sara Onali, Dr Anja Strangfeld, and Dr Alicia Algaba for generously providing additional information from their studies.

References (66)

N.A. Molodecky et al.
Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review
Gastroenterology
(2012)
T.D. Rachakonda et al.
Psoriasis prevalence among adults in the United States
J Am Acad Dermatol
(2014)
B.G. Levesque et al.
Converging goals of treatment of inflammatory bowel disease from clinical trials and practice
Gastroenterology
(2015)
M. Allez et al.
Report of the ECCO pathogenesis workshop on anti-TNF therapy failures in inflammatory bowel diseases: definitions, frequency and pharmacological aspects
J Crohns Colitis
(2010)
C. Munz et al.
Immune escape by Epstein-Barr virus associated malignancies
Semin Cancer Biol
(2008)
L. Beaugerie et al.
Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study
Lancet
(2009)
D.S. Kotlyar et al.
Risk of lymphoma in patients with inflammatory bowel disease treated with azathioprine and 6-mercaptopurine: a meta-analysis
Clin Gastroenterol Hepatol
(2015)
M.D. Long et al.
Risk of melanoma and nonmelanoma skin cancer among patients with inflammatory bowel disease
Gastroenterology
(2012)
F.I. Scott et al.
The benefit-to-risk balance of combining infliximab with azathioprine varies with age: a Markov model
Clin Gastroenterol Hepatol
(2015)
C.A. Siegel et al.
Adverse events do not outweigh benefits of combination therapy for Crohn's disease in a decision analytic model
Clin Gastroenterol Hepatol
(2012)

J. Axelrad et al.

Risk of new or recurrent cancer in patients with inflammatory bowel disease and previous cancer exposed to immunosuppressive and anti-TNFα therapy

Clin Gastroenterol Hepatol

(2016)

S. Rajca et al.

Impact of the diagnosis and treatment of cancer on the course of inflammatory bowel disease

J Crohns Colitis

(2014)

R. DerSimonian et al.

Meta-analysis in clinical trials

Control Clin Trials

(1986)

L. Carmona et al.

Cancer in patients with rheumatic diseases exposed to TNF antagonists

Semin Arthritis Rheum

(2011)

C.A. Siegel et al.

Risk of lymphoma associated with combination anti-tumor necrosis factor and immunomodulator therapy for the treatment of Crohn's disease: a meta-analysis

Clin Gastroenterol Hepatol

(2009)

D.H. Solomon et al.

Comparative cancer risk associated with methotrexate, other non-biologic and biologic disease-modifying anti-rheumatic drugs

Semin Arthritis Rheum

(2014)

J.E. Axelrad et al.

Effects of cancer treatment on inflammatory bowel disease remission and reactivation

Clin Gastroenterol Hepatol

(2012)

C.G. Helmick et al.

Estimates of the prevalence of arthritis and other rheumatic conditions in the United States

Part I. Arthritis Rheum

(2008)

C.W. Lees et al.

New IBD genetics: common pathways with other diseases

Gut

(2011)

E. Gremese et al.

Very early rheumatoid arthritis as a predictor of remission: a multicentre real life prospective study

Ann Rheum Dis

(2013)

Z. Ash et al.

A systematic literature review of drug therapies for the treatment of psoriatic arthritis: current evidence and meta-analysis informing the EULAR recommendations for the management of psoriatic arthritis

Ann Rheum Dis

(2012)

G.R. D'Haens et al.

The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn's and Colitis Organization: when to start, when to stop, which drug to choose, and how to predict response?

Am J Gastroenterol

(2011)

J.L. Nam et al.

Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2013 update of the EULAR recommendations for the management of rheumatoid arthritis

Ann Rheum Dis

(2014)

A.M. Tobin et al.

TNF alpha inhibitors in the treatment of psoriasis and psoriatic arthritis

BioDrugs

(2005)

J.F. Colombel et al.

Infliximab, azathioprine, or combination therapy for Crohn's disease

N Engl J Med

(2010)

J.S. Smolen et al.

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update

Ann Rheum Dis

(2014)

R. Kim et al.

Cancer immunoediting from immune surveillance to immune escape

Immunology

(2007)

A. Gutierrez-Dalmau et al.

Immunosuppressive therapy and malignancy in organ transplant recipients: a systematic review

Drugs

(2007)

P. O'Donovan et al.

Azathioprine and UVA light generate mutagenic oxidative DNA damage

Science

(2005)

C.M. Perrett et al.

Carcinogenic mechanisms related to immunosuppressive therapy

Cancer Treat Res

(2009)

R.G. Armstrong et al.

