Risk of Incident Cancer in Inflammatory Bowel Disease Patients Starting Anti-TNF Therapy While Having Recent Malignancy.

Poullenot, Florian; Seksik, Philippe; Beaugerie, Laurent; Amiot, Aurélien; Nachury, Maria; Abitbol, Vered; Stefanescu, Carmen; Reenaers, Catherine; Fumery, Mathurin; Pelletier, Anne-Laure; Nancey, Stephane; Peyrin-Biroulet, Laurent; Bourreille, Arnaud; Hébuterne, Xavier; Brixi, Hedia; Savoye, Guillaume; Lourenço, Nelson; Altwegg, Romain; Buisson, Anthony; Cazelles-Boudier, Christine; Racine, Antoine; Vergniol, Julien; Laharie, David

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.