Therapeutic Management of Adults with Inflammatory Bowel Disease and Malignancies: A Clinical Challenge
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
3. Diagnosis of Cancer in IBD Patients: How to Manage IBD Therapies
4. Risk of New or Recurrent Cancer in IBD Patients with a Previous History of Cancer Treated with Immunosuppressants
4.1. Thiopurines
4.2. Anti-TNFα
4.3. Vedolizumab
4.4. Ustekinumab
4.5. Novel Therapies
5. Risk of IBD Relapse in Patients with Cancer Who Discontinue Immunosuppressants
6. Discussion and Future Perspectives
- the ongoing immunosuppressants, if there was one, at the moment of previous cancer onset (i.e., melanoma under anti-TNF), in order to opt for another class of drug [51];
- the risk of cancer progression: in case of intermediated or high risk of recurrence, monotherapy with IMM or anti-TNF or VDZ should be adopted. Combo therapy should be used only in special and well-discussed situations.
7. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Study | Year | Type of Study | IBD Patients (n) | Therapies | Follow-Up | Results |
---|---|---|---|---|---|---|
Beaugerie et al. [18] | 2014 | Prospective | 405 | 91 IMM 7 anti-TNF | Median 36 months (IQR 32–43) 1091 p-y | There was no significant difference in the incidence of new or recurrent cancers between patients exposed or not exposed to any immunosuppressant. |
Axelrad et al. [29] | 2016 | Retrospective | 333 | 55 anti-TNF 51 anti-TNF + IMM 78 IMM 149 no IS | NA | No statistical difference in type (p = 0.61) or time (p = 0.14) of incident cancer. No statistical difference in risk of incident cancer or time of subsequent cancer (p = 0.22) between 4 groups. |
Poullenot et al. [30] | 2016 | Retrospective and prospective | 79 | 61 anti-TNF 18 anti-TNF+IMM | Median 21 months (1–119) | Crude incidence rate of cancer was 84.5 per 1000 p-y. It was 74.8 per 1000 p-y in pts with IMM and 87.3 per 1000 p-y in pts without IMM. |
Shelton et al. [21] | 2016 | Systematic review and meta-analysis | 3706 | N/A | 10,332 p-y | There was no statistical difference in pooled incidence rate per 1000 p-y between anti-TNF (48.5), IMM (37.9), and none (35.7), p > 0.30. |
Vedamurthy et al. [26] | 2020 | Retrospective | 463 | 184 anti-TNF 96 VDZ 183 no IS | Median 6.2 p-y | No increase in the risk of new or recurrent cancer in pts under anti-TNF (HR 1.03) and VDZ (HR 1.38) compared to pts without IS treatment, after adjusting for confounders. |
Hasan et al. [27] | 2022 | Retrospective | 341 | 99 anti-TNF 34 VDZ 27 USK 181 no IS | Median 5.2 p-y | No increased risk of incident cancer in patients receiving USK (HR 0.88), VDZ (HR 0.18), or anti-TNF (HR 0.47). |
Hong et al. [31] | 2022 | Retrospective | 390 | 41 anti-TNF 37 VDZ 14 USK 31 IMM 267 no IS | Median 52 months | No increase in subsequent cancer with VDZ (adjusted HR 1.36) or USK (adjusted HR 0.96). No increased risk in subsequent cancer in patients with more than 1 biologic exposure. |
Poullenot et al. [28] | 2022 | Retrospective | 538 | 112 anti-TNF 48 VDZ 4 USK (excluded) 143 IMM 231 no IS | Median 55 months (IQR 23–100) | Crude incidence rates for cancer were not different in patients under anti-TNF (36.6), VDZ (33.6), or no treatment (47.0), p = 0.23. |
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Ferretti, F.; Cannatelli, R.; Maconi, G.; Ardizzone, S. Therapeutic Management of Adults with Inflammatory Bowel Disease and Malignancies: A Clinical Challenge. Cancers 2023, 15, 542. https://doi.org/10.3390/cancers15020542
Ferretti F, Cannatelli R, Maconi G, Ardizzone S. Therapeutic Management of Adults with Inflammatory Bowel Disease and Malignancies: A Clinical Challenge. Cancers. 2023; 15(2):542. https://doi.org/10.3390/cancers15020542
Chicago/Turabian StyleFerretti, Francesca, Rosanna Cannatelli, Giovanni Maconi, and Sandro Ardizzone. 2023. "Therapeutic Management of Adults with Inflammatory Bowel Disease and Malignancies: A Clinical Challenge" Cancers 15, no. 2: 542. https://doi.org/10.3390/cancers15020542