Risk of cancer in inflammatory bowel disease treated with azathioprine: a UK population-based case-control study

Am J Gastroenterol

(2010)

L. Peyrin-Biroulet et al.

Increased risk for nonmelanoma skin cancers in patients who receive thiopurines for inflammatory bowel disease

Gastroenterology

(2011)

R. Buchbinder et al.

Incidence of melanoma and other malignancies among rheumatoid arthritis patients treated with methotrexate

Arthritis Rheum

(2008)

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We performed a systematic search of PubMed and Embase databases to identify studies examining the impact of immunosuppressive therapies on cancer recurrence across several immune-mediated diseases. Studies were pooled together using random-effects meta-analysis and stratified by type of treatment. Primary outcome was occurrence of incident cancers, defined as new or recurrent.
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Les maladies inflammatoires chroniques intestinales (MICI) seraient plus à risque de lésions histologiques intra-épithéliales de haut grade (LIEHG) et de cancers du col de l’utérus. Les facteurs de risque de développer ces lésions sont mal connus.
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Dans notre étude, nous n’avons pas retrouvé de facteurs de risque pour les patientes ayant une MICI de développer une LIEHG ou un cancer du col.
Chronic inflammatory bowel disease (IBD) is thought to increase the risk of high-grade histological intraepithelial lesions (HGIL) and cervical cancer. The risk factors for developing these lesions are poorly understood.
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The present guidelines include updated recommendations on assessing the severity of psoriasis and criteria for the indication of systemic treatment. They also include general principles for the treatment of patients with moderate to severe psoriasis and define treatment goals for these patients as well as criteria for the indication and selection of initial and subsequent therapies Practical issues, such as treatment failure and maintenance of response, are also addressed.

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: This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e27. Learning Objective: Upon completion of this examination, successful learners will be able to evaluate the risk of malignancy with conventional immunomodulator and anti-TNF biologic therapy in patients with chronic inflammatory diseases.

: Conflicts of interest These authors disclose the following: Ashwin Ananthakrishnan has served on scientific advisory boards for AbbVie, Cubist, and Exact Sciences; James Lewis has served as a consultant for Takeda, Amgen, Millennium Pharmaceuticals, Prometheus, Lilly, Shire, AstraZeneca, Janssen Pharmaceuticals, Merck, and AbbVie, has served on a Data and Safety Monitoring Board for clinical trials sponsored by Pfizer, and has received research support from Bayer, Shire, Centocor, Nestle, and Takeda; Frank Scott has received research support from Takeda; Jean-Frederic Colombel has served as a consultant or as an advisory board member for AbbVie, ABScience, Amgen, Bristol Meyers Squibb, Celltrion, Danone, Ferring, Genentech, Giuliani SPA, Given Imaging, Janssen, Immune Pharmaceuticals, Medimmune, Merck & Co, Millenium Pharmaceuticals, Inc, Neovacs, Nutrition Science Partners Ltd, Pfizer, Inc, Prometheus Laboratories, Protagonist, Receptos, Sanofi, Schering Plough Corporation, Second Genome, Shire, Takeda, Teva Pharmaceuticals, Tigenix, UCB Pharma, Vertex, Dr August Wolff GmbH & Co, and has served as a speaker for AbbVie, Ferring, Janssen, Merck & Co, Nutrition Science Partners Ltd, and Takeda; and Ronac Mamtani has served as a consultant to Takeda outside of the submitted work. The remaining authors disclose no conflicts.

: Funding Supported by funding from the US National Institutes of Health (K23 DK097142 to A.A., K23-CA187185 to R.M., K08-DK095951-02 to F.I.S., and K24-DK078228 to J.D.L.).

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Original ResearchFull Report: Clinical—Alimentary TractCancer Recurrence Following Immune-Suppressive Therapies in Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis

Background & Aims

Methods

Results

Conclusions

Section snippets

Literature Search

Literature Search

Discussion

Acknowledgments

Gastroenterology

J Am Acad Dermatol

Gastroenterology

J Crohns Colitis

Semin Cancer Biol

Lancet

Clin Gastroenterol Hepatol

Gastroenterology

Clin Gastroenterol Hepatol

Clin Gastroenterol Hepatol

Clin Gastroenterol Hepatol

J Crohns Colitis

Control Clin Trials

Semin Arthritis Rheum

Clin Gastroenterol Hepatol

Semin Arthritis Rheum

Clin Gastroenterol Hepatol

Estimates of the prevalence of arthritis and other rheumatic conditions in the United States

Part I. Arthritis Rheum

New IBD genetics: common pathways with other diseases

Gut

Very early rheumatoid arthritis as a predictor of remission: a multicentre real life prospective study

Ann Rheum Dis

A systematic literature review of drug therapies for the treatment of psoriatic arthritis: current evidence and meta-analysis informing the EULAR recommendations for the management of psoriatic arthritis

Ann Rheum Dis

The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn's and Colitis Organization: when to start, when to stop, which drug to choose, and how to predict response?

Am J Gastroenterol

Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2013 update of the EULAR recommendations for the management of rheumatoid arthritis

Ann Rheum Dis

TNF alpha inhibitors in the treatment of psoriasis and psoriatic arthritis

BioDrugs

Infliximab, azathioprine, or combination therapy for Crohn's disease

N Engl J Med

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update

Ann Rheum Dis

Cancer immunoediting from immune surveillance to immune escape

Immunology

Immunosuppressive therapy and malignancy in organ transplant recipients: a systematic review

Drugs

Azathioprine and UVA light generate mutagenic oxidative DNA damage

Science

Carcinogenic mechanisms related to immunosuppressive therapy

Cancer Treat Res

Risk of cancer in inflammatory bowel disease treated with azathioprine: a UK population-based case-control study

Am J Gastroenterol

Increased risk for nonmelanoma skin cancers in patients who receive thiopurines for inflammatory bowel disease

Gastroenterology

Incidence of melanoma and other malignancies among rheumatoid arthritis patients treated with methotrexate

Arthritis Rheum

Original Research
Full Report: Clinical—Alimentary Tract
Cancer Recurrence Following Immune-Suppressive Therapies in Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis