Can Patients with a History of Cancer Safely Take IBD Drugs?

A common treatment for inflammatory bowel diseases (IBD) can still be used in patients with a history of cancer, a recent study found.

Antibodies against tumor necrosis factor (anti-TNF) were previously thought to increase the risk of cancer in patients with a prior history, however, researchers suggest anti-TNF treatment should not necessarily be ruled out.

In a study published in Inflammatory Bowel Diseases, researchers used an IBD database to analyze 79 adult patients at 20 treatment centers with a prior history of cancer and who received anti-TNF therapy.

The study is among the first to examine the association between anti-TNF therapy and increased cancer risk for patients with IBD and prior history of cancer. Researchers used patients with extensive prior treatment for IBD that included anti-TNF therapy in half of patients and major abdominal surgery in one-third.

Breast and skin cancer were the most common types of cancer, with the IBD treatment starting at a median of 17 months after cancer diagnosis.

The results of the study showed that 19% of patients developed cancer during the median 21 month follow up. Furthermore, 8 patients had a recurrence of cancer and 7 developed new cancers, with 5 of them developing basal cell carcinomas. Five patients died, 4 of whom passed from recurrent cancer.

During the one-year follow up, 96% of patients were cancer free, 86% at 2 years, and 66% at 5 years. The overall incidence of new or recurrent cancers was 85 per 1000 patient-years.

Those with less serious skin cancers, such as basal cell carcinoma, which is linked to the thiopurines IBD medication type, had incidence of cancer decrease to 67 per 1000 patient-years.

According to study authors, the patients who participated were “highly selected” and had uncontrolled IBD, which lead to the start of anti-TNF therapy despite cancer history.

Over the past 2 decades, physicians have seen an increase in IBD patients with prior or current cancer who used anti-TNF and other immunomodulatory treatments earlier and longer.

Researchers say that the use of anti-TNF should be used based on an individual patient’s needs. During the study, physicians weighed the potential for increased risk of cancer against the need to control the patient’s IBD.

"Pending additional data, it should be a case-by-case decision taken with the oncologist and the patient, taking into account natural history of cancer according to location, histological type, time since cancer diagnosis, and IBD prognosis," the study authors wrote